Outsourcing your medical billing can be a game-changer—but only if you choose the right partner. The wrong choice can lead to delayed payments, compliance issues, and frustrated staff. The right partner, however, can improve your revenue, streamline operations, and give your team more time to focus on patient care.
So, how do you know if a billing company is the right fit?
Here are the key questions every provider should ask before signing a contract.
What Is Your Experience With My Specialty?
Different specialties come with different coding, payer rules, and documentation requirements. A partner who understands your field—whether it’s dermatology, cardiology, mental health, or primary care—will code more accurately, reduce denials, and speed up reimbursements.
Red flag: If their experience is vague or generalized across “all specialties,” dig deeper into specifics.
What Is Your Average Denial Rate and Days in A/R?
Ask about performance metrics. A solid billing partner should boast a claim denial rate under 5% and Days in A/R under 30–35 days. These KPIs directly impact your cash flow.
Bonus: Ask how they track and report these metrics to you regularly.
How Do You Stay Current With Industry Changes?
The medical billing landscape changes constantly—ICD and CPT code updates, evolving payer policies, and shifting CMS rules. Your billing partner should have a formal process for staying compliant and training their team.
Look for: Membership in industry organizations (like AAPC or HBMA) and ongoing education programs.
What Technology Do You Use—and Will It Integrate With My EHR?
Seamless integration saves time and reduces errors. Make sure the partner’s system can integrate with your EHR/EMR platform, whether it's Epic, Kareo, Athenahealth, or AdvancedMD. Ask to see a demo of their reporting dashboard and how data flows between systems.
What Is Your Communication and Reporting Process?
Transparency is key. You should receive regular performance reports, updates on claim status, and easy access to your account manager. Clarify how often they meet with clients, how issues are escalated, and what kind of visibility you’ll have.
What Are Your Fees—and What’s Included?
Is the pricing percentage-based or flat fee? Are there hidden costs for credentialing, coding audits, or denial follow-up? Understand exactly what services are included—and make sure the value matches the cost.
Can You Provide References or Case Studies?
A reputable company should have satisfied clients who can speak to their performance. Ask for references in your specialty or with a similar size practice.
Final Thoughts
Choosing a medical billing partner is more than a financial decision—it’s a long-term strategic move. By asking the right questions, you’ll gain insight into their expertise, transparency, and commitment to your success. A great partner doesn’t just process claims—they help your practice thrive.
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Author: Kimberly Wiethoff
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