How to Choose a Medical Billing Company: 15 Questions

Medical billing companies are not interchangeable. Performance varies wildly: top-tier companies maintain denial rates below 4% and net collection rates above 96%, while mediocre companies hover at 8 to 12% denial rates and 89 to 92% net collections. On a practice collecting $1.5 million annually, that performance gap equals $60,000 to $105,000 in lost revenue per year. The problem is that every billing company sounds good in a sales pitch. They all claim certified coders, dedicated account managers, and cutting-edge technology. The difference is in the details, and you find the details by asking the right questions. These 15 questions are designed to reveal how a billing company actually operates, not just how they market. For each question, you will find why it matters, what a great answer sounds like, and what red-flag responses to watch for.

Question 1: What is your pricing model and what does it include? Why it matters: hidden fees and surprise charges erode the savings you expected. Great answer: a clear percentage-of-collections rate (Go Medical Billing charges 2.49%) that includes billing, coding, claim submission, denial management, A/R follow-up, patient statements, eligibility verification, credentialing support, and monthly reporting. No setup fees, no per-claim fees, no monthly minimums. Red flag: vague pricing that requires a custom quote, setup fees over $500, separate charges for denial management or credentialing, or a per-claim model that incentivizes volume over quality. Question 2: What are your contract terms? Great answer: month-to-month or 90-day notice with no long-term commitment. The billing company should earn your business every month, not lock you in. Red flag: multi-year contracts, early termination fees, or automatic renewal clauses with narrow cancellation windows. Question 3: How do you define net collections for percentage-based billing? Great answer: net collections equal total payments received minus patient refunds. The billing company does not earn a percentage on write-offs, contractual adjustments, or uncollectible amounts. Red flag: charging a percentage on gross charges or on amounts that include contractual adjustments.

Question 4: Are your coders AAPC or AHIMA certified? Why it matters: certified coders demonstrate verified knowledge of CPT, ICD-10, and HCPCS coding systems. Uncertified coders make more errors, which drives higher denial rates. Great answer: yes, all coders hold CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credentials with specialty certifications relevant to your practice type. Red flag: no certifications, or certifications held by management but not by the coders who actually touch your claims. Question 5: Will I have a dedicated account manager? Great answer: yes, a named individual who knows your practice, your payers, your providers, and your billing history. You should have direct phone and email access with same-day response. Red flag: rotating contacts, a general support line instead of a named manager, or response time commitments longer than 24 hours. Question 6: What is your staff-to-client ratio? Why it matters: if one person manages 40 accounts, your practice does not get meaningful attention. Great answer: one dedicated account manager for every 10 to 15 accounts, with specialized support staff for coding, A/R, and credentialing. Red flag: refuses to answer, gives vague responses like dedicated team, or ratios above 25-to-1.

Question 7: What is your average denial rate across all clients? Why it matters: this is the single most revealing performance metric. Great answer: below 4%, with the ability to show denial rate by specialty and by payer. Go Medical Billing averages 2.8% across all clients. Red flag: cannot provide a specific number, claims zero percent denials (impossible), or averages above 7%. Question 8: What reports do I receive and how often? Great answer: monthly reports that include total charges, total payments, net collection rate, denial rate by reason code, A/R aging breakdown, top denial reasons with corrective actions, and provider-level productivity metrics. Real-time access to a client portal is a strong plus. Red flag: quarterly reporting only, reports that show only summary totals without actionable detail, or reports that you have to request rather than receive automatically. Question 9: What is your average net collection rate? Great answer: 96% or higher, with the ability to show benchmarks by specialty. Red flag: cannot provide a specific number, conflates gross and net collection rates, or averages below 93%.

Question 10: What practice management and billing systems do you use? Why it matters: compatibility with your EHR determines the smoothness of the transition and ongoing operations. Great answer: experience with multiple major EHR and PM systems (eClinicalWorks, athenahealth, AdvancedMD, Kareo/Tebra, NextGen, Epic, Cerner), with the ability to work within your existing system or provide one if needed. Red flag: requires you to switch to their proprietary system, or only works with one platform. Question 11: How do you ensure HIPAA compliance? Great answer: signed BAA before any PHI access, annual Security Risk Assessment, 256-bit encryption for data at rest and in transit, role-based access controls, regular staff training, documented incident response plan, and willingness to share their most recent SRA summary or SOC 2 report. Red flag: vague assurances of compliance, no BAA offered proactively, cannot describe specific technical safeguards, or has never conducted an SRA. Question 12: Do you use AI or automation in your billing process? Great answer: yes, with specifics — AI-assisted claim scrubbing, denial prediction models, automated payment posting with variance detection, automated eligibility verification. They should also confirm human oversight on all AI outputs. Red flag: claims to use AI but cannot describe what the AI specifically does, or relies entirely on manual processes with no automation.

Question 13: What does the transition process look like? Why it matters: a poorly managed transition can disrupt cash flow for months. Great answer: a documented transition plan with specific milestones — EHR access setup in week one, parallel processing in weeks two and three, full takeover by week four, with no gap in claim submission at any point. A named transition manager should be assigned to your account. Red flag: vague timeline, no written transition plan, or an admission that there will be a billing gap during transition. Question 14: Can you provide three references from practices similar to mine? Why it matters: references let you verify the sales pitch against reality. Great answer: yes, immediately, with practice names, contact information, and permission to call. Ideally practices in your specialty and of similar size. Red flag: no references available, references only from very different practice types, or asks you to wait while they identify someone. Question 15: What happens if I am not satisfied with your performance? Great answer: month-to-month terms mean you can leave with 30 to 90 days notice. The company will provide a complete data export, final reporting, and cooperate with the transition to your next billing solution. They should also describe their internal escalation process for addressing performance concerns before it reaches the termination point. Red flag: punitive exit clauses, refusal to release your data, or no internal process for addressing client concerns.

Score each of the 15 questions on a 1-to-3 scale: 1 point for a red-flag answer, 2 points for an acceptable answer, 3 points for a great answer. Maximum score: 45. If a company scores below 30, they are not ready to handle your billing. Between 30 and 37 they are adequate but not exceptional. Between 38 and 45 they are a strong partner. Weight questions 1, 4, 7, and 9 double — pricing transparency, coder certification, denial rate, and net collection rate are the most predictive of actual performance. Beyond the questions, trust your gut on communication. The sales process previews the service experience. If they are slow to respond during the sales process, they will be slow to respond when you have a billing issue. If they cannot answer your questions directly, they will not report your performance directly. Go Medical Billing welcomes every one of these 15 questions. Our 2.49% rate with no minimums, AAPC-certified coders, dedicated account managers, 2.8% average denial rate, and month-to-month terms speak for themselves.