Billing guide · Guide 01 of 04
What a chiropractic billing service costs.
Billing services charge a share of what they collect, a fee per claim or a flat monthly fee. Each model rewards different work. Price all three against your own visit volume before you compare quotes, and price your own staff the same way.
Three ways billing services charge
Almost every quote you receive uses one of three models, or a mix of them. Each one pays the billing service for something different, and that shapes what you get.
| Model | How it works | What it rewards | What to watch |
|---|---|---|---|
| Percentage | A share of what the service collects for you | Collecting more | Small claims earn the service little, so they can get less attention; the base the percentage applies to |
| Per claim | A fixed fee for each claim filed | Filing claims | Unless the scope says otherwise, the fee pays for filing, not for working a denial or an underpayment |
| Flat monthly | One fee for a defined volume of work | Finishing each claim with less effort | What the fee covers, and what happens when your volume grows |
Percentages are the most common model. In one marketplace survey of practices buying billing services, BuyerZone found rates from 4.25% to 8% of collections, lower for practices with larger claims. The only flat fees in its sample came from chiropractors, and BuyerZone noted that flat fees can make more sense for specialties that file many low-dollar claims. A chiropractic practice fits that description.
A percentage fee is common and, in the words of the HHS Office of Inspector General, not illegal in itself. The OIG has also warned that percentage arrangements may increase the risk of upcoding, because the service earns more when the claim is worth more. That is one more reason coding decisions must stay with your provider and the signed note.
Price three quotes for the same practice
Take one example practice: 200 insurance visits a month, $9,000 a month in insurance charges and $6,000 a month in insurance payments. Three services quote it. The quotes are examples, not market prices.
| Quote | Monthly fee | Per visit | Share of payments |
|---|---|---|---|
| A: 7% of collections | $420 | $2.10 | 7.0% |
| B: $3 per claim | $600 | $3.00 | 10.0% |
| C: $500 flat | $500 | $2.50 | 8.3% |
On the headline numbers, quote A wins. Now suppose quote A works only denials above a dollar threshold, and quote C works every one. If that leaves quote A’s practice collecting three percent less of what it is owed, the practice loses about $180 a month in payments, and quote A’s real cost rises to about $600 a month. The fee is the visible price. What the fee leaves undone is the other one.
Double the volume and the picture changes again: quote A doubles to $840 and quote B to $1,200, while a flat fee moves only if the service’s tiers say so. Ask every service for its price at your current volume and at twice that.
Percent of what?
A percentage quote is only comparable once you know its base. Ask whether it applies to:
- insurance payments only, or patient payments too, including copays your front desk collects at the visit;
- payments on claims filed before the service started;
- money a payer later takes back, and whether the fee comes back with it.
The same 7% can cost a practice very different amounts depending on those three answers.
Common extras to ask about
- A setup or onboarding fee.
- Credentialing and payer enrollment.
- Patient statements, priced per statement.
- Cleanup of older claims.
- Clearinghouse fees, passed through or included.
- Paper claims and paper remittances.
- A monthly minimum.
- Fees on payments that arrive after you leave.
Put every extra the service names into the monthly cost before you compare. The guide to questions to ask a billing service covers the rest of the proposal.
Price your own staff the same way
In-house billing is not free because nobody sends an invoice. Price it with the same arithmetic:
- Hours. The hours each week someone spends on claims, remittances, denials and payer calls, including the office manager’s evenings.
- Wage. The Bureau of Labor Statistics reports a median wage of $51,140 a year, about $24.59 an hour, for medical records specialists in May 2025. At that rate, someone spending 15 hours a week on billing costs about $1,600 a month in wages alone. Add payroll taxes and benefits.
- Tools. Clearinghouse fees and any billing add-on to your EHR.
- Coverage. Who files claims during that person’s vacation, and what it costs when they leave and the next person learns your payers from scratch.
Then measure in-house billing on the same five numbers you would use for a service. A low cost with a falling collection rate is not a saving.
How Claims Native prices
For a practice billing up to $10,000 a month in insurance charges, Claims Native costs $500 a month. Larger practices get a quote from their volume. One launch fee, quoted with your scope, covers enrollment, connecting your EHR, capturing your contract rates and the shadow period.
Claim corrections, payer follow-up and appeals, payment investigation, insurance reconciliation, posting into your EHR and fixing our own errors are included. Bookkeeping across your systems, monthly close, cleanup of older balances and patient collections are priced separately. After the launch period it runs month to month, and your records leave with you.
Sources
- BuyerZone, Real-world medical billing service prices. A marketplace’s survey of its own buyers; a small sample.
- HHS Office of Inspector General, Compliance Program Guidance for Third-Party Medical Billing Companies (1998).
- HHS Office of Inspector General, Compliance Program for Individual and Small Group Physician Practices (2000). Percentage arrangements and Medicare payments to billing services.
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Medical Records Specialists. Median wage, May 2025.