Yes. A medical billing company can often customize its pricing model based on a practice’s claim volume, collections, specialty, number of providers, service scope, and revenue-cycle complexity. Custom pricing can be especially useful when a standard percentage, per-claim fee, or flat monthly rate does not accurately reflect the amount of work required.
Why Would a Billing Company Customize Its Pricing?
A five-provider orthopedic group submitting thousands of claims each month has a very different billing workload from a newly opened solo practice with a small patient volume. Treating both practices exactly the same can make the pricing structure unnecessarily expensive for one or financially impractical for the other.
A customized agreement can account for factors such as:
- Monthly claim volume
- Average monthly collections
- Number of providers and locations
- Specialty and coding complexity
- Payer mix
- Denial and appeal workload
- A/R aging
- Credentialing requirements
- Patient statement volume
- EHR or practice-management integrations
- Services the practice keeps in-house
The goal should be to create pricing that reflects the actual workload and services delivered, not simply the size of the practice.
What Customized Pricing Models Are Available?
Percentage of Collections
A vendor may charge a percentage of money collected. This can allow billing expenses to move with revenue rather than creating a large fixed cost.
For a high-volume practice, the vendor may offer a tiered percentage, where the rate changes once collections or claim volume reaches an agreed threshold.
For example, instead of applying one percentage regardless of volume, a contract could establish different pricing tiers for different collection ranges. The exact structure is negotiable and should be documented clearly.
Per-Claim Pricing
A per-claim arrangement can make sense when a practice wants its billing expense to correspond closely with claim volume.
However, practices should ask whether the fee applies to:
- Original claims
- Corrected claims
- Resubmissions
- Secondary claims
- Denied claims
- Claims requiring additional payer follow-up
A low per-claim price can become less attractive if important follow-up work is excluded.
Flat Monthly Pricing
A fixed monthly fee can provide predictable budgeting when claim volume and service requirements are relatively stable.
The contract should specify exactly what the monthly fee covers. Otherwise, coding, denial management, A/R follow-up, credentialing, patient statements, or other services could become additional charges.
Hybrid or Custom Pricing
For a larger or more complex organization, a hybrid model may combine a base fee with a percentage, per-claim charge, or volume-based tiers.
For example, a multi-location group might negotiate a fixed fee for core billing operations and a separate arrangement for specialized coding or extensive legacy A/R recovery.
Can Low-Volume Practices Negotiate Custom Pricing?
Absolutely. A low-volume practice should not assume that it must accept a standard enterprise-style pricing structure.
A startup or small practice can ask a billing company to build pricing around its actual workload. If the practice has few claims but requires substantial credentialing, coding, authorization, or A/R work, claim volume alone may not accurately represent the vendor’s workload.
This is where a broader medical billing services discussion becomes important. The practice should compare the complete scope of support rather than choosing a vendor solely because it advertises the lowest percentage.
What About High-Volume Practices?
High-volume practices often have more leverage to negotiate pricing because their predictable workload can justify a different commercial arrangement.
A large group might ask about:
- Volume-based percentage reductions
- Tiered pricing
- Dedicated billing staff
- Multi-provider pricing
- Multi-location support
- Specialty-specific coding
- A/R management
- Denial and appeal workflows
- Custom reporting
- EHR and practice-management integrations
However, higher claim volume does not automatically mean a lower fee. If the practice has complex specialties, difficult payer contracts, high denial volume, or substantial aged A/R, the vendor may need significantly more labor and expertise.
What Should Be Customized Besides the Price?
This is where practices should be particularly careful. A customized contract should define both price and scope.
Ask the billing company to specify:
- What services are included?
- What services cost extra?
- How is the billing fee calculated?
- What counts as a collection?
- How are patient payments handled?
- How is legacy A/R priced?
- Are denials and appeals included?
- Are corrected and resubmitted claims included?
- Are credentialing and enrollment separate?
- What happens if claim volume increases or decreases?
This prevents a practice from negotiating a lower headline rate while unknowingly accepting numerous additional charges.
A Simple Example
Suppose Practice A submits 200 claims each month, while Practice B submits 5,000. Both may request customized pricing, but their agreements could reasonably look very different.
Practice A might prefer a predictable monthly or low-volume arrangement that avoids a large minimum commitment.
Practice B might negotiate volume-based pricing, dedicated support, and a broader RCM package because its billing operation requires significantly more transaction processing and account follow-up.
Neither practice should select a fee structure solely because another practice received that rate.
Look at Total Cost, Not Just the Percentage
One of the most important questions is:
“What will we pay for the complete billing workflow we actually need?”
For example, a vendor charging 4% may exclude coding, denial follow-up, or A/R management, while another charging 6% may include those services. Comparing the percentages alone would produce an incomplete analysis.
Practices can also evaluate broader revenue cycle management services when they want billing, A/R, denial management, payment posting, and other revenue-cycle functions evaluated as one workflow.
How Should a Practice Negotiate Custom Pricing?
Before requesting a proposal, prepare:
- Average monthly claims
- Average monthly collections
- Number of providers
- Number of locations
- Specialty or specialties
- Payer mix
- Current A/R balance
- A/R aging
- Current denial volume
- Services currently handled internally
- Services the practice wants outsourced
Then ask each vendor to price the same scope of work. This makes proposals much easier to compare.
The Medicator’s can structure revenue-cycle support around the operational needs of the practice rather than treating claim volume as the only pricing variable. For a practice owner, the most useful pricing proposal is one that makes the fee, service scope, exclusions, and performance expectations easy to understand.
Bottom line: Yes, billing companies can offer customized pricing for both low-volume and high-volume practices. The strongest arrangement is not necessarily the one with the lowest percentage or cheapest per-claim rate. It is the arrangement where the pricing reflects the practice’s actual workload, required services, revenue, complexity, and expected level of billing support.
