Not necessarily. Medical billing pricing varies by vendor and contract, and these services may be included in a full-service RCM package, priced separately, or offered as optional add-ons. Before signing, confirm exactly what the quoted fee covers for Credentialing, Prior Authorization, Medical Coding, patient statements, and A/R follow-up.
What Does Each Service Usually Mean for Pricing?
| Service | What to Clarify |
|---|---|
| Credentialing | Is payer enrollment and re-credentialing included, or charged per provider or payer? |
| Prior Authorization | Does the vendor obtain authorizations, track expiration dates, and handle payer requests? |
| Medical Coding | Are routine CPT and ICD-10 coding included? Are complex charts, audits, or specialty coding separate? |
| Patient Statements | Are electronic or mailed statements included, or charged per statement or transaction? |
| A/R Follow-Up | Does the fee cover current unpaid claims, denials, underpayments, and older legacy A/R? |
Why the Contract Matters
Two companies can quote the same percentage of collections while providing very different levels of service. One may include coding and denial management, while another may charge separately for credentialing, authorization work, or old A/R.
For example, a new cardiology practice may need Credentialing and payer enrollment before billing begins, while an established orthopedic group may primarily need AR Management and denial follow-up. The appropriate pricing structure depends on the actual workflow and scope of work.
Ask These Questions Before Comparing Quotes
- Is the service included in the base fee?
- If not, how is it priced?
- Which providers, locations, and payers are covered?
- Are specialty-specific requirements included?
- Who handles escalated Claim Denials and appeals?
- How is legacy A/R billed?
Expert insight: Never compare billing percentages without comparing the underlying scope. A lower percentage can become more expensive if essential RCM tasks are excluded.
The Medicator’s can help practices understand their required medical billing services and build a transparent scope covering the revenue-cycle functions they actually need.
