We Priced Out an In-House Biller. The Salary Was the Cheapest Part.
By Brianna Hall, Director of Development, Medical Billing Center
Ask a PT owner what their billing costs and you’ll almost always get the same answer: a salary. Somewhere around forty grand, maybe a little more if the person’s been there a while.
It’s not a wrong answer. It’s just an incomplete one, and the gap between the number owners quote and the number they actually pay is bigger than most people expect. So we pulled the actual 2026 compensation data and did the math for a mid-size practice – one collecting somewhere between $750K and $1M a year.
Start with what the market says
Nationally, ZipRecruiter puts the average medical billing specialist at $42,673 a year, about $20.52 an hour, with most salaries falling between $36,500 and $47,000. Indeed’s job posting data lands in the same neighborhood at $21.20 an hour. The Bureau of Labor Statistics runs higher for the broader medical records specialist category – a $50,250 national median – and certified coders climb well past that.
Here in the Southeast, the numbers dip. South Carolina billers average $42,046 a year (SC actually ranks last among all 50 states for medical biller pay), and Indeed shows $19.26 an hour in South Carolina and $19.55 in North Carolina. If the role needs real coding credentials, the market moves fast – combined billing-and-coding roles in SC average around $54,000, and closer to $57,500 in Charleston.
So call it $42,000 for a solid Southeast hire. That’s the number that goes in the budget.
It’s also the number your biller sees. It’s not the number you pay.
The part nobody budgets for
Per the BLS, benefits and payroll taxes make up 28.4% of total compensation for private-industry workers in the South. Even with modest small-practice benefits – employer FICA, unemployment, a reasonable health contribution, a 3% match – that $42,000 hire costs you somewhere north of $53,000 before they’ve submitted a single claim.
Then come the line items that exist because the role exists. Billing software, clearinghouse fees, statement processing – call it $400 a month. A workstation, a phone line, a desk in space that could arguably be a treatment table. Training time while a new hire learns your payer mix and your workflows, at full pay and partial productivity.
Stack it conservatively and one in-house biller runs about $62,000 a year in direct, countable costs.
At $850K in annual collections, that’s 7.3% of everything you bring in. For one person. Before anything goes wrong.
And things go wrong
The direct costs are at least visible. The expensive ones aren’t.
A solo biller juggling posting, phone calls, and follow-up doesn’t work every denial – there aren’t enough hours. Even a 2% revenue leak on $850K is $17,000 a year, and denials get harder to recover the longer they sit. When that biller leaves (and eventually, they leave), replacing them typically costs 30-50% of their salary in recruiting and ramp-up, and the payer quirks and authorization history in their head walk out the door with them. Meanwhile, somebody – usually you or your office manager – is spending hours every week reviewing billing work instead of doing literally anything else that grows the practice.
And none of that touches the simplest problem: one biller means billing stops when they do. PTO, sick days, a two-week notice. Cash flow doesn’t take vacations, but your revenue cycle does.
Add it honestly and a mid-size practice is paying $90,000 or more a year 10% to 11% of collections for an in-house billing operation with a single point of failure.
Now compare that to what owners think is the expensive option
Full-service RCM partners for outpatient therapy typically charge between 5% and 7% of net collections. At $850K, that’s $42,500 to $59,500 a year.
Read that against the numbers above. At the *top* of the typical fee range, an RCM partner costs about what one biller’s fully loaded compensation costs and meaningfully less than the true all-in figure. Except the fee doesn’t buy you one person. It buys a team with backup coverage, dedicated denial workflows, software and clearinghouse costs typically folded in, and an incentive structure where your billing partner only gets paid when you do.
That last part matters more than it looks. A salary gets paid whether claims get collected or not. A percentage of collections doesn’t.
The honest caveat
In-house billing isn’t inherently wrong. If you have the volume to keep a skilled biller fully utilized, documented backup coverage, and someone who genuinely likes managing billing performance – and your denial rate and days in AR back that up – you may be running a good operation. Some practices are.
But the decision deserves the full number, not the visible one. When owners see the complete picture, most are surprised at how close the comparison is on cost alone. Everything after that, the coverage, the worked denials, the hours you get back is where the investment case gets made.
Know your numbers. Then decide.
*Sources: ZipRecruiter, Indeed, and Salary.com 2026 salary data; U.S. Bureau of Labor Statistics, Employer Costs for Employee Compensation (March 2026); AAPC state salary data.*