A medical billing rate is difficult to judge until you know who works denied claims. Compare medical billing denial management fees with the ordinary billing service, identifying which follow-up tasks are included and which require a separate charge or extra work from your staff.
For medical billing services, the useful question is not simply whether denial management appears on a feature list. Ask what the company does when a payer rejects or denies a claim, what information it needs from your practice and how unresolved items are reported.
Included Denial Follow-Up
Ask the provider to distinguish initial claim corrections, denial follow-up, appeals and older unpaid accounts. These can involve different work. A proposal should show where the standard service stops rather than grouping every task under revenue cycle management.
Athenahealth’s published service description, for example, sets out particular responsibilities and conditions around claim follow-up and denial handling. That illustrates why the service agreement matters more than a broad marketing label. Use the medical billing services buying guide to compare the actual work assigned to the billing company and your practice.
Denial Management Fee Structures
Request the proposed charging method and its calculation basis. If a percentage is quoted, ask which collected amounts it applies to and whether separate recovery work attracts another charge. If a fixed fee is proposed, ask what volumes or tasks it includes.
Review medical billing services prices with a sample month of your own activity, using de-identified totals rather than patient records in an initial enquiry. Show routine collections and any backlog separately. A low headline rate can be misleading when an important part of the work falls outside it.
Ask how the provider handles denials that require information only your clinicians or practice staff can supply. Clarify the handoff, escalation route and response expectations. Outsourcing the task does not remove the need for accurate documentation or a named person at the practice to resolve outstanding questions.
Denial Management Fee Example
For a hypothetical $100,000 in monthly collections, a 5% billing fee is $5,000 and a 6% fee is $6,000. If the first proposal adds $1,500 for the same denial work included in the second, its total becomes $6,500. The lower headline percentage then costs $500 more. These are illustrative contract inputs, not typical billing rates; compare identical collection definitions, denial scope and other fees.
Reports That Show the Work
Request a sample report showing outstanding denials, their age, reasons and current action. Ask how you will distinguish work completed from claims still waiting for a response. A report should help your team identify recurring causes as well as monitor unpaid balances.
The medical billing services FAQs can help you prepare a focused comparison. Give each billing provider the same specialty, approximate claim volume and scope, then ask for its fees and responsibilities in writing. Choose the service that clearly covers the denial work you need at an understandable total price. Do not pay twice for a task you thought the original billing fee already included, or assume an appealing rate guarantees a particular collection result.
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