Our Pricing by Monthly Collections
As an ophthalmology billing company that works only with eye practices, we set our rate by your monthly collections, from 4.49% for practices collecting up to $20,000 a month down to 2.49% above $80,000, with no setup fee and no minimum monthly charge. Credentialing is priced separately per provider per payer, because volume varies too widely to fold into a percentage.
| Monthly collections | Our rate |
|---|---|
| Up to $20,000 | 4.49% |
| $20,001 to $40,000 | 3.99% |
| $40,001 to $60,000 | 3.49% |
| $60,001 to $80,000 | 2.99% |
| Over $80,000 | 2.49% |
A percentage model aligns us with you. We only earn when your claims get paid, which is the opposite of a per-claim fee that pays the same whether a claim collects or denies. The written quote states which payments count as collections and the notice period to end the agreement, and your practice keeps full ownership of its data.
Three Pricing Models for Ophthalmology Billing in the USA
Ophthalmology billing companies in the USA price in one of three ways. Each one suits a different kind of practice, as the table shows.
| Model | Typical range | Best fit | Watch for |
|---|---|---|---|
| Percentage of collections | 3% to 8% of monthly collections | Most practices, especially with surgical or drug revenue | How "collections" is defined, and whether patient payments count |
| Per claim | About $4 to $12 per claim | High-volume, low-dollar practices such as routine optometry | Fees charged on claims that are never paid |
| Hybrid or flat monthly | Base fee plus a lower percentage | Large groups with stable volume | Scope creep and add-on fees |
The rate is only part of the cost. The other part is the revenue a vendor does or does not collect.
What Changes the Cost?
Five factors move a quote up or down. Knowing them helps you compare two quotes fairly.
- Monthly collections and claim volume
- Service mix, since injections and surgery carry more value per claim than routine exams
- Scope, such as whether credentialing, prior authorization, patient statements and old A/R are included
- Number of providers, locations and systems
- Payer mix, including the share of vision plans, Medicaid and Medicare Advantage
What Should the Fee Include?
Whatever the price, a full-service eye care billing contract should cover these services without extra fees. Anything missing from the list should be priced in writing before you sign.
- Coding review for exams, tests, injections and surgery
- Claim submission and scrubbing against NCCI edits and LCDs
- Payment posting with underpayment checks
- Denial management and appeals on every denial
- A/R follow-up on all open claims
- Monthly KPI reporting with net collection rate and days in A/R
Services that are often priced separately include credentialing, eligibility and prior authorization, patient statements and soft collections and clean-up of A/R left by a previous vendor.
Ophthalmology Billing Cost Calculator
This calculator compares your in-house billing cost with our rate for your monthly collections. Enter your own numbers. The default values are examples, not quotes.
The comparison leaves out the largest variable, which is how much each option collects. A 2-point rise in net collection rate on $1.2 million of annual collections is worth $24,000 a year, so a fair comparison of in-house vs outsourced ophthalmology billing starts with collection results, not cost.
Questions to Ask About Cost
Comparing quotes is easier with the same questions for every vendor. Ask each one these five.
- Which payments count as collections for the fee, and do patient payments count?
- Which services cost extra, and what does each one cost?
- Is there a setup fee, a minimum monthly fee or a termination fee?
- What was the net collection rate and days in A/R for eye care clients last year?
- How much notice is needed to end the contract, and how is data returned?
The same questions belong on any checklist for choosing a billing partner.