Questions to Ask a Billing Company Before You Sign

Billing sales conversations tend to run on reassurance. You hear about experience, dedication, technology and results, and you leave with an impression rather than information. The questions below are designed to break that pattern. They are specific, slightly uncomfortable, and every one of them has a concrete right answer — or at least a concrete honest one.

Use them on us too. If we cannot answer any of these plainly, that is a finding.

Staffing and accountability

1. Who specifically works my account, and what else do they work?

You want a named team or role structure and an honest picture of load. "Everyone works everything" usually means nobody has developed depth in your specialty. Concentration is a good sign.

2. What happens when that person is out?

Coverage is the main structural advantage an outside biller has over a single in-house employee. If the answer is vague, that advantage does not exist and you are paying for it anyway. This is the risk described in billing for solo and small practices.

3. Who do I call about a specific claim, and what is the response expectation?

Named contact, working-hours expectation, escalation path. "Email the team" is an answer that predicts your experience in month seven.

Denials and A/R work

4. How do you distinguish rejections from denials, and can I see them as two lists?

If they arrive as one list, the operation is not separating a data-hygiene problem from a coverage problem — denials vs rejections explains why that costs money.

5. How do you categorise denial causes, and what do you do with the categories?

Working denials is table stakes. What you are testing is whether anyone counts causes and changes upstream workflow, which is the argument in why claims get denied.

6. How do you track filing limits and appeal deadlines?

Ask specifically whether queues are prioritised by deadline proximity as well as by dollar value. Deadline losses are the only fully self-inflicted denial category.

7. What is your write-off policy, and who approves write-offs?

This is the highest-yield question on the list. A biller who can write off balances without your approval can improve every metric they report to you while destroying revenue. You want a defined threshold, a reason code, and practice approval above it.

8. Do you identify underpayments against my contracted rates?

A claim paid at the wrong rate is a paid claim as far as A/R is concerned, and it disappears from every report. This requires your fee schedules loaded and actually compared. Many operations do not do it.

• Named owner
• Cause counted
• Deadline tracked
• Write-off approved
• Underpayment checked

Reporting and visibility

9. Show me a sample monthly report — a real one, redacted.

You are looking for aging by payer and bucket, the 90-plus share, denial categories, write-offs by reason, and collections. A single headline number is not reporting. What good looks like is set out in days in A/R.

10. Exactly how do you calculate days in A/R?

Numerator, denominator, trailing window, whether patient balances are included. The point is not the formula; it is whether they can answer without hesitation and whether it stays fixed month to month.

11. Will I keep direct access to my own system of record?

If claims run in your practice management system, you can verify everything yourself. If they run in the vendor's, establish now what you can extract and in what format.

Money, contract and exit

12. What exactly is included in the percentage, and what is billed separately?

Clearinghouse fees, statements and postage, credentialing work, coding audits, patient-balance follow-up, reporting. Ask what would generate an invoice line outside the percentage. Our own arrangement is described on the pricing page, and any specific rate should be quoted after someone has seen your payer mix — not published in advance.

13. What are the notice period and exit terms?

Notice length, what happens to claims in flight, whether they keep earning on payments arriving after termination, and whether they keep working denials during that period. Ask at the beginning; by the end you have no leverage.

14. What happens to my legacy A/R, and to my data, when I leave?

Claim-level notes, appeal history, payer correspondence, format, timeline. Also confirm that payer portal credentials and CAQH access belong to the practice, not the vendor — switching billing companies covers why this one question determines how painful a future change will be, and credentialing: what to expect covers the access side.

The answers you want are specific and slightly uncomfortable. Vagueness is not a communication style — it is the finding.

Answers that should worry you

• Guaranteed collection percentages or promised denial-rate improvements. Nobody can guarantee outcomes that depend on your payer mix, your documentation and your patients.
• Published results with no basis you can inspect. An average across other practices tells you nothing about yours.
• Discomfort with the write-off question. There is no good reason for this answer to be unclear.
• Exit terms treated as a distraction. The terms exist; reluctance to walk through them is informative.
• No named person for your specialty. See why specialty matters in billing.

How we would answer

Briefly, and in the same order you would ask: named staff assigned to your practice with coverage that does not depend on one person; rejections and denials reported separately; denial causes categorised and reviewed with you; filing limits prioritised ahead of dollar value; write-offs requiring your approval above a defined threshold; contracted rates loaded so underpayments are visible; monthly reporting written for a practice owner rather than a billing analyst; your system of record and your payer contracts staying yours. Scope by service is on the services page.

What we will not do is quote a collection percentage or a turnaround figure to win the conversation. Bring your denial log and your aging report to a phone call and you will get specifics about your practice instead of averages about somebody else's.