12 questions to ask a medical billing company

Ask a billing company who picks the codes, who will work your claims, what its fee is a percentage of, and what happens when you leave. Those four answers tell you more than a sales deck. The twelve questions below cover the rest, each with why it matters and what a good answer sounds like. A printable checklist is at the end.

Get the answers on fees, data and termination in writing. A good company won’t mind.

Coding and the work itself

1. Who picks the codes on our claims, and who approves them?

Why it matters. Claims go out under your practice’s name and NPI, and the practice answers for them. The HHS Office of Inspector General has said it has a “longstanding concern that percentage billing arrangements may increase the risk of upcoding” (OIG guidance for third-party billing companies, 1998). You want to know exactly where coding decisions are made.

A good answer is specific. “Our coders assign codes from the note” and “your provider picks the codes and we only scrub for errors” are both real models. Either way, you should hear who makes the final call, what happens when the company disagrees with the provider, and whether a code is ever changed without the provider seeing it. Be wary of a company that suggests higher-paying codes without pointing to what the note has to show.

2. Can I talk to the person who will actually work our claims?

Why it matters. The salesperson won’t be the one calling payers. Quality comes down to the person or small team assigned to your account and how many other practices they carry.

A good answer is a name and a call. Ask that person how many practices they handle, how they split their day between new claims and follow-up, and who covers when they’re out. If the company can’t say who will be assigned until after you sign, ask why.

3. What are the top three denial reasons for our specialty?

Why it matters. “We have experience with your specialty” can’t be checked. This question can. Someone who has worked your specialty’s claims knows where they get stuck.

A good answer names the denials, says what usually causes each one, and says what they do before the claim goes out to prevent it. A physical therapy biller might talk about visit limits and authorizations. A cardiology biller might talk about prior authorization for imaging. Vague answers about “medical necessity” with no detail are a warning.

4. How fast do claims go out, and how do you track filing deadlines?

Why it matters. Every payer has a deadline to submit a claim. New York-regulated insurers and HMOs must allow at least 120 days from the date of service (Ins. Law §3224-a(g)), but plans outside that law set their own limits, and some are shorter. The 1199SEIU Benefit Funds, for example, ask participating providers to submit within 90 days (1199SEIU provider manual, as of November 2026).

A good answer gives a target turnaround from a signed note to a sent claim, explains how they see claims nearing a deadline, and says how they prove timely filing when a payer disputes it. Our guide to timely filing limits in New York has the plan-by-plan detail.

5. Which denials do you work, and is there a dollar floor?

Why it matters. Small denials add up. Some companies don’t chase claims under a set amount because the work costs more than the fee they’d earn on it.

A good answer says whether every denial gets worked, how quickly, and when they appeal versus correct and resubmit. If there is a floor, you want to know the number and see a list of what was written off under it.

Money

6. What exactly is your percentage a percentage of?

Why it matters. Two companies quoting the same rate can bill you very different amounts depending on what they count: front-desk copays, refunds, run-out from your old biller, old AR. Our guide to billing company fees shows how much this can move the bill.

A good answer is a written list: what counts, what’s netted out, what doesn’t count. “Everything we collect” is not a definition.

7. What fees are there besides the percentage?

Why it matters. Setup fees, monthly minimums, clearinghouse fees, statement postage, credentialing and old AR are often priced separately. None is wrong to charge, but each should have a number before you sign.

A good answer goes down the list without hesitating and puts the numbers in your quote.

8. What will I see every month?

Why it matters. Once billing leaves your office, a report is how you know what’s happening. A month of quiet can hide a pile of unworked denials.

A good answer includes collections, denials by reason and dollar amount, an AR aging report by payer, and the status of anything near a filing deadline. Ask to see a sample report. Also ask how refunds and overpayments are handled and reported, because the practice owns those too. For Medicare, federal rules require an identified overpayment to be reported and returned within 60 days, with limited exceptions (42 CFR 401.305).

Privacy and compliance

9. Will you sign a business associate agreement before you see any patient data?

Why it matters. A company that bills for you handles protected health information on your behalf, which makes it a business associate under HIPAA. HHS lists billing and claims processing among the functions business associates perform, and requires a written agreement setting the limits on how they use that information (HHS, business associates).

A good answer is yes, before the audit or the first file. Ask to read the agreement in advance, and ask who in the company has access to your data and where it’s stored.

10. How do you screen your staff against exclusion lists?

Why it matters. The HHS Office of Inspector General keeps the List of Excluded Individuals and Entities. Anyone who hires an excluded individual or entity may face civil monetary penalties (OIG exclusions). New York’s Office of the Medicaid Inspector General keeps a separate state exclusion list (OMIG).

A good answer names both lists, says staff are checked when hired and on a regular schedule after, and offers to show you the policy.

11. Where is the work done, and who can see our data?

Why it matters. Some companies do part of the work through subcontractors or teams in other locations. That isn’t automatically a problem, but you should know who touches your patients’ records.

A good answer says where the people working your account are, whether any subcontractor is involved, and that any subcontractor that handles patient data has signed its own business associate agreement.

Leaving

12. What happens when we part ways?

Why it matters. The end of a contract is when practices lose money: claims nobody owns, remittances going to a portal you can’t log in to, and history you can’t get back. HIPAA requires the company to return or destroy your patients’ information at the end of the contract where feasible (45 CFR 164.504(e)). Which files you get, in what format, and who works the claims still open are contract terms.

A good answer covers notice period, any termination fee, who works the run-out and at what price, and a list of the files you’ll get back: claim history, remittances (835s), AR aging and patient balances. Ask, too, that payer portal and clearinghouse accounts stay in your practice’s name. For anything about who owns what under your contract, ask a healthcare attorney.

Printable checklist

1. Who picks the codes, and who approves them?
2. Can I talk to the person who will work our claims?
3. What are our specialty’s top three denial reasons, and how do you prevent them?
4. How fast do claims go out, and how do you track filing deadlines?
5. Which denials do you work, and is there a dollar floor?
6. What exactly is your percentage a percentage of? (in writing)
7. What fees are there besides the percentage? (in writing)
8. What will I see every month? (sample report)
9. Will you sign a BAA before you see any patient data?
10. How do you screen staff against the OIG and NY OMIG exclusion lists?
11. Where is the work done, and who can see our data?
12. What happens when we part ways? (in writing)

Marlow answers all twelve on a first call, and the security answers are also on our security page. If you’d like to test a company’s answers against your real claims, a free billing audit ranks your denials by dollars from 12 months of remittances.

Sources

• HHS OIG, Compliance Program Guidance for Third-Party Medical Billing Companies, 63 FR 70138 (1998)
• New York Insurance Law §3224-a
• 1199SEIU Benefit Funds provider manual, claims and reimbursement
• 42 CFR 401.305, reporting and returning overpayments (eCFR)
• HHS, Business associates
• 45 CFR 164.504(e), business associate contracts (eCFR)
• HHS OIG, Exclusions and the LEIE
• NY Office of the Medicaid Inspector General, Medicaid exclusions

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.