How to Choose a Medical Billing Company
The questions to ask, the red flags to walk away from, and the metrics that actually predict whether a partner will lift your revenue.
8 questions to ask before you sign
What is your average first-pass clean-claim rate?
This is the single best predictor of how much rework — and lost revenue — you will see. Look for 95%+.
What are your typical days-in-A/R and denial rate by specialty?
Vague answers are a red flag. A good partner benchmarks by specialty and shares real numbers.
How fast do you work denials, and what is your appeal success rate?
Denials decay with age. Ask for a denial-response SLA (e.g. 72 hours) and a real appeal win rate.
Will I have a dedicated account team that knows my specialty?
Specialty nuance drives coding accuracy. Generic, rotating reps miss specialty-specific revenue.
What reporting and real-time visibility do I get?
You should have 24/7 access to claims, payments, and KPIs — not a monthly PDF you cannot question.
What are your contract terms and fees — all of them?
Look for transparent pricing, no hidden setup fees, and reasonable termination terms.
How do you handle HIPAA, BAAs, and data security?
A BAA is non-negotiable. Ask about encryption, SOC 2, and how PHI is protected.
What does onboarding look like, and how do you avoid a cash-flow gap?
Parallel processing during a 30–45 day transition prevents claims from stalling.
Red flags to walk away from
- Won't share clean-claim rate, denial rate, or days-in-A/R
- Long lock-in contracts with steep termination penalties
- Hidden setup, integration, or "technology" fees
- No dedicated account team — just a ticket queue
- No BAA or vague answers on HIPAA and data security
- Reporting is a monthly PDF with no real-time access
- Promises a specific revenue lift before reviewing your data
Frequently asked questions
What clean-claim rate should a good billing company have?
Aim for a first-pass clean-claim rate of 95% or higher. Below that, denials and rework quietly erode collections. A strong partner will share their rate and benchmark it by specialty.
What questions should I ask before hiring a medical billing company?
Ask about first-pass clean-claim rate, denial rate and days-in-A/R by specialty, denial-response SLA and appeal success rate, whether you get a dedicated specialty account team, real-time reporting, full fee transparency, HIPAA/BAA practices, and how onboarding avoids a cash-flow gap.
What are red flags in a medical billing company?
Major red flags include refusing to share performance metrics, long lock-in contracts with steep penalties, hidden fees, no dedicated account team, no BAA, monthly-PDF-only reporting, and guaranteeing a revenue lift before they have seen your data.
Put us to the test
Ask us every question on this page. Start with a free assessment of where your current billing is leaking.