Marketing a medical billing company to practices: claims, case studies and HIPAA

A medical billing company sells to physicians, dentists, therapists and clinic owners who are handing over something sensitive: their claims, their revenue and their patients’ information. The buyer is a business, but the subject is health care, so the marketing sits under rules that a general B2B playbook does not mention. A promise to raise collections is an advertising claim the FTC expects you to back up. A client quote is an endorsement. A case study built from client data can involve protected health information. And the OIG published compliance guidance written for billing companies, with a list of risk areas that your sales copy should not contradict.

This guide is for owners and marketing leads at billing, coding and revenue cycle companies that sell to practices. It covers what to claim, how to talk about pricing, how to use client stories and data, and how to describe your HIPAA role. Some topics have their own guides, and we link to them instead of repeating them: what makes a vendor a business associate and what a BAA has to contain, testimonials and the FTC Endorsement Guides, the Anti-Kickback Statute and referral arrangements, per-lead fees and patient lead generation and email marketing rules. The full rules for client stories are in our guide to case studies and client success stories. Businesses that help patients with their bills are covered in patient advocate marketing.

The OIG guidance written for billing companies

In December 1998 the HHS Office of Inspector General published Compliance Program Guidance for Third-Party Medical Billing Companies at 63 FR 70138. For its purposes, “third-party medical billing companies” include clearinghouses and value-added networks. The OIG wrote that health care professionals consult billing companies “to provide timely and accurate advice with regard to reimbursement matters, as well as overall business decision-making,” and that this is why it considered guidance for billing companies particularly important.

The guidance is old, but it has not been withdrawn. The OIG Compliance Guidance page still lists it and says the existing guidance documents are “available for use as an ongoing resource to help identify risk areas in particular industry segments as we develop new ICPGs” (industry-specific compliance program guidance). Some references in it are dated, such as the Medicare Carrier Manual, so read it for the risk areas and the reasoning, and check current rules for the details.

For marketing, the guidance matters in two ways. It lists the billing practices the OIG considers risky, which tells you which promises a careful practice owner will question. And it says what billing companies should share with clients about their compliance program, which shapes how you can describe that program in a sales conversation.

The risk areas your sales copy should not contradict

The guidance lists the risk areas the OIG “has identified as particularly problematic.” Among them:

• Billing for items or services not actually documented.
• Unbundling, which the guidance defines as using separate billing codes for services that have an aggregate billing code.
• Upcoding, defined as “using a billing code that provides a higher reimbursement rate than the billing code that actually reflects the service furnished to the patient.”
• Inadequate resolution of overpayments.
• Duplicate billing in an attempt to gain duplicate payment.
• Billing company incentives that violate the anti-kickback statute or similar laws.
• Routine waiver of copayments and billing third-party insurance only.
• Discounts and professional courtesy.

Read your homepage next to that list. A line like “we find the money your coders leave on the table” or “higher reimbursement per visit” invites one question from a practice that has read the guidance: higher because of what? If the answer is coding that matches documentation more completely, catching underpayments against contracted rates, working denials and appealing on time, say that. Describe the method, not only the outcome. A claim that reads as “we code higher” points straight at the definition of upcoding above.

The guidance also recommends that billing companies “obtain clarification from the provider when documentation is confusing” and that compensation for coders and billing consultants “should not provide any financial incentive to improperly upcode claims.” If your process does those things, they are worth stating plainly, because they answer the question a careful buyer will ask.

Collection rates, denial rates and revenue promises

Section 5 of the FTC Act, 15 U.S.C. 45, prohibits unfair or deceptive acts or practices “in or affecting commerce.” It is not limited to ads aimed at individual consumers, so it reaches advertising to practice owners as well. The FTC Policy Statement Regarding Advertising Substantiation (November 23, 1984) says advertisers must “have a reasonable basis for advertising claims before they are disseminated,” and that when a claim states its own level of support, such as “tests prove” or “studies show,” the Commission expects the firm “to have at least the advertised level of substantiation.”

Collection and denial figures are objective claims, so they need that basis. Before a number goes on your website or into a pitch deck, write down:

1. What the number measures. A collection rate can be calculated against gross charges, against expected allowed amounts or against what was collectible after adjustments. A denial rate can count first-pass denials or final denials. State which one you mean, next to the number.
2. Whose results it covers. All current clients, clients in one specialty, or one client. A figure from your best account is not your typical result.
3. The time period. The months the figure covers, and whether it is still current.
4. The comparison. A claim like “we cut denials in half” needs a before figure measured the same way as the after figure.
5. Where the records are. The reports that support the figure, kept for as long as the claim runs.

If you cannot document a figure that way, leave the number out and describe the work instead. Avoid comparing yourself to an “industry average” unless you can name and date the source and show that it measures the same thing your figure measures. Do not promise a specific increase in revenue. Results depend on the practice’s payer mix, documentation and patient volume, which you do not control.

Pricing pages: percentage fees, flat fees and Medicare payment rules

A billing company may price its service as a percentage of collections, a flat fee per claim, a monthly fee, or a mix. Two sets of rules bear on how you describe and structure that pricing.

First, Medicare’s rules on payment to agents. Under 42 CFR 424.73(b)(3), Medicare may pay an agent who furnishes billing and collection services to a provider only if, among other conditions, “the agent’s compensation is not related in any way to the dollar amounts billed or collected” and “is not dependent upon the actual collection of payment,” and payment is made in the provider’s name. 42 CFR 424.80(b)(5) applies the same conditions to an agent of a physician or other supplier. The OIG guidance cites 424.73 and notes that, because of these limits, billing companies “rarely engage in receiving payment on behalf of their provider clients.” If your company receives Medicare payments for clients, have counsel check your fee structure against these sections before you advertise it.

Second, the OIG’s view of percentage arrangements. The guidance says “the OIG has a longstanding concern that percentage billing arrangements may increase the risk of upcoding and similar abusive billing practices,” and that “for billing companies that provide marketing services, percentage arrangements may implicate the anti-kickback statute.” That does not make percentage pricing unlawful in itself, but it means a pricing page that says “we only get paid when you get paid more” is selling the exact incentive the OIG flagged. Describe what the fee covers and how it is calculated, and let your compliance controls answer the incentive question.

Whatever the model, state the full price clearly: setup fees, minimums, fees on patient balances, charges for credentialing or reports, and what happens to claims in progress if the client leaves. A price that leaves out mandatory fees can mislead, and misleading advertising is what Section 5 prohibits.

If you also sell marketing services to practices

If your company adds patient marketing, such as ads, websites or appointment campaigns, to its offer, the OIG guidance addresses that directly. It says “billing companies that provide marketing services should develop policies to ensure compliance with the anti-kickback statute,” 42 U.S.C. 1320a-7b(b), and that those policies should provide that the billing company will not submit claims for patients “by virtue of a compensation agreement that was designed to induce such referrals” in violation of the statute.

In practice, that means a bundle where you bring in patients and are paid a percentage of what those patients generate needs legal review before it goes on a sales page. Our guides on per-lead and per-booking fees and referral arrangements cover the statute and the OIG advisory opinions in more detail.

Your compliance program is part of the pitch, so describe it accurately

The guidance recommends that, “at a minimum, the billing company should send a copy of its compliance program to all of its provider clients,” and coordinate with clients on training, an audit plan and policies for investigating misconduct. That gives you something concrete to offer in a sales conversation: the actual document, not an adjective.

It also warns that “an ineffective compliance program may expose the billing company’s provider clients to liability where those providers rely on the billing company’s expertise and its assurances of an effective compliance program.” So the words you use about your program are assurances a client may rely on. Say what exists: a named compliance officer, written coding policies, the audit schedule, how you handle overpayments and credit balances, and how staff report concerns. Do not describe the program as more complete than it is, and update the sales material when the program changes.

Business associate status and what you say about HIPAA

Under 45 CFR 160.103, a business associate includes a person who handles protected health information on behalf of a covered entity for functions that include “claims processing or administration,” “billing” and “practice management.” The same section defines a health care clearinghouse as an entity, “including a billing service,” that converts health information between nonstandard formats and standard transactions. Depending on what you do, your company may be a business associate, a clearinghouse, or both. Our guide to business associate agreements covers the definition and the contract terms in detail.

Under 45 CFR 164.502(a)(3), a business associate “may use or disclose protected health information only as permitted or required by its business associate contract” or as required by law. Under 164.504(e)(2), that contract must establish the permitted uses and require the business associate to use appropriate safeguards and report uses or disclosures the contract does not allow.

For marketing copy, that leads to a few rules of thumb. Avoid badges and phrases like “HIPAA certified” or “fully compliant.” Compliance depends on how you operate every day, not on a label, and a practice cannot verify a label. Describe what a buyer can check instead: that you enter into a business associate agreement with each client before receiving patient information, if that is true; how access to client data is controlled; and who in your company is responsible for privacy and security. Keep each statement true for every client, not only the largest ones.

Case studies and client data

Health information under HIPAA includes information about “the past, present, or future payment for the provision of health care to an individual” (45 CFR 160.103). Claim lists, remittances, denial letters and patient balance reports are therefore patient information when they identify a person. A screenshot of a denied claim with a patient name, date of birth or account number on it does not belong in a slide deck, a webinar or a blog post.

A case study built from client numbers is safer when it uses aggregated, practice-level figures with no patient details. Even then, two questions come first. Does your business associate agreement allow the use? Under 164.502(a)(3), your agreement sets what you may do with the data you receive. And is the data de-identified? Under 164.502(d)(2), information de-identified under 164.514(a) and (b) is not individually identifiable health information. If you want to use client data in marketing, get that permission in writing, from the client, and have counsel confirm the method.

The client’s own name is a separate question. Naming a practice as a client tells readers who the practice works with, which is a business relationship the practice may not want public. Get written permission before you show a client’s name or logo, and honor a request to remove it.

Client testimonials, logos and referral rewards

The FTC Endorsement Guides apply to business buyers too. Under 16 CFR 255.0(b), an endorsement is any advertising message that “consumers are likely to believe reflects the opinions, beliefs, findings, or experiences of a party other than the sponsoring advertiser,” and “the name or seal of an organization can be endorsements.” A client logo strip is an endorsement, not decoration. The same section defines “product” to include any service or company.

• Real clients, real views. Under 255.1(a), endorsements “must reflect the honest opinions, findings, beliefs, or experience of the endorser.” Under 255.1(c), a client quoted as using your service must have been a bona fide user when the quote was given, and you may keep running the quote only while you have good reason to believe the client still uses it. Remove former clients’ quotes and logos.
• Results quotes. Under 255.2(b), a testimonial about a key result “will likely be interpreted as representing that the endorser’s experience is representative.” If one client’s denial rate fell sharply and that is not what clients generally see, the ad needs to disclose the generally expected result, and you need support for that figure too.
• Discounts and referral credits. Under 255.5, a discount, free month or other benefit given to a client who endorses you is a material connection that must be disclosed clearly and conspicuously when readers would not expect it. A referral credit for a client who recommends you on a public forum counts.
• Reviews. 16 CFR 465.4 makes it a violation to offer compensation or incentives conditioned on reviews “expressing a particular sentiment.” 465.2 prohibits fake reviews and testimonials, including ones that misrepresent the reviewer’s experience. Ask every client for an honest review, or none.

Our guide to testimonials covers the Endorsement Guides in more depth for patient-facing practices. The principles carry over.

Channels: website, search and email

A practice owner comparing billing companies will read your website before taking a call. Pages that answer specific questions do more than a general services page: one page per specialty you actually serve, with the payers, code sets and workflows you handle for it; a page that explains onboarding step by step; a pricing page with the full fee structure; and a page that describes your compliance program and data handling in the plain terms above.

If you work with practices in a defined region, local search pages for that region make sense. If you serve practices nationally, your search work is about those specialty and question pages rather than a map listing. Paid search can target the terms buyers use, with landing pages that make the same accurate claims as the rest of the site.

Email to practice owners is commercial email. Our guide to healthcare email marketing covers the federal rules that apply to it.

Illustration: rewriting a billing company homepage

Illustration. A billing company’s homepage headline reads “Boost your revenue 30% guaranteed.” Below it is a strip of eight practice logos, two of them former clients, a quote from one practice saying its denials dropped to almost zero, a “HIPAA Certified” badge and a pricing line that says “we only get paid when you get paid more.” A case study slide shows a screenshot of a denied claim. Here is how the company reworks it with counsel:

1. Headline. The revenue figure has no documented basis across clients, so it comes out. The new headline describes the work: claim scrubbing against payer rules, denial follow-up and monthly reporting.
2. Logos. The two former clients come off. The company gets written permission from each remaining client before keeping its logo.
3. Quote. The denial quote stays only with a clear statement of what clients generally experience, measured the same way, and with support on file. Otherwise it is replaced with a quote about responsiveness and reporting.
4. Badge. The badge comes off. A short section explains that the company enters into a business associate agreement with each client before receiving patient information, and names the role responsible for privacy and security.
5. Pricing. Counsel reviews the percentage model against 42 CFR 424.73(b)(3) and 424.80(b)(5) and the OIG guidance. The pricing page now lists the rate, the minimum, setup fees and what happens to open claims at termination.
6. Case study. The screenshot is removed. The case study uses aggregated, de-identified figures with the client’s written permission, and states the measure and time period.

Checklist

• Sales copy describes methods, and no line reads as a promise to code higher.
• Every collection, denial or revenue figure states the measure, the clients covered and the time period, with records on file.
• No guaranteed revenue increases and no industry averages without a named, dated source.
• Pricing page shows the full fee structure, and counsel has reviewed it against 42 CFR 424.73(b)(3) and 424.80(b)(5) if you receive Medicare payments for clients.
• Any patient marketing service, and how it is paid, reviewed under the anti-kickback statute.
• Compliance program described as it actually exists, and a copy available to clients.
• No “HIPAA certified” or “fully compliant” badges; business associate role and safeguards described in checkable terms.
• No patient details in screenshots, decks, webinars or case studies.
• Client data used in marketing only when de-identified and permitted in writing.
• Client names and logos shown only with written permission, and removed when a client leaves.
• Testimonials from current clients, with typical results disclosed and material connections disclosed.
• No incentives tied to positive reviews.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices, and the same work applies to companies that sell to them. For a billing company, that means a website with specialty and pricing pages that make claims you can document, ads that point to those pages, and copy reviewed against the sources in this guide before it goes live. Your counsel approves pricing, contracts and compliance statements. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We do not sell lead lists or promise revenue, rankings or results.

Sources

• OIG: Compliance Program Guidance for Third-Party Medical Billing Companies, 63 FR 70138 (December 18, 1998)
• OIG: Compliance Guidance
• 42 CFR 424.73: Prohibition of assignment of claims by providers
• 42 CFR 424.80: Prohibition of reassignment of claims by suppliers
• 42 U.S.C. 1320a-7b: Criminal penalties for acts involving Federal health care programs
• 45 CFR 160.103: Definitions
• 45 CFR 164.502: Uses and disclosures of protected health information, general rules
• 45 CFR 164.504: Uses and disclosures, organizational requirements
• 15 U.S.C. 45: Unfair methods of competition unlawful
• FTC: Policy Statement Regarding Advertising Substantiation (November 23, 1984)
• 16 CFR Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising
• 16 CFR Part 465: Use of Consumer Reviews and Testimonials

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