A medical practice should look beyond the quoted billing percentage or monthly fee and ask what services are excluded. Hidden or unexpected costs can appear in onboarding, coding, credentialing, patient statements, clearinghouse access, legacy A/R, or contract termination. The safest comparison is a written, line-by-line fee schedule showing what is included, optional, and charged separately.
Where Unexpected Costs Can Appear
1. Implementation and Data Migration
Ask whether the vendor charges for EHR or practice-management setup, data migration, workflow configuration, payer setup, or clearinghouse connections.
2. Services Outside Basic Claim Submission
A low headline fee may exclude important RCM functions. Confirm whether the contract includes:
- Medical Coding and chart review
- Eligibility Verification
- Prior Authorization
- Claim Scrubbing and submission
- Claim Denials and appeals
- Payment Posting and reconciliation
- AR Management and payer follow-up
- Patient statements and billing inquiries
If each item carries a separate charge, the effective cost can be considerably different from the advertised rate.
3. Legacy A/R
Find out how the company prices accounts that existed before the contract started. Some agreements may treat older A/R separately from new claims, so define who works those balances and how compensation is calculated.
4. Technology and Transaction Costs
Check for separate charges involving clearinghouse transactions, statement mailing, payment processing, reporting dashboards, analytics, interfaces, or other software features.
5. Credentialing and Specialty Services
Ask whether payer Credentialing, enrollment, authorization work, audits, or specialty-specific Medical Coding are included. A general billing package may not automatically cover every service your practice needs.
6. Exit and Transition Costs
Review data-export fees, termination charges, notice requirements, and post-termination A/R provisions before signing.
Quick vendor comparison: Ask each company to provide one example of the total monthly invoice, including every recurring and likely additional charge. Comparing those invoices is more useful than comparing percentages alone.
Expert insight: If a service affects your ability to get paid, do not rely on phrases such as “full-service billing” without a written definition.
The Medicator’s can help practices evaluate their medical billing requirements and identify the RCM functions that should be clearly defined before selecting a billing partner.
