Rheumatology billing services: compare companies and costs

A rheumatology billing service files your claims, fights your denials, and posts your payments. Four of the five companies below say they charge a percentage of what you collect. The fifth does not publish pricing on the page we reviewed.

Before you compare those percentages, ask each company one question: is your fee charged on our drug payments too?

Here is why it matters. Medicare sets the payment limit for most separately paid Part B drugs at the average sales price plus 6%. A 2% budget cut called the sequester reduces Medicare's share. With the deductible met and the full 20% patient share collected, that leaves about 4.3% over the average price. If you bought the drug at that price and a billing company takes 5% of the payment, its fee is bigger than your whole markup. Some drugs, including biosimilars, use a different formula; the details are below.

Don't buy and bill drugs? Then your list is shorter: the rate, the monthly minimum, and who does which jobs. This page covers both kinds of practice.

Sources checked October 6, 2026. The company links on this page are unpaid. We compare what companies publish. We have not tested their billing. How we make money.

Compare the five companies

Compare my quotes

A quick example. One practice, two made-up quotes. Quote A charges 4% on everything and costs $16,800 a month. Quote B charges 6% on services and 1% on drug payments and costs $10,200. The quote with the higher headline rate is $6,600 a month cheaper. See the math.

Rheumatology billing companies compared

How we chose these five. We looked for billing companies with a public page about rheumatology. We kept the ones that say something concrete about price or about billing for infusion drugs. We left out pages that had neither. The list is in alphabetical order. It is not a ranking, and it is not every company out there.

"Not stated" means we did not find it on the pages we read. It does not mean the company can't do it. It means you have to ask.

Three things stand out.

1. No company says in plain words whether drug payments are in the fee. Medwave comes closest. Its pricing page says the fee is on everything collected. For the rest, you have to ask.
2. No company publishes a monthly minimum, a notice period, or exit charges on the pages we read. MedHeave says it does not use long-term agreements. That still leaves notice and exit terms open.
3. "As low as" and "4% to 7%" are not quotes. Your rate depends on your size and the work you hand over.

Several of these companies also post results numbers, like clean-claim rates or revenue gains. Those are each company's own claims. We did not find enough detail about the measures and client samples to compare those numbers fairly. Ask for the number for a rheumatology practice like yours, in writing.

Which one should you call first?

This is our read of what each company publishes. It is not a verdict on who does the best work.

• You run infusions and want to keep your EHR. Start with HRG and Medwave. Their pages describe specific infusion and drug-billing tasks, and both say they can work in an existing system.
• You want a published price to start from. MedHeave and BellMedEx each post a number. Neither number is a quote for your practice, and neither page describes infusion billing in detail. Ask about both.
• You mostly do office visits and joint injections, with little drug billing. Any of the five could fit. Compare the minimum, the rate, and the list of jobs included. MediBillMD's page speaks directly to visit-plus-injection billing.

Before you contact any of them, view the quote request. It asks each company for the same answers, in writing.

BellMedEx. Still unknown: your actual rate, the minimum, the contract term, and whether you can keep your EHR.

Healthcare Revenue Group. Still unknown: the price, what it is charged on, the minimum, and the contract term.

MedHeave. Still unknown: your exact rate, the minimum, the software setup, and its infusion experience. It lists credentialing at $250 per application.

MediBillMD. Still unknown: the rate, the minimum, the software setup, and the contract term.

Medwave. Still unknown: the rate, the rate on drug payments, the minimum, and the contract term.

What a fee on drug payments does to your cost

A billing fee is a rate times a pile of money. The rate gets all the attention. The pile matters more.

In a practice that buys and bills drugs, much of the pile can be drug payments. Those payments also have to cover what you paid for the drugs.

A worked example

These numbers are made up to show the math. They are not quotes from any company and they are not averages. Both quotes use the same collection amounts, with no monthly minimum or extra fees.

A practice collects each month:

• $120,000 for services (visits, procedures, and giving the drugs)
• $300,000 in payments for drugs it bought, which cost it $288,000

That leaves a drug margin of $12,000. "Drug margin" here means receipts minus acquisition cost for the same drugs. It is not net profit: it does not subtract staff time, storage, or other operating costs. Use payments actually received, not patient balances still owed.

Quote B has the higher rate on services. It still costs $6,600 less each month, or $79,200 less over a year. And Quote A's fee on drug payments uses up the whole $12,000 drug margin.

No drug payments? Then the picture flips. With $50,000 a month in service collections and nothing else, Quote A costs $2,000 and Quote B costs $3,000. There is no rate that is best for everyone.

Try it with your own quotes

Leave a box empty if you don't know the answer yet. The tool treats an empty box as unknown, not as zero, and tells you what to go ask. Confirm that both quotes use the collection amounts you enter. If a positive minimum has a different structure from the one the tool supports, ask the company for a written comparison instead of forcing it into the tool.

For an entirely flat monthly quote, enter 0% for both percentage rates and put the fixed fee under "Other monthly fees." Enter 0 for the minimum only if there is none. First-year figures assume the same collections and terms for all 12 months.

Why the Medicare number is so tight

For a drug paid at 106% of the average sales price, or ASP, here is what the standard Medicare fee-for-service calculation looks like per $100 of ASP. This example assumes the deductible is met, the usual 20% patient share is collected in full, and no other payment adjustments apply:

• Medicare pays 80% of $106. That is $84.80.
• The patient owes the other 20%. That is $21.20.
• The 2% sequester comes off Medicare's part only. That is $1.696 before rounding, or $1.70 to the nearest cent.
• You receive $104.304 before rounding, or $104.30 to the nearest cent.

Read the last column as an approximate break-even rate. If you buy at ASP, a billing fee of about 4.13% of the drug payment uses up the margin before other costs. The percentages use the unrounded payment calculation; displayed dollar amounts are rounded to cents.

This is our arithmetic for Medicare fee-for-service drugs paid at ASP plus 6%, using CMS's payment overview and the sequester rule. Commercial plans pay by contract, higher or lower. Biosimilars use their own ASP plus 6% of the reference biologic's ASP, with a temporary 8% reference-product add-on for qualifying biosimilars during an applicable five-year period. CMS uses the reference product's wholesale acquisition cost for the add-on when it is lower than its ASP. Use the current payment limit for the actual drug and your own payment records.

Margins can be thin even before a billing fee. In its 2025 survey of nearly 200 practices, the Underwater Biosimilars Coalition reported that nearly all responding practice owners were paid less than acquisition cost for some biosimilars. Those results describe the surveyed practices, not all rheumatology practices.

What to ask for

Three options to ask about are:

1. Drug payments are left out of the fee.
2. Drug payments get a much lower rate than services.
3. You pay a flat monthly fee.

We did not find a defined rheumatology drug-payment carve-out on the pages we read. MedHeave does publish a flat-monthly-rate option where percentage agreements are restricted. Ask which arrangements a company will offer your practice, and get the answer in the contract.

What kind of help do you need?

Not every practice that searches for rheumatology billing services needs the same thing.

Two terms you will hear:

• Buy-and-bill means your practice buys the drug, gives it, and bills the payer for the drug and its administration.
• White bagging means a specialty pharmacy ships a drug to your office for a named patient. The pharmacy generally bills for the drug; your practice bills for its administration and any other separately payable care. A payer may require this arrangement.

These arrangements are described in the Massachusetts Health Policy Commission's definitions and the ACR's position statement. Your arrangement can vary by payer.

Six checks for infusion and biologic billing

A company can list rheumatology among 40 specialties and still not know it. Use these six questions to ask for evidence of its rheumatology experience.

1. Drug units and waste. Drugs are billed in units, and one billing unit is not necessarily one vial. For drugs from single-dose containers that are separately payable under Medicare Part B, eligible discarded amounts generally go on a separate claim line with modifier JW. When no eligible amount is discarded, JZ is required. JZ has been required since July 1, 2023. These rules have exceptions; multi-dose containers and drugs included in a packaged payment do not follow this same requirement. Ask: "Walk me through a made-up weight-based infusion: units, NDC, the waste line, and JW or JZ where applicable."

2. The right code for giving the drug. There are basic infusion codes and codes for chemotherapy or other highly complex drug administration. Which one fits depends on the drug, how it was given, what was written down, and the payer. CMS updated its claims manual for January 2025 to spell out how its contractors should judge this. Ask: "How do you decide between the basic and complex codes for each biologic we give, for our Medicare contractor and each commercial plan?" Be wary of "always" in either direction.

3. A visit and a procedure on the same day. For Medicare, a separately billed office visit must be significant and separately identifiable from the injection or infusion work, with supporting documentation and modifier 25 when required. Medicare also treats the lowest-level office visit, CPT 99211, as already included in the code for giving a drug. Ask: "When do you add a separate visit, and when don't you? How often are those visits denied for your rheumatology clients?"

4. Prior authorizations and renewals. Authorization and renewal requirements depend on the drug and payer. A missing or expired authorization can delay or prevent payment. Ask: "Who does first-time authorizations and renewals, your team or ours? Is it inside the fee?"

5. Where the drug comes from. The claim is different when you bought the drug than when a specialty pharmacy shipped it. Billing it the wrong way can lead to rejection or denial. Ask: "How do you track, plan by plan, which drugs we buy and which arrive from a pharmacy?"

6. Drug payment versus drug cost. Someone has to compare drug receipts with acquisition cost and check whether each payer paid what its payment terms require. Ask: "Will you report drug reimbursement below acquisition cost separately from payer underpayments, by plan, every month?"

These are buying questions, not billing instructions. Your billing and clinical teams have to apply the current rules for each service, payer, and setting.

Who does what: get it in writing

"Full service" is a slogan, not a task list. Ask for each job to have an owner.

A billing company can take the paperwork. It still needs your notes and your decisions. Plan to keep one person on your side who owns the relationship.

Medicare's 2027 proposal could change your math

CMS has proposed changes for January 1, 2027. They are proposals, not final rules. These three could change a rheumatology practice's collections.

Source: CMS fact sheet, July 14, 2026. APM means alternative payment model. Qualifying APM participants have a separate proposed conversion factor of $33.17, down from $33.57. The 32% proposal applies to practitioners in Medicare Shared Savings Program or LEAD Model accountable care organizations. The visit modifiers still require eligible longitudinal care; membership alone would not qualify a visit. See the full proposed rule.

The same-day change is the one to model against your own claims. It could matter to practices that bill office visits with procedures on the same day. The American College of Rheumatology opposes the cut and says rheumatologists would be hit harder than most.

Comments closed on September 14, 2026. The final rule had not been released when we checked CMS's rule index on October 6. We will update this section when it is published.

Ask every company: "How would you use last year's claims to estimate what the same-day proposal could cost us? What would you change if it becomes final?" Ask for its method and a made-up example before sharing patient records.

Before you sign: contract and money checks

1. Pin down what the percentage is a percentage of. All money collected? Insurance payments only? Everything but drugs? The definition belongs in the contract, not in a sales email.

2. Find the monthly minimum. A minimum can raise your real rate in a slow month. See how a monthly minimum changes the cost.

3. Know how you leave. Ask for the notice period, any exit charge, who finishes claims already sent, and whether the company charges on money that arrives after you go.

4. Price old claims separately. Ask whether claims from before the handoff carry a different fee, before the company starts work on them.

5. Keep control of Medicare payments. Ask where the money will be deposited and who can move it. Under the federal payment-to-agent exception, a billing agent receiving Medicare payments must meet several conditions. Its compensation cannot depend on the amounts billed or collected, or on successful collection. The same conditions apply to physician practices. A percentage-fee billing agent does not qualify for that exception. These rules govern payment to the agent; they do not, by themselves, ban every percentage-fee billing contract.

6. Check your state's Medicaid rules on percentage fees. For example, Minnesota requires a provider's business agent to be paid in relation to the actual cost of processing bills. The pay cannot be tied to the amount billed on a percentage or other basis, or depend on collecting payment. MedHeave's pricing page says it offers a flat monthly rate where percentage deals are restricted. That is the company's policy, not proof that a particular contract meets state rules. Ask each company how its proposed arrangement meets the rules for your state and Medicaid program.

7. Get the privacy paperwork. A billing company handling protected health information for your HIPAA-covered practice is generally a "business associate" under HIPAA, the health privacy law. Ask for its business associate agreement and how it ensures subcontractors handling that information accept the required safeguards. "HIPAA compliant" on a website is the company's own claim.

8. Protect your access to your own records. HHS says a business associate generally may not block your access to patient information to settle a payment dispute. Don't lean on that alone. Put the export format, timing, and cost in the contract.

This is general information to help you compare. Have the people who handle your contracts and compliance read the agreement before you sign.

How to switch rheumatology billing companies

Claims in progress are one place a switch can go wrong. Decide who owns them before you pick a start date.

1. List the open work. Unpaid claims, open appeals, unpaid drug claims, active authorizations and their renewal dates, and patient balances.
2. Split the work by date. Decide who handles visits before the start date and who handles visits after. Agree on the fee for old claims.
3. Sort out access. List every login the new company needs: your EHR, the clearinghouse, and each payer portal. Name one contact on each side.
4. Test with a small batch. Send a few real claims through the new setup. Check that they are accepted, paid, and posted. A claim being accepted is not the same as a claim being paid.
5. Close out the old company. Match the ending balances, get your data, and follow the notice steps in your old contract.

Picture this: an infusion claim sent before the switch gets denied after it. Who appeals? Who gets a fee if it pays? Who pulls the chart? Get those three answers into the handoff agreement.

How long does it take? HRG says most of its practices switch in two to three weeks. That is one company's claim about its own process. Yours depends on how much old work there is.

Copy this rheumatology billing quote request

Send the same request to every company on your list. It has 19 questions in four groups: price, work, systems and money, and contract. Fill in the blanks first.

Subject: Rheumatology billing proposal: scope, drug payments, and terms

We are comparing billing companies for a rheumatology practice. Please send a written proposal based on this profile.

OUR PRACTICE
State and care setting: [fill in]
Clinicians and locations: [fill in]
EHR and practice management system: [fill in]
Services: [office visits / joint injections / infusions / other]
How we get drugs: [we buy and bill / a specialty pharmacy ships them / both / none]
Monthly collections for services, not counting drugs (approx.): [fill in]
Monthly payments for drugs we bought (approx.): [fill in]
Main payers: [fill in]
Work we want you to take over: [fill in]
Old unpaid claims or other handoff needs: [describe in general terms]

PRICE
1. What percentage or fee applies to service payments? What applies to drug payments, including J-code and Q-code claims? If drug payments are left out of your fee, please say so in writing.
2. Define what counts as "collections." How do you treat patient payments, refunds, payer take-backs, and money that comes in on claims filed before you started?
3. Is there a monthly minimum? Is it one combined minimum on the service and drug fees, or are there separate minimums? Which extra charges sit inside or outside it?
4. List every other charge: setup, data move, software, clearinghouse, patient statements, prior authorizations, credentialing, coding review, and work on old balances.
5. Show a sample monthly invoice using the two collection figures above.

WORK
6. Which tasks are yours and which stay with our staff? Please answer one by one: eligibility checks, prior authorizations, renewals, coding, claims, payment posting, denials, appeals, underpayments, patient billing.
7. Walk us through a made-up example of a weight-based infusion: units, NDC, the waste line and JW or JZ where applicable, and the administration codes. Use the clinician's prescribed and administered amounts.
8. How do you decide between the basic infusion codes and the complex administration codes for each biologic, for our Medicare contractor and each commercial payer?
9. How do you handle an office visit and a joint injection on the same day? Explain how you would estimate the effect of Medicare's proposed 2027 same-day payment change on our practice. Use a made-up example at this stage, without patient records.
10. How do you track, payer by payer, which drugs we buy and bill and which arrive from a specialty pharmacy?
11. Will you compare drug receipts with acquisition cost and check insurer payments against the applicable payment terms? Please report below-cost reimbursement and payer underpayments separately each month.

SYSTEMS, MONEY, AND REPORTS
12. Will you work inside our current system? What will we see directly? What changes if we leave?
13. Do insurance payments go straight to our bank account? How do you bill our state Medicaid program, given state rules on percentage fees?
14. What reports will we get, and how often? Can you show drug and service balances separately? How do you define each results number on your website?

CONTRACT AND HANDOFF
15. What are the term, renewal, notice to cancel, and exit charges? Do you charge on money that arrives after we leave?
16. How will you take over open claims, open appeals, and active authorizations? Who owns work from before the start date, and at what fee?
17. How do we get our data out, in what format, and at what cost?
18. Who will work our account, and where are they located? Do you use subcontractors?
19. Please send your service agreement, your business associate agreement, and two rheumatology references with a service mix like ours, including infusions if applicable.

If an item does not apply or you cannot answer it, please say so. We will treat anything left blank as unconfirmed until you answer in writing.

Please do not ask us for patient records at this stage. We will not send any.

If you run infusions and only ask four of them, ask numbers 1, 7, 8, and 11. For a practice without buy-and-bill drug collections, start with 1, 6, 12, and 15. If you buy and bill injection drugs, keep the questions about drug units, fees, and payments too. Clear written answers make the companies easier to compare. Ask for examples from similar rheumatology practices to support them.

Common questions

How much do rheumatology billing services cost?

There is no single price. Of the five companies here, MedHeave publishes a general range of 4% to 7% of collections, and BellMedEx advertises a starting rate of 2.49% for rheumatology billing. The other three do not publish a numeric rate on the pages we reviewed.

For scale: on $120,000 a month in service collections, 4% is $4,800 and 7% is $8,400. If the fee also applies to drug payments, the total can be much higher. Run your own numbers.

Can we keep our EHR?

It depends on the company. HRG names eClinicalWorks, NextGen, and ModMed. Medwave says you can use your own software. BellMedEx offers its own. The other two don't say on the pages we reviewed. Ask each company to show you the work inside your actual system.

Are the billers based in the United States?

HRG says its whole team works in the US. The pages we reviewed do not establish where the other four companies' billing teams work. If it matters to you, ask who works your account and where they sit. It is question 18 in the quote request.

Can MedicalBillingSelect get quotes for us?

No. We are a comparison publisher. You contact the companies yourself; we do not submit inquiries or share your details with providers on your behalf. How the site works.

I'm a patient with a question about a rheumatology bill. Who do I call?

Call the billing number printed on your statement. For questions about what your plan covered, call your insurer. This page is for medical practices choosing a billing company. Please don't send us medical records.

How we checked this page

On October 6, 2026, we read each company's public rheumatology page and, where it had one, its pricing page. We wrote down what each page says and marked the rest "not stated." We did not call the companies, ask for quotes, or use their services, so we can't tell you how well they bill.

Medicare facts come from CMS and the Code of Federal Regulations, linked where they appear. The 2027 items are proposals as of that date. The quote examples are our own arithmetic with made-up numbers.

See a price or detail that has changed? Tell us and send a source. More on how we work: our methodology.

Ready to compare? Pick the companies that match your practice. Send each one the same request. Then compare the fees in dollars, not percentages, before you sign.

Compare the five companies

View the quote request

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