A medical billing company gets clients by reaching the person who watches the practice's money, usually the practice manager or the owner, with one specific offer: a review of recent claims that shows what's being denied and why. The buyer is almost never a hospital. It's a small or mid-size practice with an in-house biller who is stretched thin.

That sentence is the whole strategy. The rest of this article covers who to target, how to find them by name, what to say, and how to handle the objection you'll hear most.

Which practices outsource billing, and why

Big health systems have billing departments. Solo practitioners often have a spouse doing it at the kitchen table. The sweet spot for an outside billing company sits in between: practices with two to ten providers, one or two people on billing, and a manager who's tired of explaining the aging report to the doctors.

Those practices tend to outsource for a handful of reasons, and your first email should name one of them:

  • The biller quit or is retiring, and the practice is afraid to hire a replacement.
  • Denials are piling up and nobody has time to work them.
  • The practice added a provider or a location and billing didn't scale with it.
  • The owner wants a number they can trust each month instead of a shrug.

Specialties with complicated coding, such as orthopedics, behavioral health, physical therapy and dermatology, feel these pains more than a simple family practice. Pick one or two to start. A billing company that says "we handle behavioral health practices in three states" is easier to remember than one that says "we do medical billing."

Find practice managers by name

An email to info@ goes to a front desk. An email to "Dear Practice Administrator" goes to nobody. You want a first name and a title.

Start with a narrow description of your buyer: specialty, practice size, state. Then look for the practice manager, office manager, administrator or the physician owner. Practice websites often list them on a "meet the team" page. State licensing boards and professional association directories help with the rest. Our guide on finding your ideal customers walks through narrowing the list so you are not writing to everyone.

Keep the first list small. Sixty practices you've actually looked at will do more for you than six hundred pulled from a database. Rocketship does this step for you: you describe the practice you want, it finds the buyers by name, and you see the first 25 before you decide anything.

An email built on a claims review

Nobody replies to "we offer comprehensive revenue cycle management." They reply when you hand them something concrete they can say yes to in one line. A claims review is that. Here's a first email from a fictional company, Clearline Billing, to a fictional manager:

Subject: Denied claims at Harbor Family Orthopedics

Hi Renata,

I run Clearline Billing. We work with orthopedic practices of your size, and the most common thing we find is a small group of denial codes costing a few percent of collections every month.

I'd like to review one month of your denial report and tell you what I see. No cost, and about 20 minutes of your time. If you share it, send only the denial summary: no patient names or identifiers. We'd sign a business associate agreement before touching anything with patient information in it.

Would Thursday or Friday work for a short call?

Dan Reyes, Clearline Billing, 400 Main St, Suite 12, Columbus, OH

A few details matter here. It names the practice and a single specialty. It promises a review, not a sales call. It says plainly what data it needs and what it doesn't, which matters in a field where the first fear is a privacy mistake. It offers two days instead of "let me know your availability."

Two compliance notes. First, never put patient information in a cold email, and don't ask for it before there's a business associate agreement in place, since HIPAA treats billing companies as business associates. Second, the usual cold-email rules apply: honest subject line, your real name, a physical address, and a working way to opt out.

The reply you'll hear: "our biller has been here 12 years"

You'll hear this a lot, and it's a reasonable thing to say. The biller is a person, probably liked, and the manager doesn't want to tell her she's being replaced. The honest answer is that you're not asking for that.

That's good to hear. Twelve years of knowing your payers is hard to replace. I'm not suggesting anything that touches her job. I'd still like to look at one month of denials and tell you what I see, and you can decide whether it's worth anything. If the numbers look fine, I'll say so.

Some practices keep their biller and hire you for the hard stuff, such as denial appeals or aging claims over 90 days. Offering a smaller job first is often how the larger one begins. If the answer is simply no, thank them and ask if they would mind you checking in once a year.

Follow up in a way that respects busy clinics

Clinic managers work in bursts. They're buried Monday mornings and at month end, when they're closing the books. Send your first email Tuesday through Thursday, mid-morning. Follow up three to four business days later with a two-line message on the same thread. If there's still no reply, wait about ten days and try a different angle, such as a short note on a payer change that affects their specialty.

A phone call to the front desk can also work, but don't ask the receptionist for the manager's direct line. Ask when the manager is usually in, and call then. See how to get meetings with decision makers for what to say to a gatekeeper, and a follow-up sequence for service businesses for timing. If you're wondering whether to do all this yourself, should founders do their own cold outreach gives a straight answer.

Pricing: percentage of collections or flat fee

Most billing companies charge a percentage of what they collect. The appeal is simple: they only get paid when the practice does. Others charge a flat monthly fee per provider, which is easier to budget and can be cheaper for high-volume practices.

Run the math before you quote. Say a practice collects $120,000 a month. A 6 percent fee is $7,200. A flat fee of $1,500 per provider with five providers is $7,500. They're about the same at this size, so the choice comes down to what the owner values more: paying only on results, or knowing the bill in advance. Offer both and let them pick. Whatever you choose, put it in writing and tell the manager what happens to your fee when a claim is denied after you've been paid.

Keep the first meeting about their numbers, not your price. A manager who has seen their own denial pattern laid out on one page will ask what you charge before you bring it up.

Keep the pipeline going

Billing contracts renew slowly, so you need a steady trickle of conversations, not a burst. Send a handful of emails every week, answer every reply the same day, and write down why each no was a no. After a quarter you'll know which specialty and which opening line work, and you can do more of those.

A medical billing company that waits for referrals grows when the referrals come. One that reaches practice managers by name grows on a schedule. Rocketship finds the buyers, emails them from your own Gmail, follows up, and books the meeting on its own. Plans that get you customers start at $24.99 a month (Launch), and every monthly plan starts with a 7-day free trial, card required. If you're building a company this way, our startup page shows how.