Subject: Written billing quote for our small practice

Hello,

We are comparing billing services and would like a written quote.

About our practice
- Specialty and care setting: [ ]
- State(s): [ ]
- Number and type of clinicians, including any supervised clinicians: [ ]
- EHR / practice software we use now: [ ]
- We want to: [keep our software / look at new software]
- Who does our billing today: [ ]
- Insurance payments we receive in a normal month: about $[ ]
- Patient payments we receive in a normal month: about $[ ]
- Claims we send in a normal month: about [ ]
- The work we most need help with: [ ]
- When we want to start: [ ]

Please answer in writing:

1. Your fee. Is it a percentage, a flat price, per claim, or a mix? What money does a percentage apply to: all eligible collections, or insurance payments only? Explain front-desk payments, self-pay, refunds, and any excluded service dates. For per-claim pricing, define the billable unit and whether resubmissions cost extra.
2. Your monthly minimum. Is it per practice, per clinician, or per location? If it applies separately to each clinician, please show the calculation for each clinician rather than only a combined practice total.
3. Every other charge: clinician or seat fees, setup, software, clearinghouse, statements, eligibility checks, training, and anything else. Please mark what is not included, when each fee starts, and any annual-prepayment commitment.
4. Can we keep our current software? If yes, how does your team work in it?
5. Who does each job: choosing codes, entering charges, fixing rejected claims, working denials and appeals, prior authorizations, posting payments, patient statements, and patient phone calls?
6. Credentialing and payer enrollment. Is it included, extra, or ours to do? How are included applications counted across providers, payers, and states?
7. Unpaid claims from before you start. Will you work them, and at what fee?
8. Contract length, notice to cancel, and any automatic renewal.
9. What we owe if we leave, how long you keep working claims after notice, and how and when we get our data out.
10. A copy of your service agreement, order form and incorporated terms, and your business associate agreement (BAA).

Please show what we would pay each month at $[lower amount] and at $[normal amount] in collections, and list one-time charges separately. Please confirm that the proposed fee structure is available for our state, profession, and payer mix.

We have not included any patient records. If you need records later, please tell us first how to put the BAA and secure transfer in place.

Thank you,
[Name, role, practice, email]