Choosing a medical billing company is one of the most consequential operational decisions a practice can make. The billing company you work with will have direct access to your patient data, control over your cash flow, and significant influence over your payer relationships. Selecting a vendor based on price alone frequently leads to worse outcomes than the in-house billing the practice was trying to replace.
The right billing partner has demonstrable expertise in your specialty and payer mix, transparent pricing, clear performance accountability, and communication processes that keep you informed. This guide covers the specific questions to ask and the red flags to watch for. See our pricing page for a transparent breakdown of our service tiers.
Questions to Ask Before Signing
- What specialties do you currently bill for, and can you provide references from practices similar to mine? See our specialty billing capabilities.
- What is your average clean claim rate and days in AR for clients in my specialty? Review our RCM reporting transparency.
- How do you handle prior authorization, and who is responsible for following up on pending authorizations?
- What practice management and EHR systems do you integrate with?
- How are denials managed, and what is your appeal resolution rate? See our denial management approach.
- What reporting will I receive, and how frequently?
- Who is my primary point of contact, and how quickly can I expect responses?
- What are the contract terms, and what does termination look like?
Pricing Models Explained
Most billing companies charge a percentage of collections, typically between 4 and 9 percent depending on specialty, claim volume, and services included. Some charge per claim or per encounter. Percentage-of-collections aligns the billing company incentives with your revenue goals. Be cautious of companies that charge based on billed charges rather than collections, as this creates no accountability for actual payment. View our transparent pricing to understand exactly what is included at each service level.
Red Flags to Watch For
- Guarantees of specific collection rate percentages without reviewing your current data.
- Refusal to provide references from current clients in your specialty.
- Unclear answers about who specifically will be working your account.
- Long-term contracts with no performance benchmarks or exit provisions.
- No reporting capabilities, any credible billing partner should offer analytics and reporting.
- Offshore billing teams without clear HIPAA compliance documentation and Business Associate Agreements.
What a Transition Looks Like
Changing billing companies requires careful planning to avoid revenue gaps. Allow 60 to 90 days for the transition process. The new company will need access to your practice management system, payer contracts, credentialing information, and open AR. Our accounts receivable management team can take over open AR from a prior billing company as part of the onboarding process.
Key Takeaways
- Price should not be the primary selection criterion, expertise in your specialty matters more.
- Ask for current client references in your specialty and actually call them.
- Percentage-of-collections pricing aligns billing company incentives with your revenue.
- Long-term contracts with no performance provisions should be negotiated before signing.
- Allow 60 to 90 days for a proper transition, including handover of open AR.
Frequently Asked Questions
Is it better to outsource billing or keep it in-house?
The answer depends on practice volume, specialty complexity, and internal staff capacity. Higher volumes, complex payer mixes, and specialty billing rules typically favor outsourcing to a team with dedicated expertise and systems.
What should I expect in the first 90 days with a new billing company?
Expect the first 30 days to focus on system setup, credentialing verification, and workflow alignment. By day 60, you should begin seeing clean claim rate and days in AR data via the RCM reporting dashboard. By day 90, you should have enough data to evaluate whether the relationship is on track.
Can I switch billing companies without disrupting my revenue cycle?
Yes, with proper planning. Define clearly in writing who is responsible for open AR from the prior period. Our accounts receivable management team specializes in taking over aged and disputed AR from prior billing companies.