Transparent Medical Billing Pricing & RCM Costs
No hidden onboarding fees, no billing module upcharges. Malakos Healthcare Solutions structures pricing starting at 4% to 10% of monthly collections, fully aligned with your specialty, claim volume, and clinic complexity.
4 RCM Pricing Structures: Which fits your practice?
Healthcare billing organizations utilize different price models. While Malakos leads with percentage-of-collections to ensure shared incentives, we adapt the pricing structure to support your operational needs.
Percentage of Collections (4% - 10%)
Our primary billing model. You pay a percentage based on the revenue we successfully collect for you. Incentives are perfectly aligned: we only make money when your clinic gets paid. Standard range is 5% - 7% for multi-provider groups; scales to 8% - 10% for lower volume or highly complex specialties.
Per-Claim Submitted ($4 - $12 per claim)
A fixed fee charged per individual claim submitted, irrespective of the final collected amount. Best suited for high-volume, low-complexity clinical niches (such as physical therapy or chiropractic) with simple payer matrices. Note: does not incentivize denial recovery or secondary collections.
Per-FTE Staff Augmentation ($12 - $18/hr loaded)
Dedicated, full-time equivalents assigned to operate exclusively within your practice environment. Ideal for hospital systems or large groups needing specific staffing focus, such as historic AR backlog clearance, clearinghouse enrollment, or dedicated patient support desks.
Hybrid Structure (Monthly Base + %)
Combines a lower percentage rate with a predictable monthly base fee to cover ongoing integrations, clearinghouse endpoints, and clearinghouse subscriptions. Often chosen by expanding specialty groups seeking baseline expense predictability alongside incentive-based upside sharing.
Variables That Determine Your Percentage
Because every medical practice operates under a unique clinical and billing framework, our underwriting team reviews five key variables to determine your final percentage.
Specialty Complexity
Surgical groups, interventional pain, and ASCs require complex coding validations, modifier verification, and prior auth tracking, placing them at 7% - 10%. Outpatient primary care or behavioral health falls closer to 4% - 6%.
Monthly Claim Volume
Scale reduces baseline operational overhead. Larger multi-provider clinics and multi-location medical groups operating at higher collections receive lower pricing tiers because of the operational efficiencies achieved.
Payer Mix & Contracts
Payer configurations with heavy out-of-network claims, workers' compensation, auto-injury, or commercial plans demand extensive administrative follow-up, which impacts the final collections rate tier.
Legacy AR Status
Transitioning to Malakos with clean, active accounts receivable (days in AR under 35) keeps rates lower. Portfolios with heavy backlogs of aged claims (90+ days) require an initial recovery project before transitioning to standard billing.
Scope of Engagement
Standard quotes assume full-cycle RCM (eligibility check through statement mailing). Practices requesting modular RCM solutions (e.g. denial management only, credentialing-only, or code audits) are quoted individually.
What Practices Like Yours Actually Pay
Illustrative monthly cost examples based on representative client configurations. Your custom scoped rate will be calibrated to your exact volumes and specialty mix.
Solo Provider Clinic
Single-provider office collecting $500K - $800K annually. Typically primary care, chiropractic, physical therapy, or solo mental health. Standard scope covers full RCM with credentialing maintenance. Typical rate: 7% - 8% of collections.
Mid-Size Specialty Group
5-provider specialty clinic collecting $2.5M - $4M annually. Includes custom EHR/PM integrations, code review audits, a named account manager, predictive denial prevention, and patient billing portal. Typical rate: 5% - 6% of collections.
Enterprise Multispecialty
Multi-specialty medical group collecting $10M - $15M annually. Standard inclusions: dedicated pod, weekly KPI reviews, systematic contract underpayment audits, and custom reporting lines. Typical rate: 4% - 5% of collections.
What is Included in the Malakos Billing Fee?
We believe in transparent, flat-rate partnerships. You will never receive hidden upcharges, onboarding setup fees, or separate bills for clearinghouse portals. What we quote is what you pay.
- CPT/ICD-10 coding review & edits
- Daily electronic claim submission
- Real-time eligibility & authorization checks
- Clearinghouse management & enrollments
- EOB & ERA auto-posting
- Payer-specific AR follow-up at 15-day cycles
- Expert denial resolution & appeals
- Underpayment detection & recovery
- Digital patient statements & payment portal
- Named account manager & dedicated pod
- Toll-free patient billing helpline
- Interactive dashboard & custom reports
- Credentialing audits & CAQH maintenance
- Malakos AI Automated appeal drafts
Malakos vs. Industry Average vs. In-House Billing
A clear breakdown of the true cost of revenue cycle management. Outsourcing to Malakos not only lowers overhead but substantially increases collections through superior clean claim rates.
| Cost Category | Malakos Healthcare | Industry Average RCM | In-House Billing |
|---|---|---|---|
| Percentage Fee / Cost | 4% - 10% of Collections | 6% - 12% of Collections | 8% - 12% equivalent TCO |
| Onboarding Setup Fees | $0 Implementation | $2,000 - $15,000 typical | Recruiting & training costs |
| First-Pass Clean Claim Rate | 99% Average | 90% - 95% Average | 85% - 92% Average |
| Average Days in AR | 24 Days | 38 - 45 Days | 38 - 42 Days |
| Contract Term | Straightforward, tailored terms | 2 - 5 years lock-in | Ongoing employee contracts |
| System Implementation | 30 - 45 Days | 60 - 120 Days | 3 - 6 Months hiring time |
| Software & Licensing Fees | Fully Included | Upcharges common | $500 - $2,500/mo (EHR/PM) |
Industry averages sourced from MGMA and HFMA billing benchmarks. In-house billing TCO calculations assume fully loaded salaries, payroll taxes, health benefits, workspace space overhead, clearinghouse endpoint subscriptions, and billing staff turnover.
Get Your Scoped Proposal in 48 Hours
A 15-minute conversation with our solutions team is all we need to analyze your payer configurations and return a customized, binding billing rate quote within 2 business days.
- 15-minute introductory discovery consultation
- Binding billing rate quote in 2 business days
- Complete analysis of CPT codes and payer configurations
- No sales pressure or long-term multi-year requirements
Learn More About Billing Optimization
Pricing Frequently Asked Questions
Find answers to the most common questions regarding our billing structures, onboarding timelines, and all-inclusive service list.
- Clinical Specialty Complexity: High-coding specialties (e.g. interventional pain, oncology, orthopedics, ASCs) range between 7%-10% due to strict prior authorization and modifier requirements. Primary care and mental health are typically 4%-6%.
- Monthly Collections Volume: Larger volumes spread our fixed operational cost across more claims, resulting in a lower percentage rate.
- Payer Mix: Clinics heavily focused on Workers' Comp or out-of-network claims require intensive manual follow-up, which affects underwriting.
- Legacy AR Status: Clean transitions are priced lower. Portfolios requiring extensive backlog cleanup projects are scoped separately before transitioning to the monthly collections rate.