What does outsourced home care billing cost?
Outsourced home care billing is usually priced as a percentage of collections, so the cost scales with revenue actually received rather than claims submitted. Compare it against fully loaded in-house cost - salary, benefits, software, training and the revenue lost to denials - not against salary alone.
Compare like for like
The honest comparison for in-house billing is not the biller's salary. It is salary plus payroll taxes and benefits, plus billing software and clearinghouse fees, plus training and the cost of keeping current with payer rule changes, plus coverage for holiday and turnover, plus the revenue difference produced by the denial rate.
That last term is the one that decides it. On a book of several million in claims, a few percentage points of first-pass acceptance is worth more than the entire cost of either option.
What percentage-of-collections actually aligns
Percentage-of-collections pricing means the biller is paid only when you are. It removes the failure mode where a vendor is paid per claim submitted and has no economic reason to care whether it is paid.
People also ask
- Are there setup fees?
- At Paradigm, no - no setup fees and no monthly minimums. Billing is charged only on claims that get paid.
- Is it cheaper to hire a biller?
- Sometimes, at high volume, if the biller is genuinely expert in your payers. The comparison people get wrong is forgetting the denial rate: a few points of first-pass difference usually dwarfs the fee.
Last reviewed · Payer rules change and vary by state - confirm specifics against your payer.
Want this handled rather than explained?
Paradigm does this work for 4,000+ home care agencies. We are paid a percentage of what actually gets collected.
Related answers
Why do home care claims get denied?
Most home care denials are created before submission, not during adjudication. The recurring causes are an expired or missing authorization, a mismatch between delivered and authorized hours, EVV data that disagrees with the billed visit, coverage that lapsed at redetermination, and wrong service codes or modifiers.