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Issue 1 · June 2026
What your billing actually costs — and the credentialing mistake that stalls cash flow
Before you act on any number here: Practice Insider gives general operational guidance on running an independent practice. It is not legal, compliance, tax, or financial advice. Confirm any billing, coding, payer-contract, or insurance step with qualified healthcare counsel, a certified professional coder, or your own advisor before acting on it.
The lead: the one billing number that tells you if you are overpaying
Most independent practices judge a billing company by its fee — the percentage it takes off the top. That number is the wrong place to look first. A billing company that charges 4% but collects 88% of what you are owed is more expensive than one that charges 7% and collects 96%, because the gap shows up in the money that never arrives at all.
The number that matters is net collection rate — the share of collectible revenue you actually bring in after contractual adjustments. A healthy independent practice runs 95% or better. Anything under 92% means real money is leaking, and the billing fee is a rounding error next to it.
Billing-company fees themselves typically run 4% to 9% of collections, depending on specialty and claim volume. Lower-complexity, high-volume specialties land near the bottom of that range; surgical and procedure-heavy practices with messier coding land higher. But the fee only tells you what you pay. The net collection rate tells you what you get.
What to ask before you sign
When you evaluate any billing vendor, ask for audited net collection rate on practices in your specialty over the trailing 12 months — not a brochure figure, and not their gross collection rate, which looks better and means less. If they cannot produce specialty-specific data, that itself is the answer. Also ask who works your denials: a vendor that bills clean claims but lets denials age past 90 days is quietly writing off your revenue for you.
Quick hits
Credentialing: the quarterly task that prevents the 120-day stall
New-payer credentialing typically takes 90 to 120 days — Blue Cross plans often clear near 90, the larger national payers run 120 or more. The avoidable version of that delay is a stale CAQH ProView profile. Payers pull from CAQH, and an out-of-date or unattested profile sends the application into a hold queue that no one tells you about. Re-attest CAQH every quarter, whether anything changed or not. It is fifteen minutes that protects three months of cash flow.
EHR: the line item that hides in modular pricing
If you are quoted a low monthly EHR price, confirm whether you are buying an integrated practice-management-plus-EHR system or a modular one. Modular setups need an interface layer to talk to your billing system, and that interface commonly adds around $300 a month that is not in the headline quote. Over a five-year contract that is $18,000 the demo never mentioned.
HIPAA: the cheapest gap to close is usually the riskiest
The most common finding in a small-practice HIPAA review is not encryption or firewalls — it is the missing or years-old risk analysis itself. A documented risk analysis is required, it is the first thing requested if you are ever investigated, and it costs nothing but a few hours to complete. Practices spend on tools while leaving the one required document undone.
Putting this issue to work
If the billing section hit a nerve, the in-house-versus-outsource decision is worth running with real numbers before your next renewal. Compare medical billing and RCM services on GetPracticeHelp and filter by your specialty and payer mix.
Compare billing services →On the numbers: net collection rate benchmarks, billing-fee ranges, and credentialing timelines reflect general medical-practice-management industry norms (MGMA-style benchmarking and payer-published timelines). Your specialty, payer mix, and state will move the specifics — treat these as anchors to check against your own data, not guarantees.