You are comparing two or three medical billing companies. Each one sent a deck, each one quoted a percentage, and the decks read the same, because each answers the questions a vendor prefers to answer. The questions below are the other kind.
A good billing company answers all nine in one meeting without checking with anyone. The answers tell you what the relationship will be like in month fourteen, when something is stuck and you need to know whose job it is. The tenth question is what it costs, all in.
Before the questions, the path they all sit on, in plain words. A visit happens. The clinician writes the note and signs it. Someone turns the visit into a charge, the billable line that says what was done. The charge becomes a claim, the bill your practice sends to the insurance company.
The insurance company answers with a payment, a denial (a refusal to pay, with a reason code), or nothing at all. Someone records that answer against the visit, the patient pays their share, and the money lands in the bank. A billing company works the part of that path that starts when a claim exists. Everything before that point stays inside your practice, whoever bills.
What should you ask a medical billing company before signing?
Ask what the percentage applies to, and what is out of scope. Ask how they measure the clean claim rate they quoted, and what arrives every month. Ask what happens when an insurance company goes quiet, who works the claims that are already sent but not yet paid when you leave, and what you get on exit.
Ask who will know your insurance companies by name. Then ask what they cannot see from where they sit, which is the question that separates the good ones.
1. What does your percentage apply to?
A billing company charges a percentage, and the base it is taken from matters as much as the rate. It can be a percentage of everything you billed, of everything you collected, or of what you collected after refunds and takebacks (money an insurance company pulls back after paying). The same rate produces three different invoices depending on which.
Ask which one, then ask what is excluded: patient payments taken at the front desk, refunds, takebacks, and payments on claims sent before the relationship started.
The answer you want is specific and short. The answer to worry about is “we can work that out in the contract.”
2. What is out of scope?
Sending claims is in. After that, nothing is safe to assume. Appeals (challenging a denial), credentialing (the approval that lets a provider bill a particular insurance company), and payer enrollment (the paperwork that lets your claims and payments move electronically with each insurer) are separate jobs. So are patient statements, patient phone calls, and contract negotiation.
Practices find out which ones were never included at the moment they need one, so ask for the list of what is in and what costs extra, in writing.
3. How do you measure the clean claim rate you just quoted?
A clean claim is one the insurance company accepts and pays the first time it is sent, and the rate is the share of claims that do. It can be measured at the scrubber, the automatic check a claim goes through before it leaves the building, or at the insurance company, and the first number reads higher than the second. Same name, different number.
Ask which one is on the slide, and ask what counts as a denial: formal refusals only, or every claim that did not pay correctly the first time. If the number is undefined, the definition will belong to whoever produces the report later.
4. What arrives every month, and does it say what is stuck?
A collections total and a receivables total (receivables are what you are owed and have not received) describe a month that has closed. Ask for the view that describes the month you are in: claims complete and not yet sent, and denials received and not yet appealed. Include claims sent and waiting longer than that insurance company usually takes, and payment reports received and not yet recorded.
A payment report is the electronic explanation an insurance company sends with a payment, and recording it against the visit is called posting. Each item should come with a count and a dollar figure.
Then ask how denials are grouped. Grouped by count, the report tells you the size. Grouped by cause, it tells you whether you have five problems recurring or fifty.
5. What happens when an insurance company stops answering?
A denied claim shows up on a denial report and gets worked. A claim that gets no answer of any kind shows up nowhere, because nothing arrived to report. It sits in “in process” until the insurance company’s filing deadline passes, the cut-off after which it will no longer accept the claim, and the money is gone.
Ask who watches for an insurance company with claims going out and nothing coming back, how long before that gets flagged, and what the first move is. A specific number of days is a routine. “Our team stays on top of it” is a hope.
6. Who works the claims already sent when we leave?
Every billing relationship ends, and the handover is the most expensive moment in it. Claims sent under the old arrangement and not yet paid still need someone to work them through to payment, and they belong to nobody unless the contract says otherwise.
Ask for the answer in writing before you sign: who works them, through what date, and how those payments get matched to the right visits. Ask whether fees continue on collections received after termination. That can be fair. Discovering it on an invoice after termination is the expensive version.
7. What do we get on exit, and in what format?
A right to your data satisfied by a locked report is a different thing from a usable export. Ask for the list: claim history including the claims the insurance company never decided on, payment report detail, and patient balances with how long each has been owed.
Ask too for insurance contracts and fee schedules (the agreed price for each service), and credentialing records with dates. Ask how long your login stays open after termination so you can verify the export before it closes.
The practice owns the data. The contract should say so in one plain sentence.
8. Who at your company will know our insurance companies by name?
Billing knowledge is local. Which insurance company needs a phone call rather than a portal, which representative answers, and what the appeal path is for each one. None of it lives in a system. It lives in a person, and when that person leaves, it leaves with them.
Ask who your day-to-day contact is, how long they have been there, and what happens to your account when they are out for two weeks.
9. What can you not see from where you sit?
This is the question that separates the good ones. A billing company acts on claims that reach it. A note waiting on a signature, a visit that never became a charge, and a claim that was built and never sent all sit inside your practice, before the company’s work begins. No billing company can see them, whatever the contract says.
The honest answer is “the steps before the claim are yours.” A company that says so is telling you where its scope ends. A company that says “we handle everything” has just described the half of the path it will never look at.
The question a good one asks you back
Somewhere in the meeting, the better companies ask about your side of the path. How long from a completed visit to a created charge. The number of notes waiting on a signature right now. The number of claims built and sitting. They ask because those numbers decide their results as much as anything they do, and one that never asks is pricing a job it has not looked at.
What this means for you
Take the nine questions to the next meeting and write down each answer as given. Any question that gets “we will get back to you” is a finding on its own. Then compare the answers to your current contract, if you have one. The gaps between what you were told and what is written are the conversation to have before signing anything.
Grab 30 minutes with us. Prep nothing. You will see which part of the path from visit to bank a billing company can cover, and which part stays yours.
Questions people ask
What should I ask a medical billing company before signing?
Ask what the percentage applies to and what is excluded, what is out of scope, how the clean claim rate is measured, what arrives every month, who watches for insurance companies that stop answering, who works the claims already sent when you leave, what you get on exit, and who will know your insurance companies by name.
How do medical billing companies charge?
As a percentage, and what it is a percentage of matters as much as the rate. Everything billed, everything collected, and what was collected after refunds and takebacks produce different invoices at the same percentage. Ask what is excluded, such as front desk payments and refunds, and whether fees continue after termination.
What should a billing company report each month?
Four things beyond the totals: what is stuck at each step with a dollar figure, denials grouped by cause rather than counted, each insurance company measured against how long it usually takes, and anything approaching a filing or appeal deadline. A pack that only summarizes the closed month does not say what to do this week.
Can a billing company see unbilled visits?
No. A billing company works claims that reach it. Visits that never became charges, notes waiting on a signature, and claims built and never sent sit inside the practice and outside the company’s view. That part of the path needs an owner in your building under every arrangement.
What happens to claims in progress when I switch billing companies?
Whatever the contract says, and if it says nothing, nobody works them. Before signing, get in writing who works the claims sent under the old arrangement, through what date, how those payments are matched to visits, and whether fees continue on collections received after termination.