What does outsourced Medicaid billing cost for a 50-client home care agency?

Short answer
Most firms charge a percentage of what they collect for you, usually 1.5 to 3 percent. If you bill about 40,000 to 80,000 dollars a week, plan on 600 to 2,400 dollars per week, tied to the money that actually comes in.

How the math works

• Weekly Medicaid billing example: 40,000 to 80,000 dollars
• Fee at 1.5 percent: 600 to 1,200 dollars per week
• Fee at 3.0 percent: 1,200 to 2,400 dollars per week

What drives the price up or down

• Mix of payers and waivers in your state
• EVV and documentation quality
• Denial rate and how much follow up is needed
• Scope of work you want handled end to end vs submit only

What a true outsourced service should include

• Claims submission, status checks, and follow through until paid
• Denial management and resubmissions
• EVV and visit to claim reconciliation
• Payment posting and remittance matching
• Clear weekly AR reporting and aging by payer

Questions to ask vendors

• Do you bill on collections only or on submissions
• Which waivers and MCOs do you work with in my state
• How do you reconcile EVV to claims before submission
• What is your average days sales outstanding by payer
• Can I see sample reports and two client references from my state

Quick reality check
The cheapest fee is not always the lowest total cost. One missed authorization, a batch of preventable denials, or slow follow ups can erase any savings.

If you want a simple benchmark, Paradigm typically prices within the ranges above and handles the full cycle so you pay only when you get paid.

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