Puerto Rico
Puerto Rico medical billing staff, working on the same US rules
Puerto Rico medical billing runs on the same federal rules as the mainland: HIPAA’s definition of a State includes Puerto Rico, and 84% of Medicare beneficiaries there were in Medicare Advantage in 2022, against 48% in the US. OffshoreMeds places full-time offshore billing staff with Puerto Rico practices, and our staff work in English. 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 3, 2026. How we check our numbers.
The rules
Why the mainland billing rules carry over
- HIPAA applies. The HIPAA definitions say a State includes “the Commonwealth of Puerto Rico” (45 CFR 160.103), so the Business Associate Agreement and safeguard rules on our HIPAA compliant offshore medical billing page apply the same way.
- Medicare Advantage dominates. An AJMC study published in February 2026 found 84% of Medicare beneficiaries in Puerto Rico were in Medicare Advantage in 2022, against 48% in the US. Most Medicare patients there are therefore in private plans, each with its own contract terms.
Before you start
The Medicare Advantage offshore checks
Medicare Advantage plans pass a CMS rule on offshore subcontractors down to the practices they contract with. One example is the Wellcare California provider attestation form:
| Point | What the form says |
|---|---|
| Point: What counts as offshore | What the form says: CMS defines offshore as any country that is not within the United States or one of the US territories, which include Puerto Rico. Staff working outside those places are offshore. |
| Point: Who must attest | What the form says: Participating providers that use offshore subcontractors handling protected health information. |
| Point: Deadline | What the form says: Within 20 calendar days of signing with the offshore subcontractor. |
| Point: Plan policy | What the form says: That plan's own policy prohibits transferring or storing data outside the United States. |
Plans differ, and some do not allow offshore access at all. Read the offshore clause in each Medicare Advantage and Vital managed-care contract before any offshore staff member gets access, and file the attestations those contracts require.
Cost
What it costs compared with a local hire
| Option | Yearly cost | Source |
|---|---|---|
| Option: Medical records specialist, Puerto Rico (mean wage) | Yearly cost: $34,060 | Source: BLS OEWS, May 2025 |
| Option: Medical records specialist, US (mean wage) | Yearly cost: $56,790 | Source: BLS OEWS, May 2025 |
| Option: OffshoreMeds seat | Yearly cost: $18,000 to $24,000 | Source: Our seat fee |
A seat at the top of our range costs $10,060 a year less than the Puerto Rico mean wage, before benefits or rehiring, while on the mainland the same gap is $32,790. The saving is smaller than on the mainland, so the stronger reasons to staff offshore in Puerto Rico are capacity and cover when someone leaves.
The seat fee is $1,500 to $2,000 per month. Prices are indicative until your written quote confirms the exact fee. Your own wages and savings will differ. The offshore medical billing cost page shows the full in-house method.
Language
Our staff work in English
Spanish and English are both official languages in Puerto Rico. Our staff work in English. If your payers, patients or records need Spanish for some tasks, say so when you scope the seat, so the role covers only work that can be done in English.
The same staff can verify coverage before visits; see insurance eligibility verification staff, and the steps in how to outsource medical billing.
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.
- How to outsource medical billing
Five steps from choosing roles to go-live, with the compliance and cost checks in the right order.
- Insurance eligibility verification staff
Coverage, benefits, authorization and patient-cost checks done before the visit, not after the denial.
- 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.
- Offshore subcontractor attestation
What CMS requires of plans, what one plan's provider form asks and what a practice should have ready.
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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