For Different Practice Sizes

Solo and small practices (1 to 3 providers) are served by a two-person service team: one specialty-trained coder/biller who handles your daily charge entry, claim submission and ERA posting, plus an account manager shared across 8 to 12 similar-sized practices for monthly KPI review and escalations. That account manager is shared, not dedicated, and this page says so rather than implying otherwise. Pricing follows the two published rates rather than a size-specific band of its own: 7.0 percent of collections on the solo tier, 6.0 percent on the group tier, which starts at two providers. The solo tier carries a monthly minimum that is scoped to the practice and set in your quote and Service Agreement rather than published, so see pricing and ask for that figure in writing before you sign. Reporting is a monthly KPI dashboard read against your own prior months, plus weekly written status notes through the first 90 days of onboarding. The case for outsourcing at this size is a labor one: at one to three providers the billing workload rarely fills a full-time in-house role, so the realistic alternative is usually a part-time or shared staff member. We do not put a benchmark number against that comparison, because no free source publishes one that separates in-house from outsourced practices.

Group practices (4 to 20 providers) are served by a three to five-person dedicated pod: a specialty senior coder, two to three coder/billers, a denial-management specialist and an account manager who is yours rather than shared. Pricing is the published group rate, 6.0 percent of collections for group practices of 2 to 15 providers; above that the engagement is scoped and quoted individually, so ask rather than assume the rate. Reporting depth expands to weekly KPI dashboards, provider-level breakouts (RVU production, charge lag, denial rate per provider) and monthly executive reviews with the practice administrator. A group spanning several specialties routes claims to more than one specialty pod, coordinated by the account manager. Targets are set against your own baseline at cutover rather than against a purchased median: MGMA's size-and-specialty medians are licensed and not public, and we will not quote you a comparison we cannot show you.

Large multi-site groups are served by an enterprise pod model: 6 to 12 dedicated billing staff structured by site, specialty or function (charge entry, denial management, A/R follow-up, payer-specific specialists for major contracts), plus a Director of Account Operations who is not shared and an executive sponsor for quarterly business reviews. Enterprise pricing typically falls in the 4 to 5.5 percent of collections range and is quoted against your actual footprint rather than listed as a rate card. Enterprise reporting includes daily operational dashboards, weekly variance reports against budget, monthly multi-site rollups with site-level and specialty-level drill-downs, and quarterly executive reviews read against your own trend, because no freely-published source supplies the specialty-and-size-matched peer medians such a review would otherwise compare you to, and HFMA MAP Keys publishes metric definitions and no target values. Enterprise clients also receive a dedicated implementation manager for site rollouts and HL7 or FHIR interface support for a multi-site EHR architecture. Security documentation, including the SOC 2 Type II report described in HIPAA and compliance, is provided under NDA on request during security review rather than published. Onboarding for a multi-site group typically runs 6 to 8 weeks rather than the standard 2 to 4.

Dedication scales with practice size, and it is not absolute at the bottom of the range. Solo and small practices (1 to 3 providers) share an account manager across 8 to 12 similar-sized clients but get a dedicated coder/biller for the daily work. Group practices (4 to 20 providers) get a fully dedicated three to five-person pod with no shared resource at the operational level. Enterprise groups (21+ providers) get a fully dedicated pod plus a Director of Account Operations. Dedication matters because accuracy depends on knowing your documentation patterns, payer mix and provider-specific habits, which a rotating queue never learns. That is a reason to structure the work this way; it is not a number we are willing to promise you in advance. What is contractual is continuity: any planned staff change, including vacation coverage and role transitions, is communicated to the practice in advance, and replacement staff complete a documented 30-day shadow before primary responsibility transfers.

Yes: they are quoted at the enterprise tier rather than at the published solo or group rates, because the work is different. Professional-component billing runs alongside the hospital's facility claims, and both volume and complexity are higher. Four requirements drive most of the accuracy work. (1) Split (or shared) evaluation and management visits: CMS pays the practitioner who performed the substantive portion, which can be more than half of the total time spent by the physician and the non-physician practitioner or a substantive part of the medical decision making, and the policy applies to visits in a facility setting rather than to office visits, per CMS's E/M compliance guidance (verified 17 September 2026). CMS revised that definition for CY 2024 and the guidance linked above still stated it that way on the date checked, so confirm the definition in force for the year you are billing. (2) Place-of-service accuracy across the codes these groups actually use: 19 for off campus-outpatient hospital and 22 for on campus-outpatient hospital, a distinction that is easy to get wrong and changes payment; 23 for emergency room (hospital); and 31 for skilled nursing facility. (3) Correct application of modifier 26 for the professional component and TC for the technical component. (4) Billing data your compliance officer can use for physician self-referral (Stark, administered by CMS) and federal Anti-Kickback Statute review, which HHS-OIG enforces: MedPrecision supplies the data, not legal advice on either statute, and how they apply to a given arrangement is a question for your counsel. Reporting includes physician-level wRVU production for compensation calculation, payer-mix analysis for contract negotiation, and quality measure performance feeding into MIPS and ACO reporting under the CMS Quality Payment Program.

Reporting scales with practice size. Solo and small practices receive monthly KPI dashboards plus quarterly business reviews. Group practices receive weekly KPI dashboards, monthly executive reviews with provider-level breakouts and quarterly business reviews. Enterprise groups receive daily operational dashboards, weekly variance reports against budget, monthly multi-site rollups and quarterly executive reviews. Every tier is read against your own baseline and trend rather than against a peer median, because the specialty-and-size-matched medians that would make such a comparison meaningful are licensed and not public, and we would rather show you a blank than a number we cannot evidence. All tiers have on-demand portal access to A/R aging, denial trends by reason code, payer payment lag and acceptance rate. Custom reporting for specialty-specific needs (RVU production for compensation calculations, payer-mix analysis for contract negotiations, CMS quality-measure rollups for MIPS reporting) is available across all tiers; how complex it is decides whether it sits inside the base fee or is quoted separately.