Questions to ask a medical billing company before you hire them
Short answer: Do not stop at “What percentage do you charge?”
Ask how they handle denied claims, aging A/R, underpayments, reporting, old accounts during the handoff, and whether your practice can keep its current EHR.
The best answers are specific. They should be able to explain who owns the work, what happens next, what you can see, and how they know when something is falling behind.
If the answers stay vague, keep asking.
Most medical billing companies sound similar during the sales process.
They submit claims. They work denials. They follow up on A/R. They promise better collections.
The real differences usually show up after the contract is signed: how consistently claims are followed, whether problems are caught early, what the practice can see, and what happens to accounts that do not fit neatly into the normal workflow.
These questions help surface those differences before you make a decision.
Questions about denial management
What happens after one of our claims is denied?
Ask them to walk you through the process from the moment the denial posts.
Who reviews it? How quickly? How do they decide whether the next step is a corrected claim, reconsideration, appeal, payer call, or something else?
A good answer should describe a workflow.
“We work all denials” is not a workflow.
How do you track appeal and filing deadlines?
A denial that could have been recovered can become much harder to collect once an appeal or filing window closes.
Ask how deadlines are tracked at the claim level and what happens when an account is getting close to one.
You should be able to understand who owns the claim, what the next action is, and when that action needs to happen.
Do you look for denial patterns, or only work individual claims?
Fixing one denial solves one account.
If the same denial keeps showing up for the same payer, CPT code, provider, or location, the bigger question is why.
Ask whether the billing company tracks recurring denial reasons and whether those patterns are taken back upstream so the same problem can be reduced.
Questions about A/R
How do you decide which A/R gets worked first?
Age matters, but it should not be the only factor.
Ask how the company prioritizes accounts based on things like:
- Balance
- Payer
- Denial status
- Filing or appeal deadline
- Previous follow-up
- Next action needed
- Likelihood of recovery
A $15,000 surgical claim approaching an appeal deadline should not necessarily be treated the same as a small balance simply because they are in the same aging bucket.
What happens to accounts over 90 days?
Older A/R is where unresolved claims can quietly turn into write-offs.
Ask whether older accounts have a clear owner and documented next step.
You should also ask how often 90+, 120+, and older balances are reviewed and whether the practice can see what is happening with the largest accounts.
Questions about payments and underpayments
Do you review paid claims to see whether they were paid correctly?
A claim can be marked paid and still deserve another look.
Ask whether the billing company compares payments against expected reimbursement when enough contract or reimbursement information is available.
If something appears short, ask what happens next.
Does someone validate the discrepancy? Is the payer contacted? Is a reconsideration or appeal submitted when appropriate?
How do you handle adjustments and write-offs?
Adjustments are part of medical billing. Unexplained adjustments are a different problem.
Ask who has authority to write off a balance, how adjustment reasons are documented, and whether the practice can review those adjustments by payer, reason, and dollar amount.
You should know the difference between money that was contractually adjusted and money that was simply closed.
Questions about reporting and visibility
What will we actually be able to see?
Ask to see a sample report before you sign.
A collections total is useful, but it does not tell you whether the underlying revenue cycle is healthy.
You should be able to see things such as:
- Aging A/R
- Open denials
- Appeal status
- High-dollar unresolved claims
- Payment activity
- Adjustment activity
- Claims approaching deadlines
- What the billing team is actively working on
Can we get claim-level detail?
Summary reports are useful for seeing the big picture.
Claim-level detail is what lets you verify the work behind the summary.
Ask whether you can see the individual claims behind A/R totals, denials, adjustments, and payment issues when needed.
If the answer is no, understand why before you sign.
How often will we review performance together?
Reporting should not just arrive as an attachment every month.
Ask whether there is a regular review of what changed, what is getting worse, and what the billing team needs from the practice.
A useful review should answer more than “collections were up.”
Questions about pricing and the contract
What is actually included in the price?
Do not compare billing companies on percentage alone.
Ask for a clear list of what is included in the base fee.
Depending on the company, that may include:
- Claim submission
- Payment posting
- Denial follow-up
- Appeals
- Old A/R
- Underpayment review
- Patient statements
- Prior authorization support
- Credentialing
- Reporting
- Patient calls
Two companies can quote the same percentage and provide very different levels of service.
Are there additional fees?
Ask about implementation fees, credentialing charges, statement costs, clearinghouse fees, patient-call fees, old-A/R fees, or separate charges for work outside the core billing scope.
You should understand the full pricing model before comparing proposals.
What happens if we decide to leave?
The exit terms matter almost as much as the starting terms.
Ask about:
- Notice period
- Data access
- Data return
- Responsibility for open claims
- Responsibility for appeals
- Who posts payments after termination
- Whether they continue working old A/R
- Any termination fees
The time to understand the handoff is before there is a dispute.
Questions about the transition
Do we have to change our EHR?
Not necessarily.
Switching billing companies and changing clinical software are two separate decisions.
Ask whether the company can work inside your existing EHR and practice-management environment and exactly what access they need.
If your physicians and staff are happy with the clinical system, changing billing vendors should not automatically mean creating another operational disruption.
Who owns old A/R during the handoff?
This is one of the most important transition questions.
Before go-live, there should be a clear owner for:
- Open claims
- Pending denials
- Appeals
- Historical A/R
- Payments arriving after the old vendor stops
- Claims approaching filing or appeal deadlines
If ownership is vague, accounts can sit between the old and new billing companies while each assumes the other is handling them.
Our guide to switching medical billing companies covers this transition in more detail.
Questions about the team
Who will actually work our account?
Ask who your day-to-day contact will be and who is responsible for the billing work.
Is there a dedicated account manager? A shared billing team? Specialty-specific billers? Offshore support? Escalation staff?
There is no single right model, but you should understand who owns the relationship and how questions move between your practice and the people doing the work.
What happens when our main contact is unavailable?
A billing relationship should not depend entirely on one person.
Ask how coverage works during vacations, turnover, illness, or staffing changes.
The practice should still have a clear path to answers.
A quick billing company scorecard
| Area | Ask | A good answer | Red flag |
|---|---|---|---|
| Denials | What happens after a denial? | Clear workflow, ownership, and timing | “We work all denials” |
| Deadlines | How do you track appeal windows? | Tracked by claim with a next action and date | No defined process |
| A/R | Who owns accounts over 90 days? | Clear owner and next step | Only an average days-in-A/R number |
| Payments | Do you review paid claims? | Payment discrepancies are reviewed when data is available | “If it paid, it is done” |
| Reporting | Can we see claim-level detail? | Yes, with supporting detail when needed | Summary reports only |
| Pricing | What is included? | Written scope and fee structure | Only a percentage quote |
| Transition | Who owns inherited A/R? | Defined before go-live | “We will figure it out later” |
| Team | Who actually works our account? | Clear ownership and escalation path | No clear point of responsibility |
Already working with a billing company?
You can ask your current billing company the same questions.
You do not have to wait until you are ready to switch.
If you cannot get clear answers about denials, A/R, payments, adjustments, and follow-up today, that tells you something useful about the current operation.
Vero's Free Revenue Leak Audit reviews your existing claims, denials, payments, underpayments, and aging A/R and shows you what may deserve a closer look.
You do not have to switch billing companies first.
Common questions about hiring a medical billing company
What is the most important question to ask a medical billing company?
Ask them to explain what happens after a claim does not pay correctly.
That answer usually reveals how the company handles denials, follow-up, deadlines, escalation, and accountability.
The more specific the workflow, the easier it is to understand how your claims will actually be managed.
How do medical billing companies typically charge?
Many billing companies charge a percentage of collections. Others use a flat monthly fee, per-claim pricing, hourly fees, or a combination.
Compare the scope of work and any additional fees along with the headline rate.
Should we audit our current billing before hiring a new company?
If possible, yes.
An audit gives you a baseline before the transition and can identify denials, aging A/R, payment issues, or other accounts that need a clear owner during the handoff.
It can also help you determine whether you actually need to switch billing companies at all.
Should a billing company let us keep our current EHR?
In many cases, yes.
If the billing company can operate within your existing EHR and practice-management environment, changing billing vendors does not necessarily require a software conversion.