Guide
How to outsource medical billing: a step-by-step guide
How to outsource medical billing comes down to five steps: choose the roles to hand over, check the compliance rules that apply to your payers, compare a seat fee with your in-house cost, interview and approve the people, then go live with daily reporting. With OffshoreMeds, our target from a signed agreement to go-live is 14 days. One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information.
Published by OffshoreMeds. Facts last checked October 10, 2026. How we check our numbers.
Step 1
Choose the roles to hand over
Start with the work that is repeatable and measurable. Roles that suit outsourcing include:
- Billing: charge entry, claim submission and payment posting.
- Denial management and A/R follow-up.
- Medical coding (ICD-10, CPT, HCC).
- Eligibility and benefits verification and prior authorization.
Write a short job description for each role: the systems used, the daily volume and the quality bar.
Step 2
Check the compliance rules first
- A Business Associate Agreement must be in place before a billing company or staffing provider handles protected health information for you.
- Read the offshore clauses in your payer contracts. Medicare Part D organizations must attest each offshore subcontractor to CMS, and some Medicare Advantage plans pass similar checks to providers; the offshore subcontractor attestation page shows what one plan’s form asks.
- State Medicaid contracts can restrict offshore access; Texas managed care is one example.
The full list, with sources, is on the HIPAA compliant offshore medical billing page.
Step 3
Compare the cost
A US in-house medical records specialist costs about $74,655 a year in wages, benefits and rehiring, based on BLS and SHRM data. A OffshoreMeds seat costs $1,500 to $2,000 per month. Prices are indicative until your written quote confirms the exact fee. A billing company that charges a percentage of collections costs more as collections grow. The offshore medical billing cost page sets the three side by side.
Step 4
Interview and approve the people
You interview, test and approve each hire. Nothing starts without your sign-off. Ask candidates to work a sample of your own claims, and agree the quality measures up front, such as the denial rate you want to stay under; AAFP calls a rate below 5% more desirable. For coders, the sampling method and credential checks are in how to audit medical coding accuracy.
Step 5
Go live with daily reporting
Our onboarding plan, from a signed agreement:
- Days 1-3: Role definition and candidate matching.
- Days 4-10: Your interviews and approval.
- Days 11-14: Onboarding, system access and supervised go-live.
Your own credentialing and system-access approvals can extend this. After go-live, our supervisors run daily QA and production reporting, and you can add or remove seats with 30 days’ notice. The rules for ending a vendor contract are in ending a medical billing contract.
Other markets
Outsourcing outside the US mainland
- Puerto Rico medical billing: the same HIPAA rules, with heavy Medicare Advantage.
- OHIP billing staff for Ontario: MCEDT designation and PHIPA agents.
- UK private practice billing staff: Healthcode invoicing and UK GDPR transfers.
The terms behind each seat
One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information. Clinical decisions stay with your US-licensed providers. See all OffshoreMeds services.
Related guides
- Offshore medical billing cost
Seat fee, US in-house cost and percentage-of-collections fees side by side, with the method shown.
- HIPAA compliant offshore medical billing
The Business Associate Agreement, the safeguards, and the payer and state rules that can rule offshore work out.
- Puerto Rico medical billing
Same HIPAA rules as the mainland, heavy Medicare Advantage, and what the offshore checks mean for Puerto Rico practices.
- OHIP billing staff for Ontario
How designated billing agents fit MCEDT, and what PHIPA and PIPEDA say about offshore agents.
- UK private practice billing staff
Insurer invoicing with CCSD codes through Healthcode, and the UK GDPR documents an offshore team needs.
- Business associate agreement for offshore billing
The terms HIPAA requires in the contract, what the practice must do about problems, and what to add for offshore work.
- Offshore restrictions by state and payer
State storage laws, payer consent clauses and Medicaid rules that can restrict offshore billing, and how to check which ones bind you.
- Percentage-of-collections fees
How the fee works, what Medicare, Medicaid and the OIG say about paying a billing agent, and questions to ask before you sign.
- Timely filing limits for medical claims
The federal caps, examples from Cigna, Aetna, Texas Medicaid and Illinois Medicaid, and how to find and track the limit that applies.
- Vendor questions before you sign
Questions on contract, access, location, payer rules, pay and exit, each tied to the rule or source behind it.
- Offshore subcontractor attestation
What CMS requires of plans, what one plan's provider form asks and what a practice should have ready.
- Ending a vendor contract
Return or destruction of data, ending access, the Medicare notice when a billing agent changes and who keeps control of payment.
- Auditing coding accuracy
OIG's sampling guidance, why no source sets an accuracy percentage, how to read the CERT rate and how to check a coder's credential.
Get Started
Book a free 30-minute call.
Pick a time below. Have these ready: the roles you need, your specialty and your EHR. We’ll come back with a fixed seat quote, candidate profiles to interview and a go-live plan.
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Please keep patient information out of the booking notes. A Business Associate Agreement is signed before anyone touches protected health information. See how this site handles your details in the privacy policy.