Published by Fastora Medical Billing Solutions. We are a medical billing company, so we have an interest in how you evaluate billing companies — which is exactly why this guide focuses on questions and what honest answers sound like, rather than on promoting any particular vendor, including us.
The worst time to learn what your billing contract excludes is three months in, when the first denied-claim report arrives. Billing relationships fail on mismatched expectations far more often than on bad intentions: the practice assumed credentialing was included; the company assumed the practice handled authorizations; nobody said either out loud. The eighteen questions below close those gaps before you sign. They are grouped by the areas where misunderstandings actually happen, and each one includes what a complete answer sounds like — and what should make you pause. For the wider decision framework, see our guide on how to choose a medical billing company.
Pricing and contract questions
1. What exactly does your fee include — and what costs extra?
The single most important question. Ask for a written scope: claims submission, eligibility verification, prior authorizations, denial management and appeals, payment posting, patient statements, credentialing, reporting. Then ask what is billed separately — per-claim fees, eligibility transaction fees, setup, data migration. A complete answer names exclusions as readily as inclusions. Pause if: the answer stays at “we handle everything” percentages.
2. How is your fee calculated, and when is it invoiced?
Percentage of collections, flat monthly fee, per claim, or per provider — each behaves differently as your volume changes. Ask what “collections” means in their definition (insurance only, or patient payments too?) and whether there is a minimum monthly fee. Our pricing page shows how a transparent two-model structure is described.
3. What is the contract term, and how do we exit?
Ask about initial term, renewal, termination notice, and — critically — what happens to your data and your A/R on exit. Pause if: exit means losing access to your own billing history or unpaid claims data.
4. Are there setup or onboarding fees, and what do they cover?
Setup work is real (payer enrollments, EDI/ERA connections, workflow build). The question is whether it is priced and itemized up front, not discovered later.
Scope and workflow questions
5. Who verifies eligibility, and when?
Eligibility denials are the most preventable denials in billing. Ask whether verification happens before every visit, what depth of benefits is checked, and who acts on failures. A good answer describes a routine, not a tool name.
6. Who handles prior authorizations — submissions only, or tracking and renewals too?
Most authorization losses come from expirations and exhausted visit counts, not rejected requests. Ask who owns renewal tracking.
7. What happens when a claim is denied?
Ask for the actual process: how denials are categorized, how quickly they are worked, what documentation is assembled for appeals, and how many appeal levels are included. Then ask what root-cause reporting you receive, because denial handling without prevention restarts every month.
8. Do you handle credentialing and enrollment?
Credentialing delays quietly cap a growing practice’s revenue. Ask whether enrollment is in scope or referred out, and what the process and timeline look like for a new provider.
9. Which systems do you work in — ours, or yours?
If the company requires its platform, understand the migration cost and what you give up. If it works in your EHR, ask how it accesses it and what your staff must still do inside it.
10. What do you need from our staff each week?
Every billing arrangement has a practice-side workload: charge entry, documentation, deposits, patient questions. A credible company itemizes it honestly instead of implying zero.
Reporting and accountability questions
11. What reports do we receive, and how often?
Ask to see sample reports — not a dashboard tour. You want, at minimum: collections and adjustments, denial rate and top denial reasons, days in A/R and aging by payer, and claim status visibility. Monthly is a floor; ask whether you can see your numbers on demand.
12. Who is our named contact, and how do we reach them?
Billing problems are time-sensitive. Ask whether you get a named account contact or a ticket queue, and what response times look like in practice.
13. How do you measure your own performance?
A serious company tracks clean-claim rates, denial rates, and days in A/R for its clients and can describe how it reviews them. Pause if: the only metrics offered are testimonials or percentages they cannot source.
Experience and compliance questions
14. What experience do you have with our specialty and our payers?
Behavioral health billing is not orthopedic billing is not therapy billing. Ask what share of their current work resembles yours, and who on the team handles your specialty’s coding patterns.
15. How do you handle HIPAA compliance and data security?
Expect a signed BAA, a description of access controls and where data lives, and a straight answer on who can see patient information. This is table stakes — hesitation here ends the conversation.
16. What references can we speak with?
Ask for practices of similar size and specialty. A company confident in its work offers them; one that cannot may be newer than its marketing suggests. Judge the reasonableness of the answer, not just the names.
Transition questions
17. What does the first 90 days look like?
A credible onboarding plan covers payer enrollment checks, EDI/ERA setup, a parallel-run or cutover approach, and how existing A/R is handled during the switch — the period when claims most easily fall between two billers.
18. What happens to claims already in A/R when we start?
Old A/R is the most commonly orphaned asset in a billing transition. Ask explicitly whether working your existing backlog is in scope, at what cost, and who owns claims submitted before the start date.
How to use this list in an interview
Send the questions ahead. A company’s preparation is itself a signal: the ones who answer in writing, with specifics, before the meeting are showing you how they will communicate when a payer problem lands on a Friday. In the meeting, listen for the difference between process answers (“denials are worked within X business days, categorized by reason code, and you see the top five reasons in your monthly report”) and personality answers (“we’re very hands-on”). Process answers can be put in a contract; personality answers cannot.
Finally, write the answers down and attach them to the agreement. Scope disputes almost never start with dishonesty — they start with two honest memories of the same conversation. The written record protects both sides, and any company that resists putting its answers in writing has told you something important about how it expects the relationship to go.
The checklist at a glance
| Area | Questions | What you are really testing |
|---|---|---|
| Pricing & contract | 1–4 | Total cost, exit freedom, no surprises |
| Scope & workflow | 5–10 | Who actually does each task, on which systems |
| Reporting & accountability | 11–13 | Visibility into your money and their performance |
| Experience & compliance | 14–16 | Specialty fit and data safety |
| Transition | 17–18 | Whether claims survive the switch |
Frequently asked questions
How many companies should we interview?
Three is a practical number: enough to triangulate answers on scope and price, few enough to evaluate seriously. Use the same question list with each, in the same order — inconsistent interviews produce incomparable answers.
Should the cheapest quote win?
Only after scope is equalized. Quotes differ mostly by what they exclude; a lower fee that excludes denial appeals, credentialing, or eligibility work is not cheaper, it is narrower. Price the complete scope for every candidate.
What is the biggest red flag in a billing contract?
Losing your data on exit — or a scope described in adjectives instead of tasks. If the contract cannot say plainly what is included, what it costs, and what you keep when you leave, those gaps will be resolved later in the vendor’s favor.
Do we need a billing company, or better software?
If your gaps are workflow discipline and follow-through, software alone will not close them; if your team is strong and your tools are the constraint, a platform may be the honest answer. The comparison guides on this site — starting with the small practice comparison — map the service-vs-software line by scenario.
Conclusion
None of these questions are tricks. A good billing company answers them specifically, in writing, before you sign — and the answers become the standard you hold the relationship to afterward. Bring the list to every interview, including ours.
Looking for a more reliable medical billing partner? Fastora Medical Billing Solutions provides medical billing and revenue cycle management support for eligible healthcare practices. Request your free initial billing audit to discuss your practice’s billing workflow and identify potential areas for improvement.
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