Hiring a billing company is a high-stakes decision that directly affects your practice's revenue, compliance, and administrative burden. The wrong choice can cost thousands in lost collections and months of frustration. The right questions — asked before you sign — can prevent most of these problems.
These 25 questions are organized into five categories. For each question, we explain why it matters and what a strong answer looks like. Use this as a structured interview guide when speaking with prospective billing companies.
Questions About Specialty Experience
Questions 1-5
"How many active clients do you currently have in my specialty?"
Why ask: This is the single most revealing question. A company that claims to serve your specialty but has only 1-2 clients in it may lack the depth of experience you need.
Look for: Specific numbers, not vague answers. A strong company will know exactly how many clients they have in each specialty.
"Can you walk me through how you handle [specialty-specific billing scenario]?"
Why ask: This tests real expertise. For mental health: ask about telehealth modifier selection. For ABA: ask about authorization tracking. For dental: ask about pre-determination workflows.
Look for: Detailed, confident answers that demonstrate familiarity with your specialty's specific codes, modifiers, and payer rules.
"What specialty-specific CPT/CDT codes do you work with most frequently?"
Why ask: A company that truly specializes in your area should be able to name the codes they bill most often without hesitation.
Look for: Immediate, specific answers. Mental health: 90834, 90837, 90847. ABA: 97151-97158. Dental: CDT codes. PT: 97110-97542.
"How do you stay current on payer rule changes specific to my specialty?"
Why ask: Payer rules change frequently, especially for specialties like ABA (state Medicaid variations) and home health (Medicare PDGM updates).
Look for: Named resources, continuing education, specialty association memberships, or dedicated compliance staff.
"Can you provide references from 2-3 practices similar to mine in size and specialty?"
Why ask: References validate claims. A company that cannot provide relevant references may lack experience in your area.
Look for: Willingness to provide references without hesitation. Follow up by actually calling them.
Questions About Services & Scope
Questions 6-10
"Do you handle credentialing, or is that a separate service?"
Why ask: Credentialing is critical for getting paid by insurance. Only 62% of billing companies in our directory offer it. If yours doesn't, you'll need a separate credentialing service.
Look for: Clear answer about whether credentialing is included, separate, or not offered. If included, ask about the process and timeline.
"What is your process for handling denied claims?"
Why ask: Denial management is where billing companies earn their keep. A strong denial management process can recover 50-65% of initially denied claims.
Look for: A structured process: root cause analysis, timely appeals, tracking of denial patterns, and proactive prevention measures.
"Do you provide prior authorization support?"
Why ask: Only 34% of companies in our directory offer prior auth support. For ABA and home health practices, this is often a non-negotiable requirement.
Look for: Proactive tracking, submission, follow-up, and re-authorization management — not just 'we can help with that.'
"What reporting do you provide, and how often?"
Why ask: You need visibility into your practice's financial performance. Good reporting helps you make informed business decisions.
Look for: Monthly reports at minimum, including: collections by payer, denial rates, days in AR, clean claim rate, and aging AR breakdown.
"How do you handle patient billing and collections?"
Why ask: Patient responsibility is a growing portion of healthcare revenue. A billing company that handles patient billing can improve your collection rates.
Look for: Patient statement generation, payment plan setup, online payment options, and a professional approach to patient communication.
Questions About Pricing & Contracts
Questions 11-15
"What is your pricing model, and what is included in the base rate?"
Why ask: Understanding the pricing model is essential. Read our pricing models guide for context on what to expect.
Look for: Clear explanation of the model (percentage, flat fee, hybrid), the rate, and exactly what services are included vs. extra.
"Are there any setup fees, minimum monthly charges, or hidden costs?"
Why ask: Many companies have fees beyond the headline rate. Setup fees ($500-5,000), monthly minimums ($1,000-3,000), and per-claim charges can significantly increase your total cost.
Look for: A complete fee schedule provided upfront. Transparency here is a positive signal.
"What is the contract term, and what are the termination provisions?"
Why ask: You should not be locked into a long-term contract with a company that is not performing. Look for reasonable exit options.
Look for: Month-to-month or 90-day termination clauses. Be cautious of multi-year contracts, especially with new relationships.
"Do you charge on billed amounts or collected amounts?"
Why ask: This distinction matters significantly. Charging on billed amounts means you pay even for claims that are denied or adjusted down.
Look for: Percentage of collected revenue (not billed charges). This is the industry standard and aligns incentives.
"What happens to my data if I terminate the contract?"
Why ask: Your billing data is a critical business asset. You need to ensure you can access it during and after the relationship.
Look for: Clear data ownership terms, a defined data export process, and a reasonable transition period.
Questions About Technology
Questions 16-20
"Do you integrate with my current EHR/practice management system?"
Why ask: Seamless integration reduces manual data entry, errors, and delays. If the company requires you to switch systems, factor that cost into your decision.
Look for: Direct integration with your specific system, not just 'we work with most systems.' Ask about the integration method (API, HL7, manual).
"What clearinghouse do you use?"
Why ask: The clearinghouse affects claim submission speed, rejection rates, and the breadth of payers you can bill electronically.
Look for: Established clearinghouses like Availity, Change Healthcare, or Trizetto. Ask about electronic vs. paper claim percentages.
"Can I access real-time dashboards or reports?"
Why ask: Real-time visibility into your billing performance helps you identify issues early and make informed decisions.
Look for: A web-based portal or dashboard with real-time or near-real-time data. Ask for a demo during the evaluation.
"How do you handle electronic remittance advice (ERA) and electronic funds transfer (EFT)?"
Why ask: Automated payment posting through ERA/EFT reduces manual work and speeds up the revenue cycle.
Look for: Automated ERA enrollment and posting. Manual payment posting should be the exception, not the norm.
"What is your business continuity plan if your systems go down?"
Why ask: System outages can halt billing operations. A mature company has redundancy and disaster recovery plans.
Look for: Documented backup procedures, redundant systems, defined recovery time objectives (RTO), and communication protocols.
Questions About Compliance & Security
Questions 21-25
"Are you HIPAA compliant, and will you sign a Business Associate Agreement?"
Why ask: This is non-negotiable. Any company handling PHI must be HIPAA compliant and willing to sign a BAA.
Look for: Immediate 'yes' with documentation available. If there is any hesitation, walk away.
"Do you carry errors and omissions (E&O) insurance?"
Why ask: E&O insurance protects you if the billing company makes errors that result in financial loss or compliance issues.
Look for: Active E&O coverage with adequate limits. Ask for a certificate of insurance.
"How do you handle protected health information (PHI)?"
Why ask: Data security is paramount in healthcare. A breach can result in significant fines and reputational damage.
Look for: Encryption at rest and in transit, access controls, regular security audits, and staff training on PHI handling.
"How do you stay current on coding and compliance changes?"
Why ask: Medical coding and compliance rules change annually. Your billing company must stay current to avoid claim denials and audit risk.
Look for: Regular training programs, certified coders (CPC, CCS), compliance officer on staff, and subscription to coding update services.
"Have you ever been audited, and what was the outcome?"
Why ask: A company's audit history reveals their compliance track record. A clean audit history is a strong trust signal.
Look for: Honest answers. No company is immune to audits. Look for how they handled it and what they learned.
Quick Reference Checklist
Use this condensed checklist during your evaluation calls. Print it or save it for reference.
Billing Company Evaluation Checklist
Specialty Experience
Services & Scope
Pricing & Contracts
Technology
Compliance