Service boundaries
- Claim preparation and submission
- Coding responsibility and documentation queries
- Rejections, denials and appeals
- Payment posting and reconciliation exceptions
- Eligibility, credentialing and old A/R
Medical billing pricing
Custom Medical Billing Pricing for U.S. Practices
ERG does not publish prices, fee ranges or packages. Pricing is customized to the practice's services and needs, then provided privately after the requested scope, systems and handoffs are understood.
Quote inputs
What shapes a medical billing quote?
A useful cost for medical billing services begins with a defined workflow, not a public number. The quote should reflect the practice's actual operating requirements and identify the work the practice will continue to own.
Practice profile
Specialty, service setting, legal entities, billing providers, locations and the type of claims the practice submits.
Requested functions
The exact work to price, such as claim submission, rejection handling, denial follow-up, payment posting, eligibility, credentialing or aged A/R review.
Systems and access
EHR, practice-management, clearinghouse and payer-portal workflows; interfaces; access owners; testing; and support responsibilities.
Starting work queues
Current unbilled work, rejections, denials, unapplied payments, aging balances and other inventory that may need a separate plan.
Reporting and handoffs
Required reports, review cadence, exception ownership, escalation paths and the information each party must provide.
Transition timing
Target start date, current-vendor handoff, payer or EDI enrollment dependencies, data access and closeout responsibilities.
Original planning tool
Use this quote-ready scope checklist
Prepare the following operational facts before requesting pricing. High-level counts and workflow descriptions are enough for the public form; do not submit patient information or claim-level files.
| Area | Prepare | Decision the proposal should record |
|---|---|---|
| Practice | Specialty, setting, locations and provider types | Entities, providers and locations in scope |
| Workflow | Functions requested and functions kept in-house | Included tasks, exclusions and handoffs |
| Inventory | High-level work-queue categories and age bands | Current work included, deferred or separately scoped |
| Technology | System names, clearinghouse path, portals and interfaces | Access, testing, support and third-party responsibilities |
| Transactions | Professional, institutional or other claim workflows and payer channels | Enrollment, acknowledgements, remittance and exception ownership |
| Controls | Reporting needs, approvals, escalation and reconciliation | Deliverables, review cadence and accountable owners |
| Transition | Desired timing and current-vendor or staff handoff | Dependencies, data access, start criteria and exit responsibilities |
Proposal review
What a written medical billing proposal should make clear
Public pricing cannot show whether two scopes are equivalent. Review the written proposal against the same responsibility list so the practice can see what is included and what still needs an owner.
Systems and data
- System and portal access owners
- Clearinghouse and EDI dependencies
- Interface testing and support
- Data availability and reporting fields
- Records access at transition or exit
Governance
- Required approvals and practice inputs
- Work-queue owners and escalation timing
- Reporting definitions and review cadence
- Security and business-associate terms
- Start, change and termination responsibilities
Current requirements
Why technology and compliance details belong in scope
Claims work depends on standards, payer channels and systems that a public price cannot represent. The proposal should identify applicable workflows and who owns each dependency.
Standard transactions
CMS lists ASC X12 Version 5010 for adopted claim, eligibility, status and remittance transactions. The claim standard took effect January 1, 2012; operating-rule dates vary by transaction.
MAC and payer instructions
CMS explains that Medicare Fee-for-Service companion guides supplement—not replace—the national implementation guides. The responsible MAC, payer and clearinghouse path should be identified during discovery.
Claims attachments
A CMS final rule for health care claims attachments became effective May 26, 2026, with compliance requirements due May 26, 2028. Transition planning may affect future system and workflow responsibilities.
PHI and vendors
HHS requires the appropriate written arrangement when a billing vendor acts as a business associate. Any subcontractor, cloud service or AI-enabled tool that creates, receives, maintains or transmits PHI should be identified before access is approved.
Scope control: vendor tools do not replace practice oversight. OIG's current compliance library retains guidance for third-party medical billing companies and its November 2023 General Compliance Program Guidance as voluntary resources for identifying risk areas.
Request process
How to request custom medical billing pricing
1. Describe the practice
Use the online form for high-level operational information only. Do not include patient or claim data.
2. Define the workflow
Review requested functions, systems, payer channels, current work queues, reporting and transition needs.
3. Review the proposal
Confirm the private pricing, included work, exclusions, dependencies, security terms and responsibilities in writing.
Common questions
Medical billing pricing FAQs
Does ERG publish medical billing prices or fee ranges?
No. ERG pricing is customized to the practice's services and needs. Submit the online pricing-request form to start a scoped review.
What information helps ERG prepare a medical billing quote?
Useful discovery information includes the practice type, requested functions, locations, systems, payer workflows, current work queues, reporting needs and transition timing. Do not send patient information through the public form.
Can a practice request pricing for selected billing functions?
Use the request form to identify the functions you want priced. The written proposal should define every included task, exclusion, handoff and dependency.
Are coding, credentialing, denial work and old accounts receivable automatically included?
Do not assume they are included. The written proposal should identify whether each function or starting inventory is included, excluded or separately scoped.
Should patient or claim information be submitted with a pricing request?
No. The public form does not need patient information. If protected health information is later required for a defined engagement, the appropriate agreement, access and safeguards should be established first.
How should EHR, clearinghouse and billing-software responsibilities be reviewed?
The proposal should identify the systems in use, access owners, interfaces, transaction workflows, testing, support responsibilities and any third-party terms that the practice must confirm.
What security terms should be reviewed before billing access is granted?
When a billing vendor will act as a HIPAA business associate, the parties should document permitted uses, safeguards, incident duties and subcontractor requirements in the required written arrangement before protected health information is shared.
Primary sources
Sources used for this pricing overview
- CMS: Adopted Standards and Operating Rules — page last modified March 16, 2026.
- CMS: Medicare Fee-for-Service Companion Guides.
- CMS: Medicare Billing: CMS-1500 & 837P — December 2025.
- CMS: Health Care Claims Attachments Final Rule — effective May 26, 2026; compliance required May 26, 2028.
- HHS: Business Associates and Business Associate Agreements.
- HHS OIG: Compliance Guidance — includes the November 2023 General Compliance Program Guidance and archived third-party billing guidance.
Sources reviewed October 2, 2026. This page provides general operational information, not legal, coding, contract or payer-specific advice.
Request pricing for your actual scope
Share high-level practice and workflow details. ERG will provide pricing privately after the services and needs are understood.