10 Questions to Ask When Evaluating Billing Companies

Selecting the right medical billing company is about more than just finding someone to handle your claims—it’s about finding a true partner in your practice’s financial health. These ten questions go beyond the basics, giving you a deep understanding of how a billing company can impact your revenue cycle and overall operations.

Coding and Compliance

Let’s start with the essentials. Coding and compliance are the backbone of any successful billing partnership. Here’s what to ask:

1. How Do You Ensure Coding Accuracy for My Specialty?

Don’t settle for a generic answer here. Push for specifics:

• What checks and balances do you have in place to catch coding errors?
• Can you walk me through a tricky coding challenge you’ve tackled in my specialty?

Why it matters: Every specialty has unique coding quirks. A billing company that truly understands your field can significantly reduce denied claims and even uncover opportunities for optimized coding.

2. How Do You Stay Up-to-Date with Regulatory Changes?

Regulatory changes don’t just affect compliance—they can directly impact your reimbursement rates, billing processes, and even long-term strategies for your practice.

• How often do you update your processes in response to new regulations?
• Can you provide an example of a recent regulatory change and how you adapted?

Why It Matters: Staying compliant is about more than avoiding fines. Regulatory updates often affect how claims are processed, what’s reimbursable, and the documentation required for certain procedures. A billing company that actively adapts to these changes can help safeguard your revenue stream and ensure your practice remains both compliant and competitive. By understanding the latest rules, they can also guide you on strategic adjustments that might be needed to maximize reimbursement and optimize workflows.

Performance and Efficiency

Efficiency drives cash flow, so be sure to dig into their process and performance metrics.

3. What Strategies Do You Use to Maximize First-Pass Claim Rates?

• Do you have a pre-submission audit process?
• What’s your current first-pass claim acceptance rate?

Why it matters: A high first-pass claim rate means fewer denials and faster payments. The right billing company should have rigorous checks in place to optimize claim accuracy from the start.

4. Do You Offer a Lockbox Process for Payment Handling?

Payment handling impacts both security and accessibility of funds.

• How does your lockbox process work, and how quickly are payments processed?
• Do you provide real-time access to deposit information?

Why it matters: A lockbox process can enhance cash flow control by providing direct access to payments as they are received. It also supports efficient deposit reconciliation, enabling your practice to manage finances with greater transparency and security.

Commitment to Comprehensive Billing

It’s crucial to know whether they’ll work on all claims, not just the easy ones.

5. How Do You Handle Smaller or Complex Claims?

Some billing companies might only prioritize claims based on ease or reimbursement potential.

• Do you have a policy on handling lower-value or more complex claims?
• Can you provide examples of managing complex claims that require appeals?

Why it matters: A reliable billing partner is committed to handling all claims with equal diligence, ensuring no revenue is left on the table due to claim complexity.

6. How Do You Approach Denials and Appeals?

Denials are inevitable, but it’s how they’re managed that matters.

• What’s your success rate on appeals?

• How persistent are you in following up on denied claims?

Why it matters: Effective denial management can reclaim revenue that might otherwise be lost. This question reveals their persistence and skill in handling challenging claims.

Technology and Data Management

Make sure their technology and data management practices align with your needs.

7. What Advanced Security Measures Do You Use Beyond HIPAA Compliance?

Data breaches are costly and can damage your reputation.

• Do you use encryption, multi-factor authentication, or other advanced security features?

• Have you experienced any data breaches, and how were they handled?

Why it matters: Going beyond HIPAA compliance with advanced security practices shows a commitment to protecting your practice and patient data at the highest level.

8. How Will You Tailor Reporting and Analytics to Our Practice’s Needs?

Customized reporting can provide insights to optimize your practice’s revenue cycle.

• Can we customize reports to focus on metrics that matter most to us?
• Do you offer predictive analytics for cash flow forecasting?

Why it matters: Customized and predictive reporting allows for more effective financial planning and helps you understand the health of your practice’s revenue cycle.

Patient Interaction and Future Growth

Finally, ensure they align with your values on patient care and are ready to support your growth.

9. How Do You Handle Patient Billing and Communication?

A top-notch billing company isn't just about insurance reimbursement; they should excel in patient collections too. This dual focus requires a blend of efficient processes, clear communication, and smart technology. Look for a partner that can handle both sides of the revenue equation, maximizing your income while maintaining positive patient relationships.

• Do you offer online bill pay, payment plans, or easy communication channels?

• How/will you resolve patient billing questions or disputes?

Why it matters: Billing interactions can affect patient satisfaction and retention. A professional approach to patient billing ensures a positive experience, reflecting well on your practice.

10. What Are Your Contract Terms and How Open Are You to Negotiation?

Contracts define the terms of your partnership, so it’s important to know where you have room to negotiate.

• Do you offer flexible contract lengths, or are they fixed long-term agreements?
• Are there any early termination fees, and how do you handle adjustments to service terms?

Why it matters: A billing company that offers flexible contract terms and is open to negotiation demonstrates a commitment to building a partnership that can adapt to your practice’s evolving needs. This question can also reveal how accommodating they are and whether they truly value your business.

Wrapping Up

Choosing the right billing company can transform your practice’s financial health. By asking these ten insightful questions, you’ll gain a clearer picture of how they operate and whether they can deliver the support you need. Take your time, look for specifics, and make sure your billing partner is ready to handle the complexities of your practice.

Ready to make an informed choice? Evaluate your current billing process, identify where a new partner could add value, and go forward confidently with a partner that feels like an extension of your practice.