Choosing a medical billing company is one of the most important financial decisions your practice will make. The right partner can increase your collections, reduce your denial rate, and free your clinical team to focus on patient care. The wrong one can cost you revenue, create compliance headaches, and leave your AR in worse shape than when you started.
The market is crowded with options — from national billing companies to local boutique firms to offshore billing services. How do you evaluate them? Start by asking these seven questions.
1. Do You Have Experience with My Specialty?
Medical billing is not one-size-fits-all. Cardiology has different coding requirements than mental health. Orthopedics has different payer rules than internal medicine. Ask any prospective billing partner how many clients they have in your specialty and what their denial rate is for that specialty.
A billing company that primarily works with primary care may not have the coding expertise to handle a complex orthopedic or oncology practice. Make sure their experience matches your needs.
2. What Is Your First-Pass Claim Acceptance Rate?
This is the percentage of claims paid by the payer on the first submission, without errors or rejections. The industry benchmark is 95% or higher. A billing company that can’t tell you their first-pass acceptance rate — or gives you a vague answer — is a red flag.
Ask for documented performance metrics, not just verbal claims. A reputable billing company will have data to back up what they tell you.
3. How Do You Handle Claim Denials?
Denials are inevitable — what matters is how quickly and thoroughly they’re worked. Ask specifically:
- What is your process when a claim is denied?
- How quickly do you act on denials?
- Do you appeal all recoverable denials, or only some?
- What percentage of your appeals are successful?
- At what point do you write off a denied claim?
A billing company that doesn’t have clear, systematic answers to these questions likely doesn’t have a strong denial management process — which means you’ll lose revenue that you’ve earned.
4. What Reporting Will I Receive and How Often?
You should never be in the dark about your own revenue. Ask what reports you’ll receive, how frequently, and whether you’ll have real-time access to a dashboard showing your key metrics — AR aging, denial rate, collection rate, days in AR, and net revenue per visit.
Transparent reporting is one of the clearest signals of a trustworthy billing partner. If a company is reluctant to give you full visibility into your financial data, that’s a serious warning sign.
5. Who Will Be My Point of Contact?
This matters more than most practices realize. Some billing companies assign you to a general support queue where every call or email goes to a different representative. Others assign a dedicated account manager who knows your practice, your payer mix, and your history.
A dedicated account manager who is proactive — not just reactive — is worth significantly more than a faceless ticketing system. Ask specifically: will I have a named account manager, and how do I reach them when I have a question?
6. What Are Your Fees, and How Are They Structured?
Medical billing companies typically charge one of three ways:
- Percentage of collections — The most common model (usually 4–9%). You pay based on what you collect, which aligns incentives well.
- Flat monthly fee — A fixed amount regardless of collections. Can be cost-effective for high-volume practices but risky if collections fluctuate.
- Per-claim fee — A fixed fee per claim submitted. Can work well for high-volume, low-complexity practices.
Watch out for hidden fees — setup fees, software fees, report fees, or exit fees. Ask for a complete fee schedule in writing before signing anything. Also ask what happens to in-progress claims if you decide to change billing companies — a reputable company will have a clear transition process.
7. Are You HIPAA Compliant, and How Do You Protect My Patient Data?
Any medical billing company will handle protected health information (PHI) on your behalf, making them a covered entity under HIPAA. They are legally required to sign a Business Associate Agreement (BAA) with your practice — if a billing company is reluctant to sign a BAA, walk away immediately.
Beyond the legal requirement, ask about their specific data security practices: encryption, access controls, staff training, breach response protocols, and whether they use offshore contractors who have access to PHI. Understanding how your patient data is handled is not optional — it’s your legal and ethical responsibility.
Bonus: Red Flags to Watch For
- Guaranteed results without knowing your current data or specialty
- Very low fees with vague explanations of how they make money
- No willingness to provide references from existing clients
- Long-term contracts with heavy exit penalties before you’ve seen results
- Lack of transparency about who actually works your accounts
- No dedicated point of contact — everything goes through a generic support line
Why TBC Solutions
We designed TBC Solutions around the answers to these exact questions. Our clients get a dedicated account manager, real-time reporting dashboards, proactive denial management, certified coding specialists, and full HIPAA compliance with a signed BAA. We work with practices of all sizes across a wide range of specialties, and we’re happy to share our performance metrics and client references.
We also offer a free billing audit before you commit to anything — so you can see exactly where your current revenue cycle stands and what a professional billing partner could do for your collections.
Ready to ask us these questions directly? Book a free consultation and let’s talk about your practice.