Top 10 Third Party Medical Billing Companies, Compared for 2026

Third party medical billing companies submit your insurance claims, post payments, and work the denials so your front desk can stay with patients. We’ve compared 10 of them for 2026 on fees, best fit, and caveats. You’ll also find the payment, contract, and data checks to run before you sign.

Disclosure:One O Seven RCM publishes this guide and ranks itself first. We scored all 10 companies, ourselves included, on the same seven criteria and checked our sources in October 2026. Any performance claim that comes only from the company gets a “self-reported” tag. Get three written proposals before you sign.

Among the 10 medical billing companies below, One O Seven RCM fits independent practices and groups that want full-service billing at 3% of monthly collections. If you’d rather have billing inside one software platform, look at AdvancedMD and athenahealth. R1 RCM suits hospitals and health systems.

What Is a Third Party Medical Billing Company?

A third party medical billing company is an outside firm your practice hires to code, submit, and follow up on insurance claims and patient balances. Medicare and commercial payers still pay your practice, in your practice’s name, and the billing company earns a fee.

You’ll also hear these firms called 3rd party billing companies or third party billing services. Most cover the back half of revenue cycle management: claims, payment posting, denials, and AR follow-up. Coding, eligibility checks, and credentialing vary more. Compare those three line by line before you sign.

The AMA’s guide to billing vendors describes the role the same way: a vendor can “manage invoicing, collect payments” and handle claims submission. That’s the core of medical billing outsourcing. HIPAA’s business associate definition covers billing, so you’ll sign a business associate agreement (BAA) before any patient data changes hands.

With third party medical billing, you add one more outside company to each claim. It’s easy to mix up third party medical billing companies with the payers and plan administrators on the other end of those claims.

Third Party Billing Company vs. Third-Party Payer vs. TPA

Your billing company works for your practice, and you pay its fee. A third-party payer is whoever pays the claim, such as Medicare, Medicaid, TRICARE, or Blue Cross Blue Shield, so yes, BCBS is a third-party payer. Third-party administrators, or TPAs, process claims for self-funded employer plans.

On a self-funded plan, the member’s card often lists the TPA under “administered by,” and your team sends claims to the TPA’s claims address.

How the five parties around a medical claim differ

Term	Who it works for	Who pays it	Example
Third party billing company	Your practice	Your practice, under contract	An outsourced billing and RCM firm
Third-party payer	Its members or beneficiaries	Premiums and taxes	Medicare, Medicaid, TRICARE, BCBS, UnitedHealthcare
Third-party administrator (TPA)	A self-funded employer plan	The employer	A firm that processes an employer plan’s claims
Clearinghouse	Your practice or its billing company	Per-claim or subscription fees	A service that checks and routes electronic claims; see medical billing clearinghouses
Billing software	Your in-house staff	Your practice, by subscription	A practice management system with a claims module

Medicare is the largest single payer in the US. Per CMS National Health Expenditure data, Medicare spent $1,118.0 billion in 2024, or 21% of national health spending, and Medicaid spent $931.7 billion, or 18%. Your payer contracts and fee schedules set your rates, and a medical billing company collects within them.

Top 10 Third Party Medical Billing Companies at a Glance

We ranked the top 10 medical billing companies in the USA for 2026 for independent practices and medical groups, using seven weighted criteria. Each row shows who the company suits, how it charges, how fast it starts, and which caveat you’ll want to raise before a demo.

Plenty of medical billing outsourcing companies in the USA sound alike on a sales call. We kept the table to facts you can check, with prices from company websites or Business News Daily (BND) reviews, checked October 2026. Ask each company to put its rate and start date in writing.

The 10 companies compared, as of October 2026

#	Company	Best for	Model	Pricing	Go-live	Not ideal for
1	One O Seven RCM	Independent practices and groups that want full-service medical billing	Service team inside your EHR	3% of monthly collections; small practices from 2.99% (company site)	First claims in under five business days on average (self-reported)	Practices that want billing software only
2	AdvancedMD	Independent practices that want practice management, EHR, and billing in one system	Software with optional managed billing	Managed billing about 4% to 8% of monthly collections (company site)	First charge entry defaults to 60 days after contract start (company site)	Practices keeping a different EHR or wanting month-to-month terms
3	athenahealth	Large practices, federally qualified health centers (FQHCs), and multi-specialty groups	Cloud platform plus services	About 4% to 7% (BND, 2025); can reach low double digits (BND, 2026)	About 11 weeks (BND, 2025)	Practices keeping their current EHR
4	CareCloud	Mid-size practices that want to keep their EHR	Services with an optional platform	About 3% to 7% of collections (BND, 2026)	60 to 80 days (BND, 2026)	Practices that want short contracts; may require three years (BND, 2026)
5	Tebra	Solo and small practices that want software plus a partner biller	Software plus partner billing companies	Not published	Three to four weeks for most practices (self-reported)	Practices that want Tebra’s own staff to do the billing
6	Transcure	Practices that want billers working inside their current EHR	Service team inside your EHR	3% to 5% of monthly collections (company site)	Not published	Practices that want a new EHR bundled with billing
7	R1 RCM	Hospitals and health systems	Enterprise RCM	Not published	Not published	Independent practices
8	GeBBS Healthcare Solutions	Large groups and hospitals	Global outsourcing team	Not published	Not published	Practices that need US-only staff
9	Omega Healthcare	High-volume organizations	Global outsourcing team	Not published	Not published	Small and mid-size practices
10	Anesthesia Business Consultants	Anesthesia and pain management groups	Specialty billing service	Not published	Not published	Other specialties

If You Only Shortlist Five

Most independent practices can start with five calls to these top medical billing companies: One O Seven RCM, AdvancedMD, athenahealth, CareCloud, and Tebra. Between them, the five cover both models you’ll meet: full outsourcing and software with managed or partner billing.

How We Ranked These Billing Companies

We ranked all 10 third party medical billing companies on the same seven criteria, weighted toward what independent practices feel first: cost, fit, and control. Each placement rests on named sources we checked in October 2026.

Our seven ranking criteria and their weights

Criterion	Weight	What we checked	Evidence we accepted
Pricing transparency	20%	Published fee model, range, and exclusions	Pricing page or written quote
Fit for independent practices	20%	Practice sizes and specialties served	Service pages and named case studies
Contract and exit terms	15%	Term length, notice period, and return of data	Published terms or a sample contract
Compliance and security	15%	BAA, HIPAA program, SOC 2 or HITRUST, and a compliance program built on HHS Office of Inspector General (OIG guidance)	Certificates and published policies
Speed to go-live	10%	Days from signed agreement to first claims	Published onboarding timeline
Proof of results	10%	Metrics with a stated period and formula, such as net collection rate, plus review counts on independent platforms	Dated reports, named clients, and platform pages
Staffing and delivery model	10%	US-based, blended, or offshore teams; billing and coding credentials, such as AAPC’s CPB or CPC	Company disclosures

Many medical billing outsourcing companies publish a clean claim rate. We counted a reported rate only when the company named the time period and the formula. A rate from one good month can look far better than your remits.

Star ratings without review counts earned no points, and we tag a company’s claims about its own performance as “self-reported.”

Medical billing companies don’t all say where their teams sit. Offshore medical billing companies can work well, but you should know where their staff access patient data. Ask which subcontractors have signed a business associate agreement with the company. We flag disclosed offshore teams on the company’s card.

Our own team wrote these criteria and ranks One O Seven RCM first, so we’ve published every weight. You can score any company yourself, us included, and build your own ranking.

The 10 Best Third Party Medical Billing Companies, Reviewed

Each review uses six fixed labels, so you can compare third party medical billing companies on equal terms. Seven are outsourced medical billing companies. Three sell software with managed or partner billing. Among the best medical billing companies, you’ll choose by size and specialty.

1. One O Seven RCM: Best Overall for Independent Practices and Groups

One O Seven RCM is best overall for independent practices that want a full-service medical billing company on month-to-month terms. As a third party medical billing company headquartered in Fulshear, Texas, it handles revenue cycle management in all 50 states inside your existing EHR.

One O Seven RCM at a glance, as of October 2026

Label	Details
Best for	Solo practices to 50+ provider groups that want full revenue cycle management
Pricing	3% of monthly collections, no setup fee; small practices from 2.99%; credentialing from $107 per payer (company site)
Not ideal for	Practices that want software to run billing in-house
Go-live	Onboarding within 48 hours for most; first claims under five business days on average (self-reported)
Proof point	Month-to-month terms, 30-day notice, no setup fee or cancellation penalties (company site)
Ownership	Privately held (Pvt. Ltd.); headquartered in Fulshear, Texas (company)

Ask us: What will my first 90-day claims review show, and which metric will you report to me each month?

See what’s included in our medical billing services, or read about One O Seven RCM’s team before you book a call.

2. AdvancedMD: Best for Independent Practices on One Unified System

AdvancedMD is best for independent practices that want scheduling, charting, and billing in one cloud system, plus the option of AdvancedMD’s own billing team.

AdvancedMD at a glance, as of October 2026

Label	Details
Best for	Independent and multi-provider practices using AdvancedMD software
Pricing	Managed billing about 4% to 8% of monthly collections (company site)
Not ideal for	Practices keeping another EHR or needing month-to-month terms; 12-month initial term (company site)
Go-live	First charge entry defaults to 60 days after contract start (company site)
Proof point	Claim Inspector scrubs claims; the company guarantees at least 95% first-pass acceptance (self-reported)
Ownership	Francisco Partners, after Global Payments sold it in December 2024 (SEC filing)

Ask them: Which claims does the 95% guarantee cover, and what happens if you miss it?

3. athenahealth: Best for Multi-Specialty Groups on One Cloud Platform

athenahealth is best for large practices, FQHCs, and multi-specialty groups that want EHR, billing, and patient engagement on one network-based platform.

athenahealth at a glance, as of October 2026

Label	Details
Best for	Large practices, FQHCs, and multi-specialty groups
Pricing	About 4% to 7% (Business News Daily, 2025); low double digits possible (BND, 2026)
Not ideal for	Practices that want to keep their current EHR
Go-live	About 11 weeks for implementation (BND, 2025)
Proof point	170K+ clinicians on its network, as of September 2025 (self-reported)
Ownership	Bain Capital and Hellman & Friedman, since February 2022 (company release)

Ask them: Who works my old AR during the switch, and what does that cost?

4. CareCloud: Best for Mid-Size Practices Keeping Their EHR

CareCloud is best for mid-size practices that want outsourced billing without leaving the EHR they already use.

CareCloud at a glance, as of October 2026

Label	Details
Best for	Mid-size and multi-location practices
Pricing	About 3% to 7% of monthly collections (Business News Daily, 2026)
Not ideal for	Practices wanting short terms; may require a three-year contract (BND, 2026)
Go-live	60 to 80 days (BND, 2026)
Proof point	RCM can integrate with your existing EHR or practice management system (self-reported)
Ownership	Public company (Nasdaq: CCLD), formerly MTBC (investor site)

Ask them: What’s the contract term, and what does it cost to leave early?

5. Tebra: Best for Solo and Small Independent Practices

Tebra is best for solo and small independent practices that want practice software plus a matched partner billing company.

Tebra at a glance, as of October 2026

Label	Details
Best for	Solo providers and small independent practices
Pricing	Not published (company site)
Not ideal for	Practices that want Tebra’s own staff to do the billing
Go-live	Most practices go live within three to four weeks (self-reported)
Proof point	Exited its own billing service; matches practices with partner billers (company site)
Ownership	Private; Hildred led its December 2025 funding round (Business Wire)

Ask them: Which partner biller will I get, and whose contract governs my data?

6. Transcure: Best for Billing Layered Over Your Current EHR

Transcure is best for practices that want an outsourced billing team working inside their existing EHR for a percentage of collections.

Transcure at a glance, as of October 2026

Label	Details
Best for	Practices that want to keep their EHR and outsource billing
Pricing	3% to 5% of monthly collections (company site)
Not ideal for	Practices that want a new EHR bundled with billing
Go-live	Not published
Proof point	1,100+ certified billers and coders; 40+ specialties; works in 40+ EMRs (self-reported)
Ownership	Not published; operating since 2002 (company site)

Ask them: Can I speak with two current clients in my specialty?

7. R1 RCM: Best for Hospitals and Health Systems

R1 RCM, listed here among the top RCM companies in the USA, is best for hospitals and health systems outsourcing revenue cycle work at scale.

R1 RCM at a glance, as of October 2026

Label	Details
Best for	Hospitals, health systems, and hospital-owned physician groups
Pricing	Not published; custom enterprise contracts
Not ideal for	Independent and small practices
Go-live	Not published
Proof point	Works with 95 of the top 100 US health systems (self-reported)
Ownership	TowerBrook and Clayton, Dubilier & Rice took it private, November 2024 (company release)

Ask them: Can we start with one function, such as denials, before a full transfer?

8. GeBBS Healthcare Solutions: Best for Large Groups Wanting a HITRUST-Certified Global Team

GeBBS Healthcare Solutions is best for large groups and hospitals that want a HITRUST-certified global team for coding and billing.

GeBBS Healthcare Solutions at a glance, as of October 2026

Label	Details
Best for	Large groups, hospitals, and health systems
Pricing	Not published
Not ideal for	Practices that need US-only staff
Go-live	Not published
Proof point	HITRUST CSF and SOC 2 Type 2 certified (self-reported)
Ownership	EQT portfolio company; teams in the US, India, Dominican Republic, Philippines (company site)

Ask them: Which countries will staff access my PHI from, and which subcontractors have signed a BAA with you?

9. Omega Healthcare: Best for High-Volume Organizations

Omega Healthcare is best for high-volume organizations that want a global delivery team for high claim volume.

Omega Healthcare at a glance, as of October 2026

Label	Details
Best for	Hospitals and large physician groups with high claim volume
Pricing	Not published
Not ideal for	Small and mid-size practices
Go-live	Not published
Proof point	About 35,000 staff in the US, India, Colombia, and the Philippines (self-reported)
Ownership	Goldman Sachs Alternatives and Ontario Teachers’ lead; Everstone holds a stake (company release)

Ask them: What will I pay per claim at my volume?

10. Anesthesia Business Consultants: Best for Anesthesia and Pain Management Only

Anesthesia Business Consultants is best for anesthesia and pain management groups that want a billing team working only in those specialties.

Anesthesia Business Consultants at a glance, as of October 2026

Label	Details
Best for	Anesthesiology, CRNA, and pain management practices
Pricing	Not published
Not ideal for	Practices outside anesthesia and pain management
Go-live	Not published
Proof point	Anesthesia billing since 1979 (company site)
Ownership	A Coronis Health company; current investors not named (company site)

Ask them: How do you bill medical direction and concurrency for CRNAs?

If you can’t tell which of these fits, start with a free 90-day billing audit. We’ll review 90 days of your claims and show you what’s driving your denials, with zero obligation.

What Third Party Medical Billing Companies Do, Step by Step

Third-party medical billing companies take over the work between the visit and the deposit: medical coding, claims management, denial management, and patient billing. Your providers still document care, and payers still pay your practice. Follow one claim from your chart to your bank account in seven steps.

1. Your front desk, or the company’s eligibility and prior authorization team, verifies coverage ahead of the visit, so you’ll catch a lapsed policy before the patient’s in the exam room.
2. Certified coders read your provider’s note and assign the CPT, HCPCS, and ICD-10-CM codes it supports.
3. The billing company builds the claim on the CMS-1500 or its electronic twin, the 837P, scrubs it for errors, and sends it through a clearinghouse.
4. Your payer adjudicates the claim and returns an electronic remittance advice (ERA), the 835, showing what it paid, adjusted, or denied.
5. Payment arrives by electronic funds transfer (EFT) in your practice’s bank account. For Medicare, that account must carry your name.
6. The billing team posts the payment, handles denial management and appeals, and bills the patient for any balance left over.
7. Each month, the company invoices its fee, most often a percentage of collections or a flat rate per claim.

Those seven steps make up end-to-end medical billing services, though some companies stop once the claim goes out at step three. Claims-only service often costs less, but you’ll still handle payment posting, denials, and AR follow-up in-house. Scope varies by contract, so confirm which steps sit inside the price before you compare quotes.

Which of the 12 RCM Steps Stay With Your Front Desk

Outsourced medical billing services cover the claim side of the common 12-step model of revenue cycle management. Scheduling, pre-registration, check-in, and point-of-service collections stay with your front desk, while the billing company handles everything from claim scrubbing through AR follow-up.

Who owns each of the 12 revenue cycle steps in most contracts

Step	Usual owner	What the contract should say
1. Patient scheduling	Practice	Who updates demographics when they change
2. Pre-registration	Practice	Which fields your staff must complete before the visit
3. Eligibility and benefits verification	Shared	Who checks, and how many days before the visit
4. Prior authorization	Shared	Who requests it and who tracks expiration dates
5. Registration and check-in	Practice	Who scans insurance cards and photo IDs
6. Point-of-service collections	Practice	Who sets copay and estimate rules
7. Charge capture	Practice, reviewed by the billing company	Daily reconciliation of charges against the schedule
8. Medical coding	Billing company, if your contract includes coding	Coder credentials and the internal audit rate
9. Claim generation and scrubbing	Billing company	Which edits run before submission
10. Claim submission	Billing company	Maximum days from charge entry to submission
11. Payment posting	Billing company	ERA and EFT enrollment in the practice’s name
12. Denial management and AR follow-up	Billing company	Follow-up cadence and appeal deadlines

Third party medical billing works best when you write this split into the contract. In practice, disputes often start with a step each side thought the other owned, such as an authorization that expired between referral and visit.

How Much Do Third Party Billing Companies Charge?

Most third party medical billing companies charge a percentage of what they collect for you. Business News Daily reported typical rates of about 3% to 9% of monthly collections in its 2025 roundup. Others charge a per-claim fee or a flat monthly fee.

The four common pricing models

Model	How it works	Fits	Watch for
Percentage of collections	A set percentage of what the company collects each month	Most practices; cost follows cash	What counts as a collection, and what’s excluded
Per-claim fee	A flat dollar amount per claim submitted	High-volume, low-dollar claims	Charges for resubmitted and denied claims
Flat monthly fee	A fixed price, often per provider	Practices that want a fixed budget	Volume caps and overage pricing
Hybrid	A base fee plus a smaller percentage	Practices adding services in stages	Two invoices that are hard to compare

At $1 million a year in collections, a 3% fee costs $30,000, and a 9% fee costs $90,000. One O Seven RCM charges 3% of monthly collections, so a practice collecting $80,000 a month pays $2,400.

If you’re hunting for an affordable billing company, compare each quote’s total cost. We’ll put your current setup next to 3% full-service billing, fee by fee.

Where Your Medicare and Medicaid Payments Must Land

Medicare and Medicaid payments should land in an account in your practice’s name. Under 42 CFR 424.73 and 424.80, Medicare pays a billing agent only if the agent’s fee bears no relation to the dollars billed or collected. For Medicaid, 42 CFR 447.10 sets the same rule.

A company you pay by percentage shouldn’t receive your Medicare or Medicaid payments. CMS’s Medicare Claims Processing Manual (Chapter 1, §30.2.5) requires an account in the provider’s name only, and only the provider may instruct the bank. You’ll see the same rule on the CMS-588 EFT form: the account must bear your name.

None of this is legal advice, so have your healthcare attorney review the payment terms in any billing contract before you sign.

Costs That Sit Outside the Percentage

Costs outside the percentage often include setup, clearinghouse, patient statement, and credentialing fees. Before you compare quotes for medical billing services, ask each company to price these seven items in writing:

• Setup or onboarding fees
• Clearinghouse charges per claim
• Patient statement printing and postage
• Credentialing, billed per provider and per payer
• Old AR cleanup, often at a higher percentage
• Custom reports or extra software seats
• Fees on claims paid after you leave

One O Seven RCM doesn’t charge setup fees or a monthly retainer, and its 3% rate covers claim scrubbing, denial management, and payer follow-up. Credentialing starts at $107 per payer, and that price includes CAQH setup and maintenance.

In-House Billing vs. Outsourcing: The Full Cost

In-house billing costs more than one salary, and outsourcing swaps that cost for a percentage fee. The Bureau of Labor Statistics (BLS) puts the median pay for medical records specialists, the closest BLS category, at $51,140 a year as of May 2025. On top of that, you’ll pay for benefits, software, clearinghouse fees, training, and vacation coverage.

What you pay for either way

Cost	In-house	Outsourced
Staff pay	Median $51,140 per specialist (BLS, May 2025), plus benefits	Inside the fee
Software and clearinghouse	Your practice pays	Often inside the fee; confirm
Vacations and turnover	AR stalls until someone covers	The company covers the work
Coding audits and training	Extra cost	Often included; confirm

For scale, the $51,140 median salary alone equals a 3% fee on about $1.7 million in yearly collections. At a 9% fee, it matches about $568,000. Price the whole job at your own volume before you decide.

Pros and Cons of Hiring a Third Party Billing Company

Hiring an outside billing team trades some daily control for specialist depth and steadier cash flow. The AMA’s March 2025 guide lists the trade-off: staff time and current coding knowledge as pros, and cost, data security, and loss of control as cons.

• Time: your staff stops chasing payers and gets back to patients.
• Expertise: certified coders track payer and code changes as their full-time job.
• Cash flow: a dedicated team works denials and aging claims on a set schedule.
• Coverage: another biller picks up your AR when your assigned biller quits or goes on leave.
• Reporting: you see denial, AR, and collection numbers every month.

Each con and the control you keep

Con	The control you keep
Hidden fees	Have the company price every exclusion in writing
Variable cost	Model the fee against 12 months of collections, including your slowest month
Less direct control	Keep EFT, ERA, payer portal, and clearinghouse admin rights in your practice’s name
Data security risk	Sign a BAA with every required term before you share patient records
Lock-in	Choose month-to-month terms or a written performance exit

You can close most outsourcing risks in the contract. A good medical billing company will help you draft that contract language before it asks for your data. Hold all third party medical billing companies on your shortlist to the same five controls.

Five Signs Your Practice Is Ready to Outsource

Your practice is ready to outsource once billing problems cost more than fixing them would. Watch for these five signs:

• Your AR aging report shows more dollars past 60 days each month.
• Denials keep rising, and no one on staff has time to find the root cause.
• Charges sit unbilled for days after the visit.
• One person holds all the billing knowledge, and their vacation stalls cash.
• Patient volume is up, but collections are flat.

In a November 2024 MGMA Stat poll, 36% of medical groups said they planned to outsource or automate part of their revenue cycle in 2025. If three of these signs sound familiar, find out what it would cost to outsource medical billing at your volume.

Best Fit by Practice Size and Specialty

The right billing company for your practice depends on how many providers you have and your primary specialty. We’ve mapped the 10 third party medical billing companies by practice type and specialty, with the One O Seven RCM page for each.

Companies to shortlist by practice type

Practice type	Companies to shortlist	One O Seven RCM page
Solo provider	One O Seven RCM, Tebra (partner billers)	private practice billing
Small practice, 2 to 5 providers	One O Seven RCM, Tebra, AdvancedMD	medical billing for small practices
Group practice, 6 to 50+ providers	One O Seven RCM, athenahealth, CareCloud	group practice billing
Multi-specialty clinic	athenahealth, One O Seven RCM, Transcure	multi-specialty clinic billing
Hospital or health system	R1 RCM, GeBBS, Omega Healthcare	hospital revenue cycle management

Search “outsource medical billing companies” and you’ll find firms that serve several sizes. Each has a sweet spot, so match your practice to it. Then check claim type. Hospitals need hospital billing companies that work UB-04 facility claims, while physician billing companies work CMS-1500 professional claims.

Specialty narrows the list further. Anesthesia groups should start with Anesthesia Business Consultants; behavioral health, therapy, and surgical practices need coders who know each specialty’s time rules and modifiers. One O Seven RCM covers 75+ specialties through its specialty medical billing services. Ask medical billing companies for two references at your size.

Companies list their specialties on their sites, so check each finalist’s list for your exact specialty and subspecialty. Multi-specialty groups should count how many of their claims fall outside their main specialty. Take your two or three finalists into the seven checks below.

How to Choose a Medical Billing Company: 7 Checks Before You Sign

To choose a medical billing company, start with your own numbers, then hold every finalist to the same seven checks. Six of them tie to a federal rule, a state rule, or official guidance, so you can verify the answer instead of trusting the pitch.

1. Know your baseline. Pull 90 days of denial rates by denial code, days in AR by payer, and monthly claim volume. Bring the same numbers to every demo. If you can’t pull them yourself, start with a 90-day claims review before you book any demos.
2. Read the BAA before the price. Under 45 CFR 164.504(e), your HIPAA business associate agreement must cover permitted uses, safeguards, breach reporting, and the same terms for subcontractors. A single vendor breach can reach millions of patients: as of July 2025, Change Healthcare’s breach affected about 192.7 million people, per HHS.
3. Keep the money in your name. EFT and ERA enrollments stay in your practice’s name, and so does the bank account. A company that asks to route payments through its own account fails this check, however good its rate looks.
4. Grant access; don’t share logins. Your Authorized Official can approve a billing company as your Surrogate in PECOS through CMS’s Identity & Access system, so no password changes hands. Remove that access the day a contract ends, and keep your practice as the admin on every payer portal.
5. Get the overpayment process in writing. Under 42 CFR 401.305, you must report and return a Medicare overpayment within 60 days after you identify it. Ask how fast the company flags one to you, and who records each overpayment and the date its team found it.
6. Check your state’s rules. New Jersey’s Department of Banking and Insurance (DOBI) certifies billing services and publishes the certified list. Its February 2026 consent order, E26-26, set a $10,000 penalty across three respondents after one company billed there uncertified from 2017 to 2022. Texas Medicaid requires billers to enroll as Third Party Billing Vendors under Section 5.2(f).
7. Ask for credentials and a compliance program. Look for coders and billers who hold an AAPC CPC or CPB, or an AHIMA CCS. The company’s compliance program should follow the seven elements in the OIG’s 1998 guidance for third-party billing companies.

For interview questions beyond these seven, see our guide to choosing a billing partner.

If a third party medical billing company stalls on any of these checks, expect the same pace on your claims. Send the seven checks to all the third party medical billing companies on your shortlist, and get the answers in writing.

Ask One O Seven RCM for written answers to all seven checks and a sample BAA. We’ll send them before you sign anything.

Contract Terms and Exit Clauses to Read Twice

Read the term, exit, and data clauses before you compare fees. Some third party medical billing companies set a 12-month initial term, and others may ask for three years. Medical billing contracts can also renew on their own if you don’t give written notice inside a set window.

Six contract clauses: what good looks like and the red flag

Clause	What good looks like	Red flag
Term and renewal	Month-to-month, or a fixed term with a written performance exit	Automatic renewal with a short notice window
Termination notice	30 days, for any reason	90 days or more, or exit only for cause
Post-termination fees	None, or a short, capped run-out period	A percentage of every dollar you collect after exit
Data return	Claims, AR, denials, payer notes, and 835 remittances in a standard export format	The company holds data until you pay disputed fees
Open claims at exit	A written plan naming who works them and for how long	No one works open claims after the exit date
Performance terms	Named performance metrics with formulas and a monthly report	Promises of results with no numbers attached

Under 45 CFR 164.504(e), your business associate agreement must require the billing company to return or destroy your patients’ data at termination, where feasible. It must also let you end the contract if the company breaks a material term. The company can meet the BAA by destroying your data, so put export terms in the service contract.

For comparison, One O Seven RCM works month-to-month with 30 days’ notice and no cancellation penalty. Ask each third party billing company you’re considering for a sample contract. Check its exit terms, then put the renewal notice deadline on the practice calendar.

How to Switch Billing Companies Without a Cash Gap

If you outsource medical billing and want to switch, pick a cutover date of service and keep both companies working until the old claims clear. Third party billing companies hand off without gaps when you spell out in the contract who works which claims and when access ends.

1. Before notice: pull your data. Export AR aging, open claims, credit balances, denials, payer correspondence, and fee schedules while you’re still on good terms. Under your BAA, the old company can destroy patient data instead of returning it, so keep your own copy.
2. In your notice: set the cutover by date of service. The old company works every claim dated before the cutover, and the new company takes everything after. Put the run-out period, its fee, and ERA forwarding in writing.
3. Before cutover: update ERA routing and clearinghouse enrollment. Notify your Medicare Administrative Contractor (MAC) or CEDI in writing before your billing agent or clearinghouse changes, per Medicare’s Claims Processing Manual, Chapter 24 (§30.4). Leave EFT alone, since it’s in your practice’s name.
4. On cutover day: swap access. Remove the old company’s Surrogate access in CMS’s Identity & Access system, add the new company, and update Section 8 of your CMS-855I or CMS-855B. Texas Medicaid providers have five working days to report the change.
5. After cutover: watch timely filing. Medicare allows one calendar year from the date of service under 42 CFR 424.44, and many commercial payers allow less. Check claims older than 60 days every week for the first 90 days.

If your outgoing company leaves claims past 90 days, our aged AR recovery team can work them while your new company bills current visits.

What’s Changing for Billing Companies in 2026 and 2027

Six rule changes hit billing in 2026 and 2027. In January 2026, CMS-0057-F decision deadlines took effect for Medicare Advantage (MA), Medicaid, and CHIP plans. CMS also launched the WISeR model, adding prior authorization for selected Original Medicare services in six states. Third party medical billing companies should now track both.

Rule changes that affect your billing, as of October 2026

Date	What changed	What to ask your billing company
January 1, 2026	MA, Medicaid, and CHIP plans: decisions in 72 hours (expedited) or seven calendar days	Do you track decision dates by payer?
January 1, 2026, to December 31, 2031	WISeR: prior authorization for selected Original Medicare services in AZ, NJ, OH, OK, TX, WA	Which of our services are on the WISeR list?
March 31, 2026	First public prior authorization metrics due from MA, Medicaid, and CHIP payers	Do you compare payer metrics with our denial rates?
October 1, 2026	FY2027 ICD-10-CM codes took effect	Did you remove deleted codes from our templates?
January 1, 2027	MA, Medicaid, and CHIP payers must run Prior Authorization, Provider Access, and Payer-to-Payer APIs	How will you connect to payer APIs?
July 2027 (Unified Agenda target)	HIPAA Security Rule update, which HHS proposed in January 2025, is still pending	Does our BAA cover current security safeguards?

In a September 2026 MGMA Stat poll of 178 medical group leaders, 44% said prior authorization turnaround got slower. Only 7% saw it get faster. Put prior authorization tracking in your revenue cycle management contract, with a named owner and a monthly report.

CMS-0057-F’s 72-hour and seven-day deadlines don’t cover Original Medicare or exchange plans. Ask third-party medical billing companies how they’ll handle each date in the table above, and listen for a person, a report, and a deadline. Our prior authorization guide covers your side of the desk.

Third Party Medical Billing Companies: Frequently Asked Questions

What are the top 10 medical billing companies?

Our 2026 list of the top 10 medical billing companies is One O Seven RCM, AdvancedMD, athenahealth, CareCloud, Tebra, Transcure, R1 RCM, GeBBS Healthcare Solutions, Omega Healthcare, and Anesthesia Business Consultants. We ordered them by seven weighted criteria, with cost and fit weighted highest. If you run a hospital or health system, you’d start with R1 RCM.

Which medical billing company is the best in the USA?

The best billing company depends on your size and specialty. Among the third party medical billing companies we compared, One O Seven RCM ranks first for independent practices and groups, R1 RCM fits hospitals and health systems, and Anesthesia Business Consultants fits anesthesia groups. We publish this list, so you’ll find our scoring under “How We Ranked These Billing Companies.”

How does 3rd party medical billing work?

Your provider documents the visit, the billing company assigns codes and submits the claim, and the third-party payer pays your practice. Medicare still deposits into an account in your name only. The company then posts the payment, works any denial, bills the patient for the balance, and invoices its fee, most often a percentage of what it collects.

What is the golden rule of third-party billing?

The golden rule of third-party billing is “If it isn’t documented, it didn’t happen.” A billing company can bill only what the medical record supports, so an unsigned note or missing visit time means no claim. HHS’s Office of Inspector General lists billing for undocumented services as a risk area in its 1998 guidance for third-party billing companies.

Is AI replacing medical billers?

No, AI isn’t replacing medical billers. AI tools handle eligibility checks, claim scrubbing, and payment posting, while people work appeals, payer calls, and coding judgment. In the AMA’s 2026 physician survey, 28% of physicians said they use AI for billing codes, charts, or visit notes. BLS projects 8% growth from 2025 to 2035 for medical records specialists, a related occupation.

Do 3rd party medical billing companies need a license?

We found no federal license for 3rd party medical billing companies, but some states and Medicaid programs regulate them. New Jersey requires state certification. Texas Medicaid requires billers to enroll as Third Party Billing Vendors, and California’s Medi-Cal enrolls billing intermediaries. For Medicare, you list your billing agency in Section 8 of your CMS-855I or CMS-855B.

Can I keep my EHR if I outsource billing?

Yes, in most cases you can keep your EHR. Service-led companies, One O Seven RCM included, work inside your EHR, so your providers keep their templates and workflows. Software-led vendors such as athenahealth and AdvancedMD may ask you to move to their platform. Ask before you sign, and see how our outsourced RCM services fit the system you’re using.

The Next Step for Your Practice

Narrow your list to three third party medical billing companies, send each one the seven pre-signing checks, and compare the written answers side by side.

If One O Seven RCM makes your list, our pricing is public. As of October 2026, One O Seven RCM charges 3% of monthly collections for full-service billing and from 2.99% for small practices, with credentialing from $107 per payer. Once you’re ready, talk to our billing team.

Sources

We checked every source below in October 2026. Company facts come from each company’s own website or the press source named in the text, and we don’t link to companies.

Government and regulation

• CMS, National Health Expenditure Fact Sheet
• CMS, Medicare Claims Processing Manual, Chapter 1 and Chapter 24
• CMS-588 EFT Authorization Agreement and CMS-855I
• CMS, Interoperability and Prior Authorization Final Rule (CMS-0057-F)
• CMS, WISeR Model and ICD-10 code sets
• CMS, Identity & Access Quick Reference Guide
• eCFR: 42 CFR 401.305, 42 CFR 424.44, 42 CFR 424.73, 42 CFR 447.10, 45 CFR 160.103, and 45 CFR 164.504
• HHS OCR, Change Healthcare Cybersecurity Incident FAQ
• HHS OIG, Compliance Program Guidance for Third-Party Medical Billing Companies (63 FR 70138)
• Unified Agenda, HIPAA Security Rule (RIN 0945-AA22)
• BLS, Occupational Outlook Handbook: Medical Records Specialists
• New Jersey DOBI: third party billing services, certified list, and Order E26-26
• Texas HHSC, Medicaid Provider Agreement F00110
• California DHCS, Medi-Cal Provider Guidelines

Associations

• AMA, Third-party billing vendors can boost private practice (March 2025)
• AMA, 2026 physician survey on AI (March 2026)
• AAPC, Certified Professional Biller (CPB)
• MGMA Stat polls: November 2024 and September 2026

Company and press sources (named, not linked)

• Each company’s own website, checked October 2026
• Business News Daily, “The Best Medical Billing Services” (updated September 22, 2025), plus its CareCloud and athenahealth reviews (April 2026)
• Global Payments annual report (AdvancedMD sale), R1 RCM newsroom, GeBBS and EQT releases, Omega Healthcare newsroom, and Tebra’s December 2025 funding release

What Changed

• October 2026: Published. We checked pricing, ownership, and rule dates on October 4 and 5, 2026.