Medical Billing Services for Small Practices: 2026 Prices Compared
November 5, 2026
Medical billing services are billing companies or dedicated billers that turn a practice's visits into paid claims: charge entry, claim submission, payment posting, denial follow-up and patient statements. As of 5 November 2026, published prices run from 2.50% to 8% of collections, and market guides put most practices at 5% to 7%, or $3 to $10 per claim. Percent-of-collections companies (e.g., Avenue Billing Services, MedSole RCM, Medical Billers and Coders): from 2.50%, 2.99%, and 5% to 8% of collections. Software plus billing (e.g., Carepatron): $99 per provider per month plus 3.9% of collections. Therapy billing (e.g., TheraThink): 6.5% to 8% of the allowed amount. Hourly healthcare virtual assistants (e.g., Hello Rache): $9.50 an hour. Remote staffing agency, Latin America in US time zones (e.g., Virtustant): a dedicated medical biller on one all-in hourly rate, quoted by specialty and claim volume, with zero placement fees.
This guide compares 11 options by the prices they publish, shows what each costs at three practice sizes, and gives you the Collections Crossover Test: the point where a percent-of-collections fee costs more than a dedicated biller's seat. It also shows what the four most recent billing and claims searches in Virtustant's recruitment records asked for. Virtustant is a remote staffing agency and one of the options compared, so we stick to published facts and show every calculation. Third-party prices were read on each provider's own pages on 5 November 2026 unless noted. This is not legal advice on HIPAA.
Billing is the back half of the revenue cycle. The front desk captures the patient and the coverage; billing turns the visit into money. A full-service billing company usually covers the steps below, and the price depends on how many of them are in the contract.
| Step | What happens | Often in a percent-of-collections contract? |
|---|---|---|
| Charge entry | Visit codes and charges entered from the chart | Yes |
| Claim scrubbing and submission | Claims checked for errors and sent through a clearinghouse | Yes |
| Payment posting | Insurance and patient payments matched to claims | Yes |
| Denial management | Rejected or denied claims corrected and resubmitted or appealed | Yes |
| Accounts receivable follow-up | Unpaid claims chased with payers | Yes |
| Patient statements | Balances billed to patients after insurance | Sometimes |
| Eligibility checks and prior authorizations | Coverage confirmed before the visit; approvals requested | Sometimes, often extra |
| Credentialing | Providers enrolled with payers | Usually priced separately |
Unpaid claims are a receivables problem as much as a billing one; for the cash side, see accounts receivable services.
| Model | How it is priced | Who it suits |
|---|---|---|
| Percent of collections | A share of what is collected, usually net of refunds and adjustments; most guides cite 4% to 10%, commonly 5% to 7% | Practices that want the whole billing job handed off and paid only when money comes in |
| Per claim | A flat fee per claim submitted; guides cite $3 to $10 | High-volume, low-complexity billing |
| Base fee plus percent | A monthly fee per provider plus a lower percent | Practices buying software and billing together |
| Per hour (dedicated person) | One person, billed by the hour, working inside your systems | Practices with enough volume, their own software, and work beyond billing |
The percent is only comparable when the base is the same. Some companies take a share of net collections, therapy billers often take a share of the allowed amount on each claim, and a few count patient payments as well as insurance. Ask which base the percent is applied to before comparing two quotes.
| Provider | Published price | Terms published |
|---|---|---|
| Avenue Billing Services | From 2.50% of monthly collections | Percent varies by specialty and scope |
| MedSole RCM | 2.99% of collections for full-service billing; credentialing $99 per payer | No setup fees; month-to-month |
| Carepatron (managed billing) | $99 per provider per month ($79 on an annual plan) plus 3.9% of collections; $0.25 per claim; $0.15 per eligibility check | Setup waived; credentialing for up to five payers per provider included |
| Medical Billers and Coders | 5% to 8% of collections | No upfront costs; 90-day performance guarantee; transition 4 to 6 weeks |
| TheraThink (therapy billing) | 6.5% to 8% of the contracted rate or allowed amount; $35 a month clearinghouse fee per tax ID and rendering NPI; credentialing $120 to $260 per application | No setup or per-claim fees; month-to-month; 30-day trial |
| MedCare MSO | Percent of net collections (rate not published) | Every engagement starts with a business associate agreement, per its page |
| BellMedEx | Flat percentage (rate behind a form) | No startup fees or long contracts |
| CureMD | Quoted by claims per month and service level | Quote on request |
| Hello Rache | $9.50 an hour for a healthcare virtual assistant (insurance and billing among the listed tasks) | No contracts or setup fees; weekly billing |
| MEDVA | Not published; its pricing page says one number “would mislead” | Full-time placements, up to 85 hours bi-weekly; no setup fees |
| Virtustant (remote staffing agency) | A dedicated medical biller on one all-in hourly rate, quoted by specialty, claim volume and software; healthcare virtual assistants from $7/hr all-in | Month-to-month; zero placement fees; lifetime replacement guarantee |
Market guides put most practices between 4% and 10% of collections, commonly 5% to 7%, and per-claim pricing at $3 to $10 (Carepatron, citing Physicians Side Gigs, 2025). The two lowest published rates here, 2.50% and 2.99%, sit below that range, so check what is included at that price.
Monthly billing cost at three levels of monthly collections, using the published rates above. One provider is assumed for the base-fee model; per-claim charges are left out.
| Pricing | $25,000 a month collected | $40,000 | $60,000 |
|---|---|---|---|
| 2.50% (Avenue, starting rate) | $625 | $1,000 | $1,500 |
| 2.99% (MedSole RCM) | $748 | $1,196 | $1,794 |
| $99 plus 3.9% (Carepatron, one provider) | $1,074 | $1,659 | $2,439 |
| 5% (low end of Medical Billers and Coders) | $1,250 | $2,000 | $3,000 |
| 7% (common market rate) | $1,750 | $2,800 | $4,200 |
| 8% (high end of Medical Billers and Coders) | $2,000 | $3,200 | $4,800 |
The percent grows with the practice. At $25,000 a month, which is the size of Carepatron's own worked example ($300,000 a year), billing costs between $625 and $2,000 a month. At $60,000, the same rates cost $1,500 to $4,800, while a person's hourly cost stays where it was.
A percent-of-collections fee and a dedicated biller are priced on different things: one on your revenue, the other on hours. We call the comparison the Collections Crossover Test. It has three lines:
The crossover is the monthly collections at which the two lines meet: seat cost ÷ fee percent. Above it, the percent costs more. The grid below shows it for five seat costs; put your own quote in the first column.
| Monthly seat cost | at 3% | at 4% | at 5% | at 6% | at 7% | at 8% |
|---|---|---|---|---|---|---|
| $1,000 | $33,333 | $25,000 | $20,000 | $16,667 | $14,286 | $12,500 |
| $1,500 | $50,000 | $37,500 | $30,000 | $25,000 | $21,429 | $18,750 |
| $2,000 | $66,667 | $50,000 | $40,000 | $33,333 | $28,571 | $25,000 |
| $3,000 | $100,000 | $75,000 | $60,000 | $50,000 | $42,857 | $37,500 |
| $5,774 (US billing clerk, loaded) | $192,483 | $144,362 | $115,490 | $96,241 | $82,493 | $72,181 |
Read it this way: if a biller's seat costs $2,000 a month and your billing company charges 5%, the seat costs less once you collect more than $40,000 a month. At 3%, the line moves to $66,667. Below the line, the billing company is the cheaper buy, and it also brings the software, the clearinghouse and coverage when someone is out. The test does not cover quality: denial rates, days in receivables and first-pass acceptance decide how much you collect, which matters more than the fee.
Under the HIPAA Privacy Rule, a practice that lets a vendor handle protected health information on its behalf generally needs a business associate agreement with that vendor first. HHS does not recognize private “HIPAA certifications”, so ask for the agreement and the controls, not a badge. What the pages we read publish:
| Provider | What its page says |
|---|---|
| MedCare MSO | “Every engagement starts with a formal Business Associate Agreement” |
| MEDVA | HIPAA and cybersecurity training “validated through a third-party” partner (Compliancy Group) |
| Hello Rache | “HIPAA-Trained & Certified” |
| TheraThink | Data “encrypted and backed up to HIPAA compliant standards” |
The other pages we read describe HIPAA in general terms or not at all, and none of the remaining ones publish a BAA statement. Location rules matter too when billing work is done from outside the United States. Texas SB 1188 requires, from 1 January 2026, that electronic health records of Texas patients be stored in the US, while remote access is allowed; Medicare Advantage plans need an attestation about work done outside the US by their providers and subcontractors (42 CFR 422.503); and some state Medicaid programs and payer contracts restrict it. Ask your payers before you choose.
With a dedicated biller, the practice sets the HIPAA rules and controls the access: the biller works only inside the EHR, practice management system and clearinghouse accounts you grant, with access you can revoke the same day.
We read the four most recent positions for medical billing and claims work in Virtustant's recruitment system, opened between February and October 2026.
| What we counted | Result |
|---|---|
| Marked hired | 4 of 4 |
| Full-time | 3 of 4, all on 9 a.m. to 5 p.m. Eastern |
| Mental health practices | 2 of 4 |
| English level required | C1 or C2 in the three that state it |
| Applicants per post | 66 to 553 (894 in total) |
All four job posts asked for claim submission and claim follow-up. Three asked the biller to deal with insurance companies directly, two asked for payment posting, and one asked a senior claims specialist to oversee the billing team. The posts asked for experience with the practice's own EHR or billing software; one named TherapyNotes. Client names, rates, budgets and salaries from these records are not published.
The US Bureau of Labor Statistics puts the median wage for billing and posting clerks at $48,500 a year, about $23.32 an hour, and for medical records specialists, the occupation that includes medical coders, at $51,140, about $24.59 an hour (BLS 2025 wage data, via O*NET). AAPC's 2025 salary survey reports an average of $63,874 for a Certified Professional Biller. With benefits at 30.0% of total compensation in private industry (BLS Employer Costs for Employee Compensation, June 2026), the loaded hour for a billing clerk is about $33.31, or about $5,774 a month full-time, before recruiting, software and a desk.
How the rate works at Virtustant: if you pay your agent $10/hr, we give them $9 and keep the dollar in the middle. The rate is all-in, with zero placement fees and month-to-month terms; see Virtustant pricing.
| Your situation | Best fit | Why |
|---|---|---|
| Solo or small practice, no billing staff, collections below the crossover | A percent-of-collections company (e.g., Avenue, MedSole RCM) | Published rates from 2.50% and 2.99%; you pay when you collect |
| You want scheduling, notes and billing in one system | Software plus billing (e.g., Carepatron, athenahealth) | One vendor for the platform and the claims |
| Therapy or behavioral health practice | A therapy billing specialist (e.g., TheraThink) | Priced on the allowed amount; credentialing priced per application |
| Collections above the crossover, and you already run your own EHR and clearinghouse | A dedicated medical biller through a remote staffing agency (e.g., Virtustant) | Hourly cost does not grow with revenue; the biller works in your systems on your hours |
| You need eligibility checks, prior authorizations and patient calls more than claims | A healthcare virtual assistant (e.g., Hello Rache at $9.50/hr, Virtustant from $7/hr) | Front-end work that keeps claims clean before they are sent |
For the front desk that feeds billing, see virtual medical receptionist prices; for the full range of tasks a remote assistant can cover in a practice, see what a healthcare virtual assistant does.
Virtustant is a remote staffing agency that places vetted medical billers and other remote professionals from Latin America with US practices, on one all-in hourly rate quoted by specialty, claim volume and the billing software you use. Each placement is one named person working the US hours you set, full-time or part-time, inside your EHR, practice management system and clearinghouse. Virtustant accepts the top 1% of applicants: 100% apply, 22% clear the recruiter screen, 9% pass cognitive (IQ), skills and English testing, 3% reach a live interview, 1% are hired. You get a shortlist of 3 to 5 vetted candidates within 48 hours of your first call, and your hire can start in 72 hours. Terms are month-to-month, with zero placement fees and a lifetime replacement guarantee with no time cap. Business associate agreement terms are reviewed on the discovery call.
What it does not do: Virtustant does not bill on a percent of collections, provide billing software or a clearinghouse, or take over your receivables as a billing company. It places the biller who works your claims in your systems. See the medical biller role, the healthcare virtual assistant role, and the healthcare and mental health industry pages.
As of 5 November 2026, published prices run from 2.50% of collections (Avenue Billing Services) and 2.99% (MedSole RCM) to 5% to 8% (Medical Billers and Coders). Carepatron publishes $99 per provider per month plus 3.9%, and market guides put most practices at 5% to 7%, or $3 to $10 per claim. A remote staffing agency such as Virtustant places a dedicated medical biller on one all-in hourly rate.
Most guides put it between 4% and 10% of collections, commonly 5% to 7% (Carepatron, citing Physicians Side Gigs, 2025). Published rates on the pages we read range from 2.50% to 8%, and therapy billers such as TheraThink charge 6.5% to 8% of the allowed amount.
Use the Collections Crossover Test: divide the biller's monthly cost by the billing company's percent. Above that level of monthly collections, a dedicated biller costs less; below it, the billing company does. A $2,000 seat crosses a 5% fee at $40,000 a month collected.
It compares three lines: the fee line (collections times the percent, plus other fees), the seat line (the biller's cost plus any software or clearinghouse fees you would take on) and the scope line (work outside the billing contract the same person could do). The crossover is seat cost divided by fee percent.
They should, if they handle protected health information for your practice. Of the pages we read, MedCare MSO publishes that every engagement starts with a business associate agreement; others describe HIPAA training or controls without a BAA statement. Ask every option in writing.
A billing company usually brings its own software and clearinghouse, coding review, coverage when someone is out and reporting across many clients. A dedicated biller works in your systems on your hours and can also take eligibility checks, prior authorizations and patient balance calls.
HIPAA itself does not ban it, but other rules can limit it: Texas SB 1188 requires Texas patients' electronic records to be stored in the US from 1 January 2026, Medicare Advantage plans need an attestation about work done outside the US, and some Medicaid programs and payer contracts restrict it. Check with your payers first.
You get a shortlist of 3 to 5 vetted candidates within 48 hours of your first call, and your hire can start in 72 hours, with zero placement fees and month-to-month terms.
Third-party prices. Read on each provider's own pages on 5 November 2026: Avenue Billing Services, MedSole RCM, Carepatron billing cost guide (17 June 2026; Carepatron discloses a commercial interest), Medical Billers and Coders, TheraThink pricing (parts of the page are dated 2019), MedCare MSO, BellMedEx, CureMD, Hello Rache pricing and MEDVA pricing. Figures are reported as published; prices and terms change, so confirm them in writing.
Calculations. Billing cost: monthly collections × the published percent (Carepatron adds $99 for one provider). Crossover: monthly seat cost ÷ fee percent. Loaded US hour: median wage ÷ 0.70; full-time month: 40 hours × 52 ÷ 12 = 173.3 hours.
Virtustant data. The four most recent positions for medical billing and claims work in Virtustant's recruitment system, opened February to October 2026, read on 5 November 2026. Counts include only what each record states.
Public data. O*NET, Billing and Posting Clerks and Medical Records Specialists (BLS 2025 wage data); AAPC salary survey (2025); BLS Employer Costs for Employee Compensation (June 2026); HHS business associate agreement guidance.
