Pricing for AdvantEdge Medical Billing Services

Medical billing services, often referred to as revenue cycle management (RCM), are usually priced as a percentage of net collections. In other words, the monthly invoice is calculated as a percentage of the money deposited in your bank account the previous month. In some cases, for regulatory or customer preference reasons, AdvantEdge pricing is per encounter/case or per procedure.


The traditional “percentage of net collections” exists because it aligns AdvantEdge incentives with yours.


Before considering the actual percentage, it is important to clarify the actual scope of services. Some medical billing companies perform only part of the billing process. For example, they may expect the customer to enter charges. Or they may expect the customer to follow-up on patient accounts.

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The vast majority of AdvantEdge revenue cycle management services cover the entire cycle; i.e. from charge entry (where information is on paper) to coding, claims scrubbing and filing (including clearinghouse), payment posting, patient billing, A/R follow-up, denial management, comprehensive reporting and even provider enrollment services (“credentialing”). Plus a dedicated account manager (we refer to them as Client Managers).


Since AdvantEdge costs vary primarily with the volume of encounters or procedures in your organization, a key parameter that affects the final price is your typical reimbursement per procedure. All other things being equal, if your average reimbursement is low, the percentage will be higher and vice versa.


Factors that affect average reimbursement include your payer mix and procedure mix. For that reason, to provide firm pricing, AdvantEdge will always ask for this data.


We are always willing to provide a “ballpark” price over the phone based on your specific situation. As a general rule, pricing can be as low as three percent or less (for physicians performing high ticket procedures) to eight plus percent (for an organization with lots of procedures with low reimbursement). Most prices are between these extremes. Again, this represents full end-to-end revenue cycle management. A lower price quote may not include all of the same services or functions.


It is also important to point out that price isn’t the most important consideration in choosing a billing partner. Effectiveness and consistency of collections should be your first priority. As an example, if AdvantEdge can achieve a 96% net collection rate for you and someone else charging half a percent less only achieves 93%, the savings in the rate is swamped by the revenue loss.


Finally, let’s look at the “add on’s”. Often, there are incremental fees for patient statements (“postage”) and/or enrollment. This can make sense for you since statements are typically a pass through cost (without markup). And enrollment work varies substantially based on your provider turnover so it can be a plus or minus to have it broken out. At the same time, you may prefer to have one all-inclusive rate—which AdvantEdge is pleased to accommodate.


Other add on’s can include clearinghouse charges, implementation fees, software or licensing costs, etc. As a general rule, AdvantEdge does not charge separately for these items.