Pricing
Offshore medical billing cost, compared with in-house staff and percentage billing
The offshore medical billing cost at OffshoreMeds is $1,500 to $2,000 per seat per month, or up to $24,000 a year for one full-time person. One flat monthly fee per seat, never a percentage of collections. Prices are indicative until your written quote confirms the exact fee. 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 billing company paid a percentage of collections costs more as your collections grow.
Published by OffshoreMeds. Facts last checked October 10, 2026. How we check our numbers.
Seat fee
What one offshore billing seat costs
| Item | Amount |
|---|---|
| Item: Monthly fee per seat | Amount: $1,500 to $2,000 |
| Item: Yearly, at the top of the range | Amount: $24,000 |
| Item: Pricing model | Amount: Flat fee per seat |
A seat is one full-time staff member who works in your EHR and practice management system, using your licenses. Our supervisors run the seat day to day and report to you daily. If someone leaves, a cross-trained backup covers the seat while we source a replacement, typically within 10 business days, at no extra cost. You can add or remove seats with 30 days’ notice.
Included in the seat fee:
- Recruitment and vetting
- Training and onboarding
- Management and daily QA
- Secure office and hardware
- Turnover replacement
- BAA and compliance setup
Prices are indicative until your written quote confirms the exact fee.
In-house
What a US in-house billing hire costs
| Component | Source | Yearly cost |
|---|---|---|
| Component: Median wage | Source: BLS Occupational Outlook Handbook, May 2025 | Yearly cost: $51,140 |
| Component: Benefits (30% of compensation) | Source: BLS Employer Costs for Employee Compensation, June 2026 | Yearly cost: $21,917 |
| Component: Rehiring, spread over a year | Source: SHRM cost per hire of $4,700 times BLS JOLTS 34% annual turnover in health care, 2025 | Yearly cost: $1,598 |
| Component: Total | Source: Our calculation | Yearly cost: $74,655 (about $6,221 a month) |
Benefits are scaled from the wage using the BLS benefit share of 30%, so wages make up the other 70% of compensation. Rehiring multiplies the average cost of one hire by the share of staff who leave in a year. The total leaves out workspace, hardware, software and supervisor time, so it understates the in-house cost.
We use the BLS medical records specialist occupation as the comparison because BLS publishes a national median for it. Wages for billing roles in your area may be higher or lower. Your own wages and savings will differ.
Percentage billing
What a percentage-of-collections billing company costs
Many billing companies charge a percentage of the money they collect for you. The table uses an illustrative 5% rate to show how that kind of fee scales. It is an example, not a quoted market rate, so use the rate from your own quotes.
| Monthly collections | Fee at 5% | One seat, top of range |
|---|---|---|
| Monthly collections: $25,000 | Fee at 5%: $1,250 | One seat, top of range: $2,000 |
| Monthly collections: $50,000 | Fee at 5%: $2,500 | One seat, top of range: $2,000 |
| Monthly collections: $100,000 | Fee at 5%: $5,000 | One seat, top of range: $2,000 |
| Monthly collections: $150,000 | Fee at 5%: $7,500 | One seat, top of range: $2,000 |
At $40,000 in monthly collections the illustrative fee equals one seat at the top of our range. Below that, the percentage fee costs less; above it, the seat costs less.
The comparison is not one-for-one. A billing company’s fee pays for its whole team and its software, while a seat is one full-time person working in your systems. A practice with a high claim volume may need more than one seat, so compare the number of seats your volume needs against the full percentage fee. The rules and incentives of that model are on the medical billing percentage of collections page.
Federal rules also limit how an agent that receives Medicare or Medicaid payments for a provider may be paid. For Medicare, the agent’s pay must not be related in any way to the dollar amounts billed or collected, and must not depend on actual collection (42 CFR 424.73(b)(3)). For Medicaid, it must relate to the cost of processing the billing, not to a percentage or other basis tied to the amount billed or collected (42 CFR 447.10(f)). Both provisions concern an agent that receives payment in the provider’s name, so ask your counsel whether they reach the arrangement you are being quoted. This is general information, not legal advice. Review your payer contracts and the rules where you practice with your compliance advisor.
Prices are indicative until your written quote confirms the exact fee.
Hidden costs
Costs a seat fee does not remove
- Your EHR and practice management licenses stay with you, as they would with an in-house hire.
- Someone on your side sets the workflows and the quality bar. We enforce them and report to you daily.
- Onboarding takes time. Our target is 14 days from a signed agreement, and your own credentialing and system-access approvals can extend it.
- Compliance review comes first: a Business Associate Agreement, plus any payer or state rule on offshore access. Our guide to HIPAA compliant offshore medical billing lists the rules to check.
Checklist
How to compare medical billing quotes
- Is the fee a flat amount per seat, or a percentage of collections?
- What does the fee include: supervision, QA, reporting, and cover when someone leaves?
- Is a Business Associate Agreement in place before anyone touches patient data?
- Which denial rate will they report against? AAFP calls a rate below 5% more desirable than the industry average; see what denial management staff do.
- Who codes the claims, and how is coding accuracy audited? See offshore medical coding staff.
- Which company employs each person, and who pays for equipment, security tools and any software outside your own EHR?
- How much notice do you need to give to add or remove staff?
- How does it end, and how is your data returned or destroyed? The questions to put to a vendor, each with the rule behind it, are in offshore medical billing vendor questions.
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
- HIPAA compliant offshore medical billing
The Business Associate Agreement, the safeguards, and the payer and state rules that can rule offshore work out.
- Offshore medical coding staff
ICD-10, CPT and HCC coders working in your EHR, audited daily against a published accuracy standard.
- Denial management staff
Appeals, A/R follow-up and root-cause work, measured against published denial-rate benchmarks.
- Prior authorization staff
Staff who prepare, submit and track prior authorizations, with the clinical line kept where it belongs.
- 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.
- How to outsource medical billing
Five steps from choosing roles to go-live, with the compliance and cost checks in the right order.
- 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.
- Vendor questions before you sign
Questions on contract, access, location, payer rules, pay and exit, each tied to the rule or source behind it.
Get Started
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