Choosing your billing partner
Questions to Ask Before Choosing a Medical Billing Company
A convincing proposal can explain what a billing company does. Your evaluation needs to establish how the relationship will work when information is missing, a payer disagrees, or collections change unexpectedly. Choose a recent problem, prepare a de-identified example, and ask each prospective partner to walk through it. The most useful answers will identify the work, the responsible person, the handoff, and the evidence you will receive.
1. Who owns an account when it stops moving?
Ask: “A claim needs additional documentation, and our team has not responded. What happens next?”
Follow the answer through reminders, escalation, deadlines, and final disposition. Find out who owns the account while another person is supplying information. Then ask who covers that responsibility during absence or turnover. An account manager may coordinate the relationship without personally working every claim; understand how the two roles connect. A useful answer explains how an unresolved item remains visible and when your organization must make a decision.
2. Can you show how a result was measured?
Ask for a relevant example with its starting point, measurement period, work performed, and limitations.
If collections increased, ask whether visit volume, payer mix, additional providers, or historical A/R contributed. If denials fell, ask how the company defines and counts a denial.
Request a sample performance review. Can you identify what changed, why it changed, and the next action? Consistent definitions matter when you compare proposals and later assess the relationship. A large percentage without a denominator or timeframe provides little basis for a decision.
3. What will happen inside our existing systems?
Name the EHR, practice-management system, clearinghouse, and relevant reporting tools you use.
Ask which activities the partner performs in those systems and which require another application or a manual handoff.
Ask who maintains access, resolves interface problems, and reconciles information between systems. Where new technology is proposed, request a demonstration of the specific task it improves. Establish how your staff will see outstanding work and retain access to the information they need. Record any assumptions that require technical validation.
4. What work remains with us?
Walk through eligibility, authorizations, documentation queries, coding, submission, payment posting, appeals, patient balances, and reporting.
For each activity, identify whether it is included, separately priced, or retained internally. Include provider enrollment and older accounts if they are part of your need.
MGMA’s vendor-selection guidance emphasizes organizational fit, measurable expectations, and responsibilities on both sides of the relationship. [R12] Turn that principle into a written scope. A service described as “included” still needs a definition, particularly when it depends on records or decisions from your clinicians.
5. How will you communicate with our patients?
Ask to see a sample statement and hear how a billing question would be handled.
Who answers when a patient disputes a balance or says the insurer should have paid? What reaches your front desk, and what does the billing team resolve?
Discuss language support, contact methods, escalation, and the payment arrangements your organization permits. Specify who can approve adjustments or write-offs. The communication should reflect how you want patients treated, with a clear route for resolving errors and sensitive situations.
6. How will open work be handled during transition?
Request a transition outline before signing.
It should identify the accounts and dates each party will handle, required access, enrollment dependencies, unresolved payments, and the information needed from the outgoing team.
Ask how the new partner will reconcile the starting position and avoid duplicate action. Who handles a payment received after the handover for a claim submitted earlier? What happens if an export is incomplete? Establish readiness criteria and an escalation route, then set dates against confirmed dependencies.
7. What will our first review tell us?
Agree on the initial priorities, baseline information, reporting cadence, and decisions that will require your involvement.
Ask what the first review can reasonably establish and which outcomes need a longer observation period.
Keep the answers from each company in the same comparison document. Record evidence provided, open questions, and commitments that must appear in the agreement. Before deciding, involve the people who will supply documentation, manage access, and review performance. A workable relationship needs their understanding as well as leadership approval.