Your billing company touches every dollar your practice earns. The wrong partner quietly costs you money through unworked denials, stale accounts receivable, and reporting that tells you everything except what to fix. The right partner does the opposite: clean claims go out fast, denials get worked with discipline, and you always know exactly where your revenue stands.
This guide is a practical vetting framework — a checklist to run, red flags to watch for, and the questions to ask on a sales call. It applies whether you are outsourcing for the first time or switching away from a vendor that is not delivering.
Start with your problems, not their pitch
Before taking a single sales call, write down what is actually broken. Is your days in A/R climbing? Are denials piling up unworked? Is credentialing backlogged? Did your in-house biller leave and take all the institutional knowledge with them? Do you have no visibility into any of it?
A vendor should be evaluated against your specific problems, not against a generic feature list. If your core issue is denial management, a company that excels at clean-claim submission but has a thin follow-up process will not solve it. Define the job before you hire for it.
The vetting checklist
Run every candidate through these eight checks. A strong vendor will answer all of them directly and in writing.
1. Fee transparency. Ask for the complete fee picture: is the fee a percentage of collections or a flat monthly fee, and exactly what goes into the denominator — gross charges, net collections, or something else? Ask about setup fees, per-claim charges, clearinghouse pass-throughs, and separate fees for credentialing or old A/R recovery. Pricing should be quoted and scoped in your written proposal after the vendor reviews your volume and payer mix. Verbal estimates are not a fee schedule. For a deeper look at how billing fees are typically structured, see our guide to medical billing pricing.
2. Reporting you can actually use. Ask to see sample reports before you sign: an A/R aging summary, a denial report broken down by reason and payer, and a monthly performance summary. Ask how often reports arrive and whether you get live dashboard access. If a vendor will not show you a sample report during the sales process, assume you will not get useful reporting after you sign.
3. Specialty experience. Billing for orthopedics is not billing for behavioral health. Ask which specialties the vendor serves today, how many providers in your specialty they currently bill for, and how they stay current on your specialty’s coding and payer rules. Generic experience is not a substitute for your specialty’s specifics. You can browse how billing differs across fields on our specialties page.
4. References you can check. Ask for two or three current clients similar to you in size and specialty — and actually call them. Ask the references what surprised them after signing, how the vendor handles problems when they arise, and whether they would sign the contract again.
5. Contract terms. Read the initial term length, the auto-renewal clause, the termination notice period, and any early-termination fees. Look for who is responsible for transition assistance if you leave and how long post-termination support lasts. Shorter initial terms with clear exit language are a sign of vendor confidence.
6. Data ownership. Your claims data, remittance history, and patient records belong to you. Confirm in writing that you own all data, that you can export it in a usable format at any time, and that your export rights survive termination of the contract.
7. Communication. Ask who your day-to-day contact will be, how quickly they respond, and what the escalation path looks like when something goes wrong. Ask for a regular meeting cadence — monthly at minimum — with agenda items tied to your numbers, not theirs.
8. Compliance posture. Confirm the vendor will sign a business associate agreement and that your data is handled under HIPAA safeguards. Ask how they train staff on privacy practices and how they control access to your systems.
Red flags that should end the conversation
- Guaranteed results. No ethical vendor guarantees a specific collection increase or a target denial rate. Promises of guaranteed results are a walk-away signal.
- Vague or evasive fee answers. If you cannot get a clear written fee schedule during the sales process, you will not get clear invoices afterward.
- Long lock-ins with heavy exit penalties. Multi-year terms with steep termination fees protect the vendor, not you.
- No sample reporting. A vendor confident in its work shows you the reports upfront.
- High-pressure sales tactics. Legitimate partners let you check references and have your attorney read the contract.
- Reluctance to sign a business associate agreement. This one is non-negotiable. Move on.
Questions to ask on the sales call
Bring this list and take notes on the answers:
- What exactly is included in your fee, and what costs extra?
- Can you show me a sample monthly report and a denial breakdown by payer?
- Who will be my day-to-day contact, and what is the escalation process?
- How many providers in my specialty do you currently bill for?
- What happens to my data and my open claims if I terminate the contract?
- What does onboarding look like, and what will you need from my team?
- How do you handle credentialing and payer enrollment for new providers?
Making the final decision
Score each candidate against the checklist rather than deciding on price alone. The cheapest vendor is rarely the cheapest once unworked denials and write-offs are factored in. Weight the factors that map to your specific problems, check the references, and read the contract before you sign it.
If you are still unsure, start with an independent review of your current billing before committing to a vendor. An audit shows you exactly where revenue is leaking, which makes the vendor conversation far more productive.
Frequently asked questions
What should a medical billing company charge?
Fee models vary — most commonly a percentage of collections or a flat monthly fee, sometimes with separate charges for credentialing, clearinghouse use, or old A/R recovery. Because the right structure depends on your specialty, claim volume, and payer mix, pricing is quoted and scoped in your written proposal after we review those details.
How long does it take to switch billing companies?
Typically several weeks to a few months, depending on the clearinghouse cutover, payer enrollment status, and the size of the A/R being handed off. A structured transition plan keeps claims moving during the switch.
Can I keep my current EHR and practice management system?
In most cases, yes. We work inside your existing systems, and compatibility is confirmed during onboarding — you do not need to change software to change billing vendors.
Will a billing company increase my collections?
No one can honestly guarantee a specific result. What disciplined billing does is fix the processes that lose money: faster clean-claim submission, systematic denial follow-up, and consistent A/R work. Note that no client outcomes are cited until verified and permissioned.
Who owns my billing data if I outsource?
You do. Confirm in the contract that you own all claims data, remittance records, and reports, and that you can export them in usable formats at any time — including after termination.
Does MBSG work with small practices?
Yes. Smaller practices often feel billing pain most acutely because there is no margin for unworked denials. Our outsourced medical billing service and our guide for medical billing for small practices cover how the model works for smaller teams.
Ready to see exactly where your revenue is leaking? Get a Free Billing Audit. Medical Billing Services Group — Medical Billing & Revenue Cycle Management — is a remote company serving practices in all 50 states. Call +1 (307) 396-4107 or email contact@medicalbillingservicesgroup.com. You can also learn more about us or contact us directly.
General educational information, not legal advice or a guarantee of reimbursement. Requirements vary by payer, plan, setting and date of service.