Is Per-Claim Billing Cheaper Than Percentage Billing?

Per-claim billing is cheaper only when the fee per counted claim produces a lower total for equivalent work. It is also a different cash-flow arrangement: a submission-based fee can be due even when insurance has not paid. For some practices, state restrictions determine which fee structure can be used.

What does per-claim pricing actually buy?

The contract must define both the service and the counted event. A claim can mean an original submission, every transmission, a service line, or another unit in a vendor’s agreement. Ask whether a correction, appeal, secondary submission, or rejected file creates another charge.

A clearinghouse transaction price usually buys a different service from a billing company’s claim-management fee. Do not compare those numbers as if they both include eligibility work, payment reconciliation, denials, and patient balance follow-up.

How do I compare a claim fee with a collections percentage?

Use the same claim cohort and collection period when possible. Suppose 100 original claims eventually produce $15,000 of eligible net collections. At an illustrative $6 per original claim, the fee is $600. At 4%, it is also $600. If those claims instead produce $10,000, 4% is $400; at $20,000, 4% is $800.

With these illustrative prices, the equivalent collection level is $150 per original claim: $6 divided by 0.04. That is a fee comparison, not a reimbursement forecast. A monthly snapshot can mislead when this month’s receipts belong to last month’s submissions. Include unpaid claims and follow-up work in the analysis.

What are the advantages and disadvantages?

A fixed price per defined claim makes the unit price understandable and lets cost move with claim volume. It can also avoid using a share of professional revenue where that compensation method is prohibited. The practice can forecast submission cost before knowing final payment.

The downside is that a submission fee can remain due on claims that never pay. A contract charging for every transmission can also make corrections expensive. The solution is a clear counting rule and a service obligation that extends beyond sending the file. Pricing alone does not tell you whether follow-up is included.

How does Bomi’s restricted-state per-claim arrangement work?

Bomi’s current standard agreement uses $6 per original claim first submitted for services covered by its restricted-state clause. The fee replaces the percentage base fee for those services and is earned at first submission regardless of payment. Corrections, replacements, resubmissions, appeals, secondary or tertiary submissions, and follow-up on that underlying claim do not add another claim fee.

The clause also excludes collections for those services, including patient and self-pay receipts, from the percentage base fee. A patient statement alone is not a claim. Standalone self-pay billing or work without a payer claim requires a separately approved fee when applicable. Review your agreement for the exact arrangement.

Can a per-claim biller still work like a teammate?

Yes. The fee unit changes the financial incentive, but a clear service scope can still make someone responsible for unresolved claims. Ask who owns a denial, what you will see when a claim stalls, and what information the practice needs to provide. Those responsibilities should remain concrete under either model.

Related questions

Why state law can change billing compensation

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Frequently Asked Questions

Do I pay a per-claim fee if the claim is denied?

That depends on the agreement. Bomi’s applicable restricted-state fee is earned at first submission regardless of payment.

Does Bomi charge again for an appeal on the same claim?

Under the current standard restricted-state clause, appeals and follow-up for the same underlying claim do not trigger another per-claim fee.