Hiring a medical billing company is not simply an administrative decision. You are giving another organization access to one of the most important operational systems in your practice: the process that converts patient care into collected revenue.
A polished presentation, attractive percentage rate, or promise to increase collections is not enough.
Before hiring a medical billing company, practice leaders should understand exactly how the company submits claims, manages denials, follows aging accounts receivable, protects patient information, measures performance, communicates problems, charges fees, and returns data if the relationship ends.
That matters whether you operate a primary care office, urgent care center, behavioral health practice, specialty clinic, diagnostic facility, or growing physician group.
The wrong billing partner can create months of cleanup. The right one should make your revenue cycle easier to understand, monitor, and manage.
Key Takeaways
Before signing a medical billing agreement:
- Ask about actual billing workflows, not just collection promises.
- Understand exactly which services are included in the fee.
- Verify how denials, rejections, and aging A/R are worked.
- Require meaningful reporting and access to your own billing data.
- Review HIPAA, cybersecurity, and subcontractor controls.
- Understand termination and transition terms before becoming a client.
- Compare accountability and total value, not simply the lowest billing percentage.
Here are the 15 questions that deserve a real answer.
1. What Experience Do You Have With Practices Like Ours?
Start with specialty experience, but go deeper than asking whether a billing company has worked with primary care, urgent care, behavioral health, or your particular specialty.
Ask how many similar practices the company currently supports, what payer problems are common in your specialty, and which parts of the revenue cycle typically require the most attention.
For example, an urgent care billing team may need to understand same-day services, procedures, supplies, payer-specific claim edits, high patient volume, and eligibility issues. A surgical practice may have very different concerns involving global periods, modifiers, prior authorizations, procedural documentation, and postoperative billing.
Specialty knowledge matters because payer policies and coding requirements change over time. CMS maintains the National Correct Coding Initiative, or NCCI, to promote correct coding and prevent improper payments, with published edit files updated during the year. CMS
A useful follow-up question is:
Give me an example of a recurring revenue cycle problem you see in practices like mine and explain how your team handles it.
A specific answer tells you far more than a list of specialties on a sales page.
2. Exactly What Is Included in Your Medical Billing Service?
The phrase full-service medical billing can mean very different things from one company to another.
Clarify responsibility for:
- Charge entry
- Claim scrubbing
- Electronic claim submission
- Clearinghouse rejections
- Payment posting
- Insurance follow-up
- Denial management
- Appeals
- Secondary claims
- Patient statements
- Patient billing calls
- Credit balances
- Underpayment review
- A/R follow-up
- Reporting
- Eligibility and benefits verification
- Credentialing and payer enrollment
Do not assume a service is included simply because it sounds like part of medical billing.
One company may include denial appeals in its standard fee while another charges separately. One may answer patient billing calls while another sends those calls back to your front desk. Credentialing, eligibility verification, old A/R recovery, and patient statements may also be separate services.
The written service agreement should match what was discussed during the sales process.
3. Who Will Actually Work on Our Account?
You may meet an experienced executive, account manager, or sales representative during the proposal process. That does not necessarily tell you who will work your claims on a Tuesday morning.
Ask:
Who performs the day-to-day billing work? Who supervises the account? Who reviews difficult denials? Who do you contact when something goes wrong?
Also determine whether any work is subcontracted and which individuals or teams may have access to protected health information.
The location of the billing team is less important than the controls surrounding the work. What matters is appropriate training, supervision, security, documented procedures, access controls, and accountability wherever billing is performed.
You should also understand what happens if your assigned biller is absent, changes roles, or leaves the organization.
Critical revenue cycle knowledge should live in documented systems and workflows, not only in one employee’s memory.
4. How Quickly Are Claims Submitted?
Claims should not sit unnecessarily because a billing company works from a weekly batch or has an internal backlog.
Instead of simply asking:
Do you submit claims quickly?
Ask:
Walk me through what happens from a completed patient encounter to an accepted claim submission.
That conversation should reveal how the company handles:
- Missing documentation
- Unsigned notes
- Coding questions
- Incomplete encounters
- Clearinghouse rejections
- Claims requiring additional information
- Unbilled encounters
You should also know whether the medical billing company measures charge lag and tracks encounters that have not yet reached claim submission.
A claim cannot be collected if it never properly enters the revenue cycle.
5. What Happens When a Claim Is Rejected or Denied?
This is one of the most important questions to ask before hiring a medical billing company.
Rejections and denials are not the same thing, and they often require different responses.
Some errors can be corrected quickly. Others may require supporting documentation, authorization records, corrected coding, payer reconsideration, escalation, or a formal appeal.
Ask:
How do you categorize denials, determine the next action, and make sure the same problem does not continue happening?
A strong denial management process should do more than recover individual claims. It should identify patterns and help eliminate their root causes.
If 20 claims deny because of the same registration error, correcting those 20 claims is only part of the solution. Someone should determine why the problem occurred and work with the practice to prevent claim number 21.
Related reading: Medical Denial Management Services
6. How Do You Work Aging Accounts Receivable?
New claims often receive plenty of attention because they are easier to process.
Older, complicated accounts show whether a medical billing operation has real follow-through.
Ask how frequently unpaid claims are reviewed and how follow-up is prioritized. The company may consider claim age, payer, dollar amount, denial reason, filing deadline, appeal deadline, or other risk factors.
Then ask to see the type of A/R report you would actually receive as a client.
You should be able to distinguish between a claim that is legitimately pending with a payer and an account that has gone untouched for weeks.
Be cautious with vague statuses such as “in process” or “being followed up” when there is no visible last action, next action, follow-up date, or responsible owner.
7. How Will You Measure Medical Billing Performance?
Avoid evaluating a billing company only by the total dollars collected.
Collections matter, but collection totals are affected by patient volume, payer mix, procedure mix, reimbursement rates, seasonality, provider schedules, and changes within the practice.
A stronger performance review may include:
- Days in A/R
- A/R aging by bucket
- Claim rejection trends
- Denial trends
- Charge lag
- Unbilled encounters
- Net collection performance
- Claims without recent activity
- Patient balance performance
- Payer-specific delays
- Underpayments
- Outstanding high-dollar claims
Then ask how frequently these indicators are reviewed and what happens when a metric begins moving in the wrong direction.
A reporting dashboard is useful.
A reporting dashboard combined with an explanation, responsible owner, and corrective action plan is much more valuable.
A Simple Medical Billing Company Evaluation Framework
| Evaluation Area | Suggested Weight |
|---|---|
| Claims, A/R and denial management | 25% |
| Transparency and reporting | 20% |
| HIPAA, security and compliance | 20% |
| Specialty experience | 15% |
| Communication and account support | 10% |
| Contract, data ownership and transition | 10% |
This is an illustrative framework rather than an industry standard. A practice should adjust the weighting based on its size, specialty, payer mix, internal staff, and revenue cycle problems.
The principle is simple: a slightly lower billing fee should not outweigh serious weaknesses in denial follow-up, compliance, reporting, or access to your own data.
8. Will We Have Access to Our Billing Data?
Your practice should know where its billing data lives and how much access it will retain.
Ask whether leadership will have access to relevant practice management systems, clearinghouse information, claim notes, reports, remittance information, payment activity, denial details, and payer follow-up history.
This becomes particularly important if the relationship eventually ends.
You do not want to discover during termination that claim histories, reports, notes, or clearinghouse information are controlled exclusively by your billing vendor.
Ask before signing:
“If we terminate the agreement tomorrow, what billing data do we receive, in what format, and how quickly?”
The answer should be reflected in the contract.
9. How Do You Handle HIPAA and Cybersecurity?
A medical billing company commonly creates, receives, maintains, or transmits protected health information while providing billing and claims-processing services.
HHS specifically lists billing and claims processing among activities that can make an organization a HIPAA business associate when those services involve PHI. Covered entities generally need an appropriate written Business Associate Agreement with their business associates. HHS.gov
Do not stop at:
“Are you HIPAA compliant?”
Ask about the company’s Business Associate Agreement, access controls, employee security training, risk analysis, backup procedures, incident response plan, subcontractors with access to PHI, breach notification process, and how access is removed when an employee leaves.
Multifactor authentication should also be discussed where appropriate.
Cybersecurity deserves real attention when selecting a billing vendor. In July 2026, HHS OCR announced its 21st ransomware enforcement action and again emphasized the importance of an accurate and thorough HIPAA risk analysis. HHS.gov
Security should be an operational process, not merely a sentence in a contract.
10. What Is Your Approach to Medical Coding and Compliance?
If coding services are included, understand exactly what the medical billing company will and will not do.
Ask:
How are coding questions escalated? What happens when documentation does not support the requested code? Who monitors payer and coding updates? Is there an internal quality review process?
Be cautious of promises that a billing company will automatically “code higher” or dramatically increase reimbursement.
The objective should be accurate, supportable billing based on the medical record, applicable coding guidance, payer requirements, and documented services.
The HHS Office of Inspector General’s guidance for third-party medical billing companies emphasizes compliance processes and coordination between billing companies and their provider clients. HHS Inspector General
Responsibilities should be clearly defined rather than assumed.
11. How Will You Communicate Problems to Our Practice?
Good medical billing requires collaboration.
Eventually, the billing team will need something from the practice. It may be:
- Missing documentation
- An insurance correction
- Authorization information
- A provider signature
- Credentialing information
- Medical records
- Clarification about a procedure or service
What matters is how efficiently these issues are communicated and resolved.
Ask whether you will have a dedicated account contact, how urgent problems are escalated, and how unresolved requests are tracked.
You should also understand how frequently performance reviews are conducted.
For some practices, a scheduled monthly revenue cycle review may be sufficient. A practice undergoing a major billing cleanup, payer issue, or transition may require much more frequent communication.
Silence should never be mistaken for a healthy revenue cycle.
12. How Are Patient Billing Questions Handled?
Patients increasingly interact directly with the revenue cycle through deductibles, coinsurance, statements, payment plans, and questions about insurance processing.
Ask whether the billing company:
- Sends patient statements
- Accepts patient billing calls
- Posts patient payments
- Explains insurance processing
- Handles disputed balances
- Supports payment plans
- Manages patient follow-up
If these services are excluded, determine who will handle them internally.
Patient experience does not end when the clinical visit ends.
Someone can receive excellent medical care and still leave frustrated because nobody can explain why a balance appeared, whether insurance processed the claim correctly, or whom to contact for help.
13. Do You Handle Credentialing and Payer Enrollment Issues?
Medical billing and provider credentialing are separate functions, but they frequently collide.
A claim can be perfectly coded and still fail because a provider was not correctly enrolled, linked to the group, associated with the service location, or effective with the payer on the date of service.
If credentialing is included, ask exactly what is managed and how application progress is reported.
If credentialing is not included, ask how the billing company identifies enrollment-related denials and communicates those problems to the practice or credentialing team.
You do not want months of claims repeatedly submitted under an incorrect payer configuration while two separate vendors assume the other one is resolving the problem.
Clear ownership matters.
14. How Does Your Medical Billing Pricing Actually Work?
Medical billing companies may charge a percentage of collections, flat monthly fee, per-claim rate, hybrid arrangement, or another pricing model.
Do not compare percentages until you understand what each percentage actually includes.
Ask whether the fee applies only to insurance collections or also to patient payments.
Also determine whether there are separate charges for:
- Credentialing
- Eligibility verification
- Patient statements
- Software
- Clearinghouse fees
- Medical coding
- Old A/R
- Onboarding
- Denial appeals
- Patient calls
- Reporting
- Termination or transition assistance
Then compare the total value of each proposal.
A company charging slightly more while actively managing denials and aging balances may cost less in practical terms than a low-rate billing company that performs limited follow-up.
Price matters. Scope, accountability, and performance matter too.
15. What Happens If We Decide to Leave?
This may be one of the most important questions on the list because the exit process rarely receives much attention during a sales presentation.
Read the termination language before signing.
Understand:
- Required notice period
- Termination fees
- System access after termination
- Responsibility for outstanding claims
- Final payment posting
- Patient balances
- Open appeals
- A/R follow-up
- Claim notes
- Data exports
- Report transfer
- Clearinghouse ownership
- Payer portal credentials
Your practice should not become operationally trapped simply because switching vendors would make your billing data difficult to retrieve.
A good medical billing agreement should explain both how the relationship begins and how it ends.
Look Beyond the Medical Billing Sales Presentation
Before choosing an outsourced medical billing company, ask for evidence of how the operation actually works.
Request a sample monthly report. Review the agreement. Meet the account-management team when possible. Ask how difficult denials are handled. Discuss your largest payer problems. Understand data access. Review security responsibilities. Clarify additional fees.
References can also be useful, but relevance matters.
A five-provider specialty practice may learn more from another five-provider group with similar payer and operational challenges than from a testimonial involving a 100-provider organization with a completely different revenue cycle.
Related reading: Outsourced Medical Billing Services
Frequently Asked Questions About Hiring a Medical Billing Company
What should I look for when choosing a medical billing company?
Look for relevant specialty experience, transparent reporting, strong denial and A/R workflows, clear communication, appropriate HIPAA and security controls, reasonable contract terms, and reliable access to your billing data.
Pricing matters, but it should be evaluated alongside the scope and quality of the work being performed.
Should I choose the medical billing company with the lowest percentage?
Not automatically.
First determine what is included in each proposal. A lower percentage may exclude services such as appeals, patient calls, eligibility verification, coding, old A/R recovery, or credentialing.
The more meaningful comparison is total cost versus the amount and quality of revenue cycle work being performed.
Should a medical billing company sign a Business Associate Agreement?
When a medical billing company acts as a HIPAA business associate and handles PHI on behalf of a covered entity, an appropriate written business associate arrangement is generally required under HIPAA. HHS specifically identifies billing and claims processing among potential business-associate activities. HHS.gov
Should my practice keep access to its billing software?
Whenever practical, practice leadership should maintain enough visibility to verify claims, payments, denials, outstanding accounts, and reporting.
At minimum, the agreement should clearly address data ownership, access, export procedures, and responsibilities when the relationship ends.
How can I tell whether a medical billing company’s reporting is good?
A useful billing report should answer more than:
“How much did we collect?”
It should help leadership understand charges, payments, adjustments, A/R aging, denials, rejections, unresolved claims, payer trends, and significant operational problems.
More importantly, the billing company should be able to explain what the numbers mean and what it plans to do when negative trends appear.
Should medical billing and credentialing be handled by the same company?
They do not have to be.
What matters is clear ownership and communication.
When separate companies handle billing and credentialing, there should be an effective process for resolving payer enrollment issues, credentialing-related denials, provider participation problems, and effective-date discrepancies.
How long does it take to switch medical billing companies?
There is no universal timeframe.
The transition depends on practice size, billing software, payer structure, outstanding A/R, contract terms, access to historical data, credentialing status, and whether new systems or clearinghouse arrangements are required.
The transition should be planned carefully so current claims continue moving while historical accounts, reports, and data are transferred.
Choose an RCM Partner, Not Just a Claim Submitter
A medical billing company affects much more than electronic claim submission.
It influences how quickly revenue cycle problems are identified, how consistently unresolved balances are worked, how clearly leadership understands financial performance, and how much administrative work remains inside the practice.
That is why the most important questions to ask before hiring a medical billing company focus on what happens after the easy claims are submitted.
Who owns the difficult accounts?
Who notices the pattern?
Who follows the denial?
Who contacts the payer?
Who tells your practice what went wrong?
And who makes sure the same problem does not happen again?
Claims Med provides comprehensive revenue cycle management support for healthcare organizations, including medical billing, denial management, A/R follow-up, eligibility and benefits verification, credentialing support, payer enrollment, and practical revenue cycle reporting.
If you are evaluating a new medical billing partner, replacing an existing vendor, or trying to determine whether your current revenue cycle is performing as it should, contact Claims Med.
We can review your current workflow, identify potential revenue cycle gaps, and help you understand what a more transparent and accountable medical billing process should look like.