58 Questions to Ask a Medical Billing Company Before You Sign

Make Them Prove It Before You Sign

A billing company should prove -- before the contract is signed -- how it will submit cleaner claims, reduce avoidable denials, follow up on A/R, communicate with patients, and protect PHI. Sales claims are not enough. Use these questions with every finalist and compare answers against the GetPracticeHelp RCM Vendor Evaluation Scorecard.

Choose the service scope with the medical billing company fit quiz. Compare your own staff costs and collections with the outsource medical billing calculator. Put the first billing tasks in order with the medical billing cheat sheet.

For the full framework on vendor types, pricing models, and selection strategy, read How to Choose a Medical Billing Company alongside this question set. That guide covers what to look for. This page gives you the specific questions to use in vendor conversations.

Send these questions in writing before a final call. Vendors that hesitate to commit performance data, scope definitions, or compliance terms to writing show you something about how they operate under a live contract.

Performance Questions

1. What is your average first-pass clean claim rate for practices in our specialty? (A disciplined billing operation hits 95% or above -- the level industry benchmarks classify as excellent. 85-94% is considered good; below 85% warrants serious scrutiny.)
2. What is your average denial rate by payer category?
3. What are average days in A/R for clients in our specialty and practice size? (MGMA benchmark data puts median days in A/R at 33-42 depending on specialty. Sustained performance above that range signals A/R management problems.)
4. How do you define and calculate each of these metrics?
5. Can you separate this data by specialty, payer type, and practice size?
6. What performance metrics appear in monthly client reports?

Do not accept unsupported numbers. If a vendor claims a 98% clean claim rate, ask how it is calculated -- whether it includes all claims across all specialties, recent clients only, or selected best-case accounts. "Clean claim" at the clearinghouse and "accepted for payment" by the payer are different numbers.

Pin the definitions before you compare the numbers. HFMA's MAP Keys publish fixed numerators and denominators for Clean Claim Rate (CL-1), Net Days in Accounts Receivable (FM-1), Remittance Denial Rate (AR-5) and Cost to Collect (FM-6); ask each vendor whether its reported figures follow those definitions and, if not, what they measure instead. Then read the answer against revenue cycle benchmarks by specialty, and use how to read a billing service's monthly report to check whether the sample report would let you recompute them yourself.

Workflow Questions

1. Who handles eligibility checks before each visit?
2. Who reviews coding and documentation issues before submission?
3. Who submits claims?
4. Who works denied claims from first denial through appeal?
5. Who posts payments?
6. Who sends patient statements?
7. Who answers patient billing questions?
8. Who handles old A/R and aged accounts?
9. What remains the practice's responsibility?

Billing failures most often happen at handoffs -- eligibility to claim, claim to denial, denial to appeal, payer payment to posting. Both sides must have written scope. Verbal agreements on task ownership become expensive during A/R problems.

The denial-to-appeal handoff has a federal clock behind it. CMS-0057-F (89 FR 8758) requires Medicare Advantage, Medicaid and CHIP payers, beginning January 1, 2026, to decide prior authorization requests within 72 hours for expedited and 7 calendar days for standard requests and to give a specific reason for each denial. Ask who in the vendor's workflow reads that reason and who acts on it; how to reduce claim denials covers what a working denial process looks like from the practice side.

EHR and Integration Questions

1. Which EHRs do you support natively?
2. Do you work inside the EHR or through data exports?
3. Is claim status visible in the practice's EHR workflow?
4. Are payments posted automatically or manually?
5. Will the practice need to change clearinghouses?
6. What happens if the EHR vendor changes or the practice switches systems?

Manual handoffs between the EHR and the billing vendor create re-entry errors and delay. If the vendor cannot access your system directly, ask for a clear data exchange process with a fallback when exports fail or are delayed.

Add one forward-looking integration question. 91 FR 14350 (effective 2026-05-26, compliance required by 2028-05-26) adopts the first HIPAA standards for electronic claims attachments and electronic signatures, so ask whether the vendor's clearinghouse path will carry attachments in the new standard or keep faxing them. The 2024 CAQH Index puts the remaining industry savings from automating administrative transactions at $20 billion a year, and the manual handoffs this section describes are where that money sits.

Reporting Questions

1. Will the practice have real-time dashboard access?
2. What reports are included as standard?
3. Can reports be filtered by provider, payer, and location?
4. Can we see denial reasons broken down by payer?
5. Can we see A/R aging broken down by payer and provider?
6. How often will the vendor meet with the practice to review performance?

Ask to see a live (anonymized) sample dashboard before the contract is signed. A vendor that cannot demo its reporting with actual client data is limiting your ability to evaluate the product before committing.

Pricing Questions

1. Is pricing percentage-of-collections, flat-fee, per-claim, or hybrid?
2. What is the percentage calculated on -- charges, collections, payer payments, or all revenue?
3. Are patient payments included in the fee calculation?
4. Are refunds, credits, or payer takebacks excluded?
5. What services are excluded from the base rate?
6. Is old A/R cleanup included?
7. Are clearinghouse, patient statement, and payment processing fees included?
8. Are there minimum monthly fees?
9. What does termination cost, and what is the notice requirement?

Standard percentage-of-collections billing runs 4-10% of collections for most outpatient practices, with 5-8% the most common range for physician practices, depending on specialty and service scope.

Compliance Questions

1. Will the vendor sign a BAA before accessing any PHI?
2. How does the vendor control employee access to patient records and payment data?
3. Are all access and activity events logged with an audit trail?
4. What security certifications or third-party audits are current, and can documentation be provided?
5. What is the vendor's breach notification process and timeline?
6. How is patient payment data handled and protected in transit and at rest?

No BAA should stop the evaluation immediately. A vendor that hesitates on basic security documentation should not be handling PHI or payment data for the practice.

Both of those compliance answers have a regulatory floor. 45 CFR 164.502(e) lets a practice disclose PHI to a business associate only on satisfactory assurance, documented in a written contract, that the associate will safeguard it; 45 CFR 164.410 requires a business associate to notify the practice of a breach without unreasonable delay and no later than 60 calendar days after discovery. A contract that promises less than that is offering less than the regulation already requires. For a billing company specifically, OIG's Compliance Program Guidance for Third-Party Medical Billing Companies (63 FR 70138, December 18, 1998) is the document to ask them to map their compliance program against. Which practice vendors require a BAA covers the rest of your vendor stack.

Service Questions

1. Who is the named account manager for this practice?
2. What is the response-time SLA for standard questions?
3. What qualifies as an urgent issue, and what is the SLA for urgent problems?
4. How are escalating payer problems handled?
5. How often does the vendor initiate account reviews?
6. What happens if the assigned account manager leaves?

Service quality -- not software -- is usually the difference between a billing relationship that works and one that drifts. Ask references specifically whether support response times matched what the contract said.

Reference Questions

1. What were days in A/R before and after onboarding?
2. What denial rate do you see now, and has it changed?
3. How quickly does the vendor respond when a billing problem surfaces?
4. What did onboarding actually require from the practice?
5. What billing tasks still fall on the practice's own staff?
6. What would you change about the relationship?

References that offer only general praise are not useful. Ask for operational specifics. References should be from your specialty or practice-size range, not the vendor's largest or most successful accounts.

Contract Questions

1. What is the initial contract term?
2. Is there a performance exit clause tied to agreed benchmarks?
3. Who owns the billing data?
4. How does data export work if the practice leaves, and what does it cost?

The safest contract gives the practice a clear exit path if performance misses agreed benchmarks. A vendor that resists a performance exit clause is asking you to trust its claims without accountability.

How to Use These Answers

After each vendor call, score the answers across the five GPH scorecard categories while the conversation is fresh. Give the highest scores to vendors that provided sample reports, defined scope in writing, separated performance data by specialty, and answered compliance questions without hesitation. Give low scores to vendors that answered with broad promises and no supporting method.

The final decision should identify the specific risk the vendor reduces for your practice -- speed to improved A/R, backlog cleanup, denial reduction, or staff relief from billing tasks. A strong vendor in one area is not automatically the right choice if that strength does not match your actual problem.

Compare medical billing companies on GetPracticeHelp to build your interview shortlist.