A realistic annual model for a single-biller O&P practice collecting $3,000,000 a year — built from current CMS, BLS, Federal Reserve, Gallup and claim-journey data, not guesswork. Every source is listed at the foot of this page.
$3M / yr · 1 RCM specialist
Billing cost isn’t a salary — it’s a salary plus the hours it consumes, the capital it ties up, and the revenue it quietly loses. Here it’s all on one line each.
Insurance-rule education and compliance alone runs roughly 200 hours a year for an in-house medical biller and 50 hours a year for each O&P clinician — real time pulled from claims work and patient care, priced here at each person’s own fully loaded hourly rate.
Replacing an employee costs 0.5×–2× their annual salary, and U.S. employers lose roughly $1 trillion a year to voluntary turnover, per Gallup’s analysis of national workforce data.6
Absenteeism, turnover and burnout rarely show up as their own line item — until the biller is out and the claims aren’t moving.
| Annual cost line item | In-house | OP Solutions |
|---|---|---|
| Medical biller — fully loaded cost 1,2 | $70,497 | $0* |
| Software & hardware (EHR/PM) | $6,000 | $2,000 |
| Cost of capital on carried terms 3 | $77,525 | $0 |
| Regulatory monitoring & compliance — insurance-rules education 8 | $9,663 | $0 |
| Staffing strain — absenteeism, turnover, burnout 6,7 | $5,800 | $0 |
| Clearinghouse — training, maintenance & transaction cost † | $10,000 | $0 |
| Revenue loss — denials & leakage 5 | $60,000 | $15,000 |
| Attorney & audit fees | $5,000 | $0 |
| Time value of money — aging A/R, from real claim-journey data 9,3 | $33,984 | $0 |
| Service fee | $0 | $180,000 |
| Total annual cost | $278,469 | $197,000 |
† Working assumption, not independently verified — see source 10.
* Compass Complete replaces the in-house biller role with our RCM team; there is no separate biller salary on our side.
That’s how much more this $3M-collections O&P clinic spends every year running billing in-house compared to Compass Complete’s full-service model — and that’s before counting the owner’s own time, stress and attention pulled away from patients and the rest of the practice.
This model uses current published data plus disclosed assumptions for a $3M-collections, single-biller clinic. Every input — collections volume, biller salary, compliance hours, clearinghouse cost — can be swapped for your own.