What to ask a medical billing company before you sign

Handing your billing to an outside company is a big decision for a small practice. These are the questions worth asking any billing company, including us. Ask for the answers in writing.

1. What exactly is included?

Billing can mean many things. Ask whether the service covers claim submission, denial follow-up and appeals, payment posting, follow-up on old unpaid claims, and patient statements. Anything not on the list is probably not included.

2. How is the fee calculated?

Common models are a percentage of collections, a flat monthly fee and a fee per claim. Ask what the fee is based on, and whether there are setup fees, monthly minimums or charges for ending the agreement.

3. Will you sign a Business Associate Agreement?

Under HIPAA, a billing company that handles patient information for your practice is a business associate. A Business Associate Agreement should be signed before any patient information is shared. If a company hesitates, stop there.

4. Who will work on my account?

Ask who does the work, what training they have had, and who you contact when you have a question. Ask who will have access to your system and how that access is controlled.

5. Which system will you work in, and who owns the data?

Some companies work inside your practice management system. Others move you onto theirs. If your data lives in their system, ask how you get it back if you leave.

6. What reports will I get?

You should be able to see, at least monthly, what was billed, what was paid, what was denied and what is still open. Ask to see a sample report.

7. How do you handle denials?

Ask how denials are tracked, how quickly they are worked, and how the company makes sure appeal deadlines are not missed. A vague answer here is a warning sign.

8. How do I leave?

Ask about the notice period, what happens to claims that are still open, and how access to your systems is removed. A fair agreement is as clear about ending as it is about starting.

One more thing

Notice how quickly and how plainly a company answers these questions. It is a good preview of how they will answer you once you are a client.