A billing company touches every dollar your practice earns, so the choice deserves more than a sales call and a price. This guide gives you a practical way to compare companies: what to check, what to ask, what the contract should say and which warning signs mean you should keep looking.
Start With What Your Practice Needs
Before you talk to anyone, write down a short profile of your practice. Every company will ask for it, and having it ready makes quotes comparable.
- Specialty and the services you bill most
- Number of providers and locations, and the states you work in
- Monthly claim volume and monthly collections
- Your EHR and practice management system
- What is going wrong today: denials, slow payments, old A/R, staff turnover, credentialing
- What you want to keep in house, if anything
Check Fit Before Price
Specialty Experience
Ask how many current clients they bill for in your specialty. Coding rules, modifiers and prior authorization patterns differ a lot between, for example, behavioral health, orthopedics and radiology. A company that bills mostly primary care may struggle with surgical global periods.
Your EHR and PM System
Ask whether their team works inside your system every day. A company that has to move your claims into its own software adds cost and another place for errors.
Who Does the Work
Ask where the team is based, whether coders hold AAPC or AHIMA credentials, how many accounts each biller handles and who your single point of contact will be.
Questions to Ask Every Company
- How many practices in my specialty and state do you bill for, and can I speak to one?
- What happens in the first 30, 60 and 90 days after we sign?
- How often do you submit claims, post payments and work denials?
- What reports will I receive each month, and can I see a real sample with names removed?
- Who decides when a balance is written off, and do I approve write-offs above a set amount?
- How do you handle patient statements and patient calls about bills?
- What do you need from my staff each week?
- Will you sign a HIPAA business associate agreement?
- How do I get my data and open A/R back if we part ways?
What the Contract Should Cover
| Section | What to look for |
|---|---|
| Scope of services | A written list of what is included and what costs extra. |
| Fees | The rate, what it is applied to, and every other fee in one place. |
| Reporting | The reports you receive and when. |
| Access | You keep full access to your own billing system and data at all times. |
| HIPAA | A business associate agreement, required by HIPAA when a company handles patient information for you (45 CFR 164.502(e) and 164.504(e)). |
| Term and exit | Notice period, any termination fee, and how open claims and data are handed back. |
Warning Signs
- A firm price before anyone has looked at your volume, payer mix or specialty
- Promises of a specific increase in collections before they have seen your data
- No access for you to your own billing system or reports
- Long contracts with large exit fees and no performance terms
- Reluctance to sign a business associate agreement
- No references in your specialty
Compliance Matters Too
The HHS Office of Inspector General has published compliance guidance written specifically for third-party medical billing companies (Compliance Program Guidance for Third-Party Medical Billing Companies, 63 Fed. Reg. 70138). Ask whether the company has a compliance program, how it trains staff on coding and billing rules, and how it handles a billing error it finds after a claim was paid. A good partner will answer without hesitation.
Compare Two or Three Companies Side by Side
Ask each company the same questions, collect the answers in writing, and compare total cost against the work included. Speak to a reference practice of your size and specialty before you sign.
You can compare medical billing companies by specialty, state and EHR system, put up to three side by side, read our guide to what billing costs, or send one request and we will point you to companies that fit.
