How does Quilven pricing work?

We are paid as a percentage of net collections, not a flat monthly fee. Industry percentage billing typically ranges from 4% to 9% of net collections, with the most competitive quotes between 5% and 7%. Your exact rate depends on specialty, claim volume, and scope.

Is there a long-term contract?

No. Engagement is month-to-month with no multi-year lock-in. You can leave at any time.

Is Quilven HIPAA compliant?

Yes. Before any protected health information is exchanged, we sign a HIPAA Business Associate Agreement under 45 CFR 160.103.

Which EHR and practice management systems do you support?

We work in your existing system, including Athenahealth, eClinicalWorks, Epic, Tebra and Kareo, AdvancedMD, and NextGen.

What does the free 48-hour AR audit cover?

We review AR aging by payer and bucket, top denial reasons by CARC and RARC code, payer mix, and clean-claim patterns. Within two business days you receive a written report. The audit is free and obligation-free.

You do. Quilven works in your systems on your behalf; your data stays yours, and Apex gives you live access to it at all times.

Will outsourcing replace our billing staff?

No. We augment your billing manager and staff, not replace them. We take the payer grind while your biller keeps oversight and local knowledge.

What practice size is the best fit?

Independent specialty practices with roughly 3 to 12 providers, $2M to $15M in collections, and 500 to 3,000 claims per month.

How much does a medical billing company cost?

Percentage-based billing in the US generally runs 4 to 9 percent of net collections, with most quotes to practices of three to twelve providers landing between 5 and 7 percent. What moves the number is claim volume, how much prior authorization your specialty carries, and coding complexity. We quote after the free AR audit rather than before, because a rate given without seeing your claim data is a guess.

What percentage of collections is reasonable to pay a billing company?

Reasonable depends entirely on scope. Five percent for claim submission only, with denials and appeals excluded, is expensive. Eight percent covering coding, denials, AR recovery, prior authorization, credentialing and reporting can be cheap. Before comparing two quotes, get both exclusion lists in writing and confirm whether the percentage applies to gross charges or net collections.

Is 8 percent too much for a practice our size?

Possibly, but the rate alone will not tell you. Ask what net collection rate they are currently achieving for practices of your size and specialty, and ask to see it. A practice moving from 92 to 97 percent net collections gains far more than the two points of fee it might save by switching to a cheaper vendor with a narrower scope.

Is it cheaper to outsource billing or hire our own biller?

In raw salary, in-house is usually cheaper. The comparison changes once you count benefits and payroll tax, billing software, cover during leave, and the recruitment cost when someone resigns. It changes again if one biller cannot keep pace with your claim volume. The US Bureau of Labor Statistics puts the median wage for this role at $50,250 as of May 2024, before any of those additions.

Do you charge on gross charges or net collections?

Net collections. You are charged on money that reaches your account, not on what was billed. This matters more than most rate comparisons: a vendor charging on gross charges is paid the same whether the claim pays in full, pays partially, or is denied outright. Always confirm which basis a quote uses before comparing it to another.

Are there hidden fees?

No setup fee, no monthly platform fee, no charge for reports, support, onboarding or account management. Four things sit outside the percentage: clearinghouse fees billed to you directly, your practice management or EHR licences which stay in your name, payer application fees for credentialing passed through at cost with no markup, and postage if you ask us to handle patient statements.

Is there a minimum monthly fee?

No. There is no monthly minimum and no floor. In a slow month you pay less, which is the point of the model. Watch for this when comparing quotes, because a minimum is where a low headline percentage often becomes a much higher effective rate for a smaller practice.

We are a solo or two-provider practice. Does this work for us?

Quilven fits best at roughly three to twelve providers. Below that, the fixed cost of running an account does not shrink with your claim volume, which is why many billing companies either decline small practices or apply a monthly minimum that becomes the real price. If you are solo and collecting over roughly $1M, or planning to add providers, the conversation is worth having. Below that a per-claim service will usually cost you less.

Will we lose money in the month we switch?

There is usually a short dip in the first cycle while claims move across, and it recovers as the new pipeline fills. The bigger risk is legacy AR being abandoned because nobody owns it during the handover. Before signing with anyone, get it in writing who works the outstanding AR, for how long, and how it is reported to you.

Does outsourcing mean we have to let our biller go?

No, and most practices keep them. What stays in-house is the work that needs someone in the building: patient balance calls, front-desk eligibility, and chasing documentation from providers. What moves to us is submission, coding review, denial work, AR follow-up, prior authorization and credentialing. Most billing staff end up with less of the work they disliked and more of what they are good at.

Are your billers based in the US?

We operate a global team. Coding, denial work, AR follow-up, prior authorization and credentialing are handled across our US and international staff, working your payers inside your own practice management system. A business associate agreement covers every person who touches your data, wherever they sit. Two things worth checking on your side: whether any of your payer contracts restrict protected health information leaving the US, and whether your state adds requirements of its own.

Is offshore billing cheaper, and is it worth it?

Offshore is materially cheaper on labour and that is a real advantage. The trade-offs are timezone lag on payer calls, and the fact that a business associate agreement is enforceable in principle but hard to act on against a foreign subcontractor. Some payer contracts also restrict protected health information leaving the country. Ask any vendor where the work is physically performed and check your payer contracts.

How long is the contract and what notice do we give?

Month to month, with 30 days written notice to leave. Your data and reports are yours and are provided on exit. Long contracts exist because the first ninety days of an engagement are the expensive part for the vendor, and the contract protects that investment. We would rather carry that risk than have you sign something you cannot exit.

How Quilven charges for revenue cycle management

Quilven charges a percentage of what it collects for your practice. There is no setup fee, no monthly platform fee, no minimum, and no long-term contract. Engagement is month to month. If Quilven does not collect, Quilven does not get paid. Your rate depends on claim volume, specialty, and scope, and we quote it after the free 48-hour AR audit, when we have actually seen your claim data.

% of collections

quoted after we see your data

setup fee

Month to month

no long-term contract

Get your free 48-hour AR audit

What is included in the percentage

One percentage covers the entire revenue cycle. Quilven does not price functions separately or add fees per claim, per provider, or per report. Everything below is included for every client at the agreed rate.

Medical billing. Claim submission through your clearinghouse, payment posting, and follow-up to final resolution on every claim.
Certified medical coding. AAPC-certified coders translating clinical documentation into compliant CPT and HCPCS codes.
Denial management. Denials worked by CARC and RARC code, root causes corrected, appeals filed, and recurrence prevented.
Accounts receivable recovery. Aged AR worked by payer and aging bucket on a fixed cadence until each claim is paid, appealed, or written off with a documented reason.
Prior authorization. Authorizations secured before service so procedures are not denied for lack of approval.
Provider credentialing. Payer enrollment and recredentialing so claims are not held or denied for credentialing gaps.
Revenue cycle optimization. Review of charge capture, coding, and denial patterns to recover revenue and lower cost to collect.
Reporting and analytics. Continuous visibility through Apex, including collections, days in AR, denial rate, and claim status.

There are no add-on modules. If it is part of the revenue cycle, it is in the percentage.

What determines your rate

Quilven quotes a specific rate after the free audit, not before. Four things move it.

Specialty

Specialties with complex coding, high prior-authorization burden, or heavy surgical billing take more work per claim. Orthopedics and general surgery sit differently from primary care.

Claim volume

Higher monthly volume lowers the cost to serve each claim, so higher-volume practices generally see a lower percentage.

Average reimbursement per claim

A practice with a high average claim value reaches the same revenue with fewer claims, which affects where the rate lands.

Scope

Practices that add credentialing for multiple providers, or that need aged AR cleanup alongside ongoing billing, carry more work in the first months.

Percentage of collections compared to other pricing models

Billing is sold four ways. Each aligns incentives differently. The comparison below is about pricing models, not about the people doing the work.

	Percentage of collections	Flat monthly fee	Per-claim fee	In-house salaried staff
What you pay	A share of what is actually collected	The same amount regardless of collections	A set amount per claim submitted	Salary, benefits, payroll tax, software, training
When collections drop	Your cost drops with them	Your cost stays the same	Your cost stays roughly the same	Your cost stays the same
Incentive to chase small or difficult claims	Aligned, the vendor is paid on recovery	Weak, the fee is already earned	Weak, payment is for submission not collection	Depends on staffing and workload
Incentive to work aged AR	Aligned	Weak	Weak	Often deprioritized under daily workload
Cost predictability	Scales with revenue	Fixed and predictable	Varies with volume	Fixed but high, plus turnover risk
Coverage during leave or turnover	Continuous	Continuous	Continuous	Gaps when staff are absent

Quilven uses percentage of collections because it is the only model where the vendor loses money when the practice does.

Industry context

What outsourced medical billing typically costs

Percentage-based medical billing in the US generally falls between 4 and 9 percent of net collections, with most quotes to practices of this size landing between 5 and 7 percent. Rates below that range usually signal a narrow scope, such as claim submission only, with denials, appeals, and AR follow-up excluded or billed separately. Rates above it usually reflect a high-complexity specialty or a heavy credentialing load.

Worked example

What you actually pay, once you count what you stop paying

The percentage is not your cost. Your cost is the percentage minus what you stop spending on in-house billing, minus the collections you were previously leaving on the table. For most practices in the three to twelve provider range, that arithmetic lands in low single digits.

A practice submitting $5,000,000 in annual charges, around 2,000 claims a month.

Billing in-house

Net collection rate: 92%
Collected: $4,600,000
Two billers, fully loaded: -$150,000
Billing software and clearinghouse: -$14,000
Practice nets: $4,436,000

Billing with Quilven

Net collection rate: 97%
Collected: $4,850,000
Quilven fee at 7%: -$339,500
Billing software and clearinghouse: -$14,000
Practice nets: $4,496,500

Billing in-house

Collected $4.60M

Nets $4.44M

Billing with Quilven

Collected $4.85M

Nets $4.50M

Practice nets Billing cost

2.4%

effective net cost

The headline rate is 7 percent. The practice is $60,500 better off, because two salaries came off the payroll and five points of net collection rate came back. Against what the practice was already spending, the real cost of the change is 2.4 percent of collections.

Illustrative arithmetic on the assumptions shown. Your numbers will differ, which is what the free 48-hour AR audit is for.

How this compares to the alternatives

Most practices are choosing between four setups, not two. Here is what each one actually costs and what it actually covers.

A flat monthly fee

Quilven

You pay the same whether they collect $80,000 or $40,000 this month

We are paid a percentage of what actually lands in your account

A slow month costs you twice, once in revenue and once in a fee that did not move

A slow month costs us too, which is the point

No financial reason to chase a difficult denial

An unworked denial is money we do not get paid on either

Predictable cost, which genuinely suits some practices

Variable cost, tracking your revenue

Flat fee is not a bad model. It is the right model if your volume is stable and you value budget certainty over recovery. It is the wrong model if your AR is already struggling, because nothing in it rewards fixing that.

A percentage vendor with a narrow scope

Quilven

Claim submission and payment posting

Denials handled selectively, or billed as a separate project

Denial management included, worked by reason code

Aged AR often excluded, or quoted as a one-off recovery engagement

AR recovery included

Prior authorization stays with your staff

Prior authorization included

Credentialing quoted separately, per provider, per payer

Credentialing included, payer application fees passed through at cost

Reporting limited to a monthly summary

Reporting and analytics included, visible in Apex whenever you want it

A lower headline rate

A rate that covers all eight functions

This is the comparison worth doing carefully. A rate two points lower that excludes denials, AR, prior auth, credentialing and reporting is not cheaper. It is a smaller service. Ask any vendor for their exclusion list in writing before you compare their number to ours.

Running billing in-house

Running billing with Quilven

One or two people carrying every payer, every code set, every appeal

Certified coders, denial analysts, credentialing specialists, and an account manager, each on their own part

Coverage gaps when someone is on leave or off sick

Continuous coverage, no single point of failure

Payer rule changes tracked in whatever time is left after the day job

Tracked as part of the job

Knowledge of your payers lives in one person's head

Documented, and it stays when people move on

Recruiting and retraining a biller takes months

Capacity scales without a hiring round

Fixed salary cost whatever your collections do

Cost moves with your collections

None of this is a comment on your billing team. It is a comment on what two people can hold at once. Most practices that move to us keep their billing staff, and hand them the front-desk eligibility, patient balance calls, and provider documentation chasing that nobody else can do from outside the building.

A common objection

Does percentage pricing mean you only chase the easy claims?

It is a fair question and the incentive is real. If a biller earns a percentage, a denial that takes twenty minutes on the phone to overturn is worth less to them than three clean claims. Practices are right to ask about it, and most billing companies will not discuss it. The answer is not a promise, it is visibility. Every claim in your account has a status you can see in Apex, including the ones sitting unworked. If low-value denials are being skipped, the report shows it. Ask any billing company you are considering for the same view before you sign.

What is not included

Quilven is transparent about what sits outside the percentage:

Clearinghouse fees charged directly to your practice by your clearinghouse
Practice management or EHR software licences, which stay in your name
Payer application fees for credentialing, which are set by the payer and passed through at cost with no markup
Postage and patient statement costs, if you ask Quilven to handle patient billing

Nothing else is billed. There are no fees for reports, support, onboarding, or account management.

How to get an exact quote

Quilven does not quote a rate from a phone call. The free 48-hour AR audit is the pricing process.

Send your accounts receivable aging report and a summary of your payer mix. Within two business days you receive a written report showing where revenue is leaking, top denial reasons by CARC and RARC code, what Quilven would expect to recover, and the exact rate for your practice. The audit is free with no obligation. You keep the report whether or not you engage Quilven.

Get your free 48-hour AR audit

FAQ

Pricing questions

See what your practice is leaving on the table

The audit is free, takes two business days, and comes with your exact rate. No obligation and no contract.

Get your free 48-hour AR audit