Not all outsourced billing is priced the same way, and the pricing model quietly shapes how the work gets done. The two most common structures — per-claim (or a percentage of collections) and flat full-service RCM — create very different incentives for the company you hire.
Per-claim and percentage-of-collections.
In a per-claim model you pay for each claim submitted; in a percentage model you pay a cut of what the biller collects. Both sound aligned — the biller only earns when claims go out or money comes in — but the incentives are narrower than they look. A per-claim biller is paid to submit, not necessarily to chase the hard denials or work the aged AR that takes real time. A percentage model rewards collecting the easy money, and can make a biller reluctant to spend an hour on a small, stubborn claim.
Flat full-service RCM.
A flat model charges one predictable fee for the whole revenue cycle, regardless of claim volume or how hard a given claim is to collect. Because the fee doesn't change, the incentive is simply to keep the cycle clean and complete — verify early, file same-day, appeal every winnable denial, and work every bucket of the aging, including the unglamorous 90+ claims a percentage model might quietly abandon.
What you're really buying.
Per-claim pricing buys claim submission. Full-service RCM buys ownership of the number — verification, coding, submission, posting, denials, appeals, and AR, run as one operation with someone accountable for the result. For most practices, the second is what they actually wanted when they said they needed "billing help."
Predictability matters too.
A flat fee is a line item you can budget; a percentage of collections rises exactly as your practice grows, taxing your own success. ZenHub runs on a flat monthly model — no per-claim charge, no percentage of collections — precisely because it aligns our work with your whole revenue cycle, not just the parts that are easy to bill. See what a full cycle includes in our guide to outsourced dental billing.