Medical billing outsourcing: costs, models and how to choose a partner
Outsource defined billing queues, keep clinical and financial authority, and test the team on your claims first.
Actigy BPO, a nearshore business process outsourcing (BPO) company headquartered in Prague, Czech Republic, provides medical billing outsourcing for defined queues. Claims, denials and follow-up stay in client-approved systems. A process audit sets the billing scope before a paid pilot. The client retains clinical decisions, coding policy and financial approvals.
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Describe your queue, monthly volume and payer mix. Review the written scope before committing to a pilot.
Your systems · Your approvals · Pilot before scale
Is outsourcing medical billing a good idea?
Outsourcing can fit a repeatable queue with sufficient volume, complete records and an approval owner. Compare full operating costs before selecting a team. Irregular work can fit a local biller better. Missing clinical records and unresolved payer rules still need the practice's attention.
Key takeaways
- Actigy BPO delivers from teams in Bulgaria, Romania, Poland and Ukraine.
- Every Actigy BPO engagement starts with a process audit and a paid pilot.
- The client retains clinical, coding-policy and financial decisions.
- Compare total cost and defined queue results, not a promised collection increase.
| Service | Managed billing queues |
|---|---|
| Who it is for | Practices, specialty groups and billing companies |
| Delivery locations | Bulgaria, Romania, Poland and Ukraine |
| Coverage | Business hours through 24/7, as scoped |
| Pricing model | Usually per full-time equivalent (FTE) by role |
| Typical start | Pilot usually 2 to 4 weeks after audit, subject to access, training and approvals |
What does medical billing outsourcing cost?
Actigy BPO prices most services per full-time equivalent (FTE) by role and sends a written quote after the process audit. The quote depends on workload, coverage and required supervision. Compare included tasks and retained practice costs before comparing a staffing quote with a percentage-of-collections fee.
| Pricing model | What the fee follows | What to check |
|---|---|---|
| Percentage of collections | An agreed share of collected revenue | Which collections count, exclusions, minimum fees and treatment of old balances |
| Per claim | An agreed unit of claim work | Whether corrections, resubmissions, denials and follow-up cost extra |
| Per FTE | Monthly capacity for defined roles | Included hours, supervision, quality assurance (QA), training and workload assumptions |
Include retained management, coding review, software, clearinghouse charges and transition costs. The billing and coding salary report separates wages from employer costs.
The FTE benchmark is a historical monthly planning model published August 9, 2026, using 2025 and 2026 inputs. It is not a current price survey or quote. Not every input can be independently reproduced from the published files.
Medical billing services for small practices
Actigy BPO fits small medical practices that want a managed billing team in their existing systems. Start with the work that is falling behind: claim checks, denied claims, payment posting or unpaid balances. The practice keeps its EHR, coding policy and financial approvals. A process audit checks workload, staffing and cost before a paid pilot.
A small practice with a billing backlog
Assign a queue owner, review method and daily handoff. Separate new claims from old denials to protect filing deadlines. Scope staffing against actual volume; this page sets no provider-count threshold or minimum.
Denials and AR that existing staff cannot clear
Actigy BPO can work denial-management queues and aged AR follow-up under approved correction and appeal rules. Review actionable balances, deadline risks and missing records first. Track accepted work, repeat errors and unresolved exceptions; do not treat the face value of old claims as recoverable cash.
Prior-authorization submissions and follow-up
Actigy BPO handles authorization submissions, document collection, payer follow-up and status tracking within the agreed workflow. The provider supplies and approves clinical information. Payers decide authorization, and your clinical team decides care. Record submission dates, missing evidence and escalation owners; an authorization is not a guarantee of claim payment.
When that work needs its own queue, the prior-authorization outsourcing scope separates request intake, submission evidence, payer follow-up and handoffs to the clinical reviewer. Keep pending authorizations visible to billing instead of marking them complete when a request is sent.
Replacing a billing provider without losing open work
Use a staged handover: export open claims and notes, name filing deadlines, confirm access, and assign every unresolved item. Test one payer or queue before transferring more work. Keep the current and new teams' responsibilities clear so neither duplicate submissions nor abandoned claims fall between them.
Remote medical billing for US practices and groups
Actigy BPO primarily serves US buyers, with Western Europe as its secondary market. European delivery teams support practices, provider groups and billing companies in client-approved systems. A practice comparing medical billing services in New York, Houston, Dallas or Los Angeles should confirm whether it needs local on-site staff or remote delivery. Assess specialty and payer fit, permitted access and operator-location requirements before choosing the team.
Actigy BPO can scope teams of up to 100 people and 24/7 service coverage. The written proposal defines roles, shifts, supervision, access, training and ramp-up; the staffing figure does not mean 100 people on every shift. Separate 24/7 administrative processing from payer calls, which follow each payer's business hours. Confirm time zones, daylight-saving changes, patient-data access and healthcare agreements before live work.
Is revenue cycle management the same as medical billing?
Revenue cycle management (RCM) covers the wider financial workflow from patient intake through final payment. Actigy BPO scopes billing within revenue cycle management outsourcing. Moving claims or denial follow-up does not transfer clinical, coding-policy or payment authority. Full, partial and hybrid models still need written task boundaries.
| Model | Work moved into scope | Retained work and fit |
|---|---|---|
| Full | Several agreed stages, from eligibility through follow-up | Client retains records, policies and approvals; fits coordinated, repeatable workflows |
| Partial | One queue, such as denials or older balances | Client runs other stages; fits a defined backlog or capacity gap |
| Hybrid | Defined tasks alongside an internal billing team | Client manages handoffs; fits a practice retaining selected payer or specialty work |
Actigy BPO fits repeatable practice queues, including mental health billing and ABA billing, with named approval owners. This service is not the right fit when clinical records or decision owners are unavailable. A small, irregular queue can fit a local biller better.
What Actigy BPO handles in medical billing
Actigy BPO prepares claims and appeals; the provider keeps clinical, coding and payer-contract decisions. Standard operating procedures (SOPs) name each queue and approval owner. Medical coding outsourcing needs a separate coding scope.
| Stage | Actigy BPO scoped work | Client retains |
|---|---|---|
| Before submission | Eligibility, charge entry, coding support and claim scrubbing | Clinical records, necessity and final coding approval |
| Claims | Submission, correction and queue notes | Payer contracts and rules |
| Payment posting | Post approved payment records and flag exceptions | Write-offs, refunds, bank and payment authority |
| Denials and balances | Appeal preparation, accounts receivable (AR) follow-up and patient statements | Final decisions and compliance accountability |
Rejections precede adjudication; denials follow it. Billing companies retain client contracts and need client-specific access, SOPs and reporting.
Billing operations by specialty
Choose the Actigy BPO workflow that matches your practice before scoping a team. These services keep the existing clinical or practice-management system and separate routine billing work from questions that need a clinician, coding reviewer or finance approver.
Dental billing
Connect benefits, approved procedure records, attachments, claim status and insurance balances inside the dental PMS.
Cardiology billing
Reconcile office and diagnostic work, authorization records, remittances and underpayment follow-up across providers and sites.
Orthopedic billing
Keep surgical documentation, authorization, implant records and approved denial work in a controlled handoff.
Urgent care billing
Match completed walk-in encounters to billing queues and separate health-plan claims from employer-billed work.
Podiatry billing
Check approved documentation, coverage and device-related handoffs before claims move to posting and A/R follow-up.
Physical therapy billing
Track visit and authorization records, missing documentation and approved treatment-unit records alongside claims and balances.
How Actigy BPO protects patient data
Actigy BPO works on protected health information (PHI) only in the systems the client approves. Access follows agreed roles, logging and segregation of duties. Client review covers work locations and Health Insurance Portability and Accountability Act (HIPAA) terms.
Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms.
General Data Protection Regulation (GDPR)-compliant delivery uses client-agreed locations and data-processing terms. Ukraine is outside the EU. The written scope names work locations, subprocessors and any transfer terms.
ISO 9001-aligned quality management. Aligned, not certified. SOC 2-aligned controls: role-based access, logging and segregation of duties. Aligned, not audited.
Some payer and government contracts restrict offshore patient-data access. Client legal review must resolve restrictions before the pilot. Read the security control summary and data-processing terms.
Which billing tools and automation fit the workflow?
Actigy BPO works in the client's tools, with access limited to the systems the client approves. These include scoped practice management systems (PMS), electronic health records (EHR), clearinghouses and eligibility tools. Before access, agree export fields, approved data paths, queue owners and unresolved-item handoffs.
Artificial intelligence (AI) or automation requires written scope approval, with human review of every exception. Client owners retain clinical, coding and financial decisions.
Use the AI billing pilot worksheet and calculator to compare one task's quality, review effort and full cost. The medical billing process checklist records the human handoffs around that task; neither tool supplies clinical or financial approval.
How do you start a medical billing pilot?
A pilot with Actigy BPO usually starts 2 to 4 weeks after the process audit. Timing depends on system access, training scope and client approvals. Start with one bounded queue and agreed acceptance criteria. Confirm readiness before live work, then test normal tasks and exceptions before adding volume.
- Audit and scope. Agree tasks, roles, controls, costs and client-owned SOPs with Actigy BPO.
- Train and pilot. Test claims, denied claims, missing records and posting exceptions.
- Review and scale. Correct gaps before adding volume. Apply agreed SOP thresholds.
Payer calls are scheduled during the relevant payer's business hours. For 24/7 administrative processing, the written scope separates overnight work, US payer-call coverage and the escalation path. Read the full pilot process.
How do you measure billing outsourcing benefits?
Actigy BPO measures agreed queue outcomes against the audit baseline, not an assumed collection increase. Define each key performance indicator (KPI), denominator, source and exclusion before the pilot. Track claim quality, delayed balances and retained staff time. Separate billing-team actions from payer delays and missing clinical records.
| Report | Metric definition | Owner | Cadence |
|---|---|---|---|
| Claim quality | Clean-claim and first-pass acceptance rates: accepted claims over claims submitted at the agreed stage | Team lead and client billing owner | Weekly |
| Denials and rework | Denial rate: denied claims divided by adjudicated claims | Billing owner | Weekly |
| Receivables | Days in AR and share of balances over 90 days, with agreed exclusions | Client finance owner | Monthly |
| Collections | Net collections against collectible charges, using client-approved adjustments | Client finance owner | Monthly |
| Capacity and QA | Backlog, sampled posting accuracy, exceptions and retained staff time | Team lead | Weekly; monthly review |
Agree weekly reporting and monthly review before launch. Claim acceptance does not establish coding accuracy or payment.
How do you choose a medical billing partner?
Compare Actigy BPO with alternatives using the same queue, payer mix and approval boundaries. RCM outsourcing needs explicit limits on tasks, access and retained costs. Ask for QA evidence, denial paths and exit terms. Test sample work before approving scope; a lower fee does not establish fit.
RCM outsourcing selection checklist
- Name each queue, metric definition and decision owner.
- Approve system access, exports and unresolved-item handoffs.
- Include retained staff, software and clearinghouse costs.
| Decision | Actigy BPO managed team | In-house billing | Percentage vendor |
|---|---|---|---|
| Daily work | Manages agreed queues | Practice directs employees | Confirm managed tasks |
| SOP ownership | Client owns SOPs | Practice owns procedures | Confirm ownership and access |
| QA | Maker-checker review and sampling | Practice supplies reviewers | Confirm review evidence |
| Coverage | Agreed shifts and payer hours | Hiring and absence cover | Confirm contact hours |
| Start | Audit, then paid pilot | Recruitment and training | Confirm transition plan |
| Pricing | Usually per FTE by role | Salary plus operating costs | Defined collections share |
| Exit | Client-owned SOPs | Internal handover | Confirm data transfer |
Compare billing companies, BPO costs and healthcare workflow boundaries before requesting quotes.
Compare partners for your specialty
Compare specialty sources: anesthesia, cardiology, dental, mental health, orthopedics, radiology, DME billing services and telehealth billing services.
What did the telehealth billing engagement report?
The telehealth billing case reports clean claims rising from 84.1% to 97.8% and 31% lower days sales outstanding (Actigy BPO-reported). The work combined eligibility, coding, billing, denials and AR follow-up. These are not coding-only results or a forecast for another practice.
Source: the linked anonymized case study, reviewed October 2026. Engagement dates are not disclosed.
Results come from anonymized client engagements, are reported by Actigy BPO and are not independently audited. Results depend on scope.
Medical billing outsourcing FAQ
What is medical billing outsourcing?
Medical billing outsourcing assigns agreed billing tasks to an external operations team.
Actigy BPO provides managed billing queues for practices and billing companies. Scope can include eligibility, claims, payment posting, denials and follow-up. It does not transfer clinical authority, payer contracts or control of bank accounts. The audit separates outsourced tasks from retained approvals, then a paid pilot tests that split.
What are the benefits of outsourcing medical billing?
Actigy BPO tests potential benefits against a practice's baseline during the paid pilot. Relevant measures include claim acceptance, denial rework, aging balances and staff time spent on billing administration. Added capacity can address repeatable backlogs when records and rules are available. Payment also depends on documentation, payer decisions and contracts. The pilot must separate those dependencies from the team's own work.
How much does medical billing outsourcing cost?
Actigy BPO usually prices billing work per FTE by role after a process audit. A quote needs queue volume, payer mix, coverage and supervision requirements. Compare it with percentage-of-collections or per-claim offers using the same task scope. Add retained staff time, software, clearinghouse fees and transition work. No published percentage or per-claim range on this page substitutes for that scoped quote.
What is the difference between full and partial medical billing outsourcing?
Full outsourcing combines several agreed operational stages, while partial outsourcing moves one defined queue. A practice can outsource denials while retaining eligibility, submission and posting internally. Hybrid delivery keeps an ongoing split between internal and external teams. None of these labels transfers clinical or financial authority. Define handoffs, access, exception ownership and reporting before selecting a model or comparing its cost.
How does Actigy BPO protect patient data?
Actigy BPO limits work to client-approved systems and agreed role-based access, with logging and separation of duties. The written scope identifies permitted tasks and decision owners. Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms. Review work locations, subprocessors, retention, incident handling and required evidence before granting access to live records.
Can patient data be handled outside the US?
Only after the client confirms that applicable requirements and contracts permit the proposed access. Some payer and government contracts restrict offshore handling. Legal review must cover locations, data flows, subprocessors and transfer terms before live work.
Actigy BPO's EU delivery locations are Bulgaria, Romania and Poland; Ukraine is outside the EU. A general control statement does not establish permission for a particular patient-data workflow.
How do you choose a medical billing outsourcing company?
Compare Actigy BPO and other providers on the same specialty, payer mix and queue boundaries. Request sample notes, denial handling, QA evidence and reporting definitions. Confirm who controls coding changes, write-offs and payments. Review access limits, contract exclusions and exit support with client owners. A pilot tests operational fit; a low fee or unrelated case result does not establish it.
Which billing systems can the team work in?
Actigy BPO works in client-approved billing systems rather than requiring a separate billing platform. The audit reviews the practice management system, electronic health records, clearinghouse and eligibility tools needed for the queue. Confirm user permissions, training, logs and available reports before access. Any automation needs written approval and human review of exceptions. Do not infer support for a particular product without checking the scope.
How long does the transition take?
A pilot with Actigy BPO usually starts 2 to 4 weeks after the process audit. Access, training and client approvals affect readiness. Begin with one bounded queue, documented procedures and agreed acceptance criteria. Review normal claims, denied claims and missing-record exceptions during the pilot. Broader transition follows only after agreed SOP thresholds are met; the pilot start window is not a full migration deadline.
Should you hire a medical biller or outsource medical billing?
Hire internally when the practice has enough work, supervision and absence cover for an employee. Outsourcing can fit a recurring queue that needs managed capacity and documented handoffs. Compare salary plus recruitment, training, software and QA with the full outsourced scope. Small or irregular queues can fit a local biller or shared service better. In either model, retain clinical, coding-policy and financial approval owners.
For supervised capacity, hire a medical biller. Your practice keeps daily management.
Test one billing queue before you scale
Tell Actigy BPO which billing queue needs an owner, your existing EHR, monthly claim volume, payer mix and required coverage. The written scope defines staffing, retained approvals and what the pilot must prove.
Actigy BPO provides written scope before a paid pilot. You approve scale.
Scope a pilot
What happens next
The team reviews the workflow before proposing a written scope. You decide whether to start a paid pilot after reviewing it.