The answers that predict a good relationship are about definitions and termination, not about promised collection rates. How "collections" is defined, who works denials, what reporting you receive, and what happens to your A/R when you leave.
Most billing evaluations focus on results a vendor cannot control. The questions that actually predict the relationship are duller and more specific.
On money
- What exactly counts as collections? Copays taken at the desk? Capitation? Incentive payments? Refunds netted?
- Is there a monthly minimum? No minimum on a percentage arrangement means small practices are served at a loss, which shows up as service.
- What is billed separately? Clearinghouse fees, statements, postage, setup.
- How is legacy A/R priced? It is harder work and should not be at the standard rate.
On the work
- Do you code, and are your coders certified? If they code and are paid a percentage, what governs the interaction?
- How is clean claim rate defined? Clearinghouse acceptance or first-pass payment. The answer tells you a lot.
- How quickly are denials worked, and rejections? Rejections are the invisible queue.
- Which metrics do you report, and can I reproduce them from my own system?
On the ending
The most revealing section, because it is the part vendors have thought about least.
- Who works outstanding A/R after notice, for how long, at what rate?
- What data do I get back, in what format, and how quickly?
- Do payer enrollments stay in my name?
- What is the notice period, and is there a penalty?
The tell
A vendor who answers these precisely has been through a transition and learned from it. One who waves them off in favor of talking about collection improvements is selling an outcome they do not control.
Ask who does the work
Submission is largely automated. Denial follow-up and appeals are where the labor and the recovery sit, so ask how staff are allocated between them and what a denial workflow looks like end to end.
A proposal detailed on submission and vague on denials is describing where its effort actually goes.
Ask for a sample report before signing
Reporting is easy to evaluate in advance and hard to renegotiate later. If the sample counts denials rather than grouping them by cause, that is the visibility you are buying.
Ask what they need from you
A vendor who says they need nothing is selling back-end billing and calling it revenue cycle management. Front-end denials cannot be fixed without changes at your front desk.
A candid answer about what your team must do is a better sign than a promise that nothing changes.
Common questions
- What should I ask a medical billing company?
- How they define collections, who works denials versus submissions, what monthly reporting you receive, whether they reconcile to your bank, and what happens to A/R on termination.
- Should I ask about their collection rate?
- You can, but treat the answer skeptically. Collection rate depends on your payer mix, coding and documentation as much as their work.
- What reporting should I expect?
- Denials grouped by cause, aged A/R with the unrecoverable portion named, and claims approaching filing deadlines. Ask for a real anonymized sample.
- How do I check references properly?
- Ask for practices of similar size and payer mix, and ask them specifically about the transition and about how problems were handled.
- What is the most overlooked question?
- What happens on termination — who works submitted claims, in what format your data returns, and over what period.
Denials Piling Up?
We handle the revenue cycle end to end — coding by certified coders, claim submission, denial management and appeals, and A/R follow-up, with six reported numbers every month.