Outsourcing medical billing can cover staffing gaps, reduce rework and improve collections, but only with the right partner. The wrong fit can leave you with less visibility into your own revenue than before. Use this checklist to compare billing companies on the things that matter.
Be clear about why you are outsourcing
Before you talk to anyone, write down the problem you want to solve: denials, staff turnover, old A/R, slow payments or simply the time billing takes. It will help you see which proposals address your real issue and which only sound good.
Scope of services
Ask exactly which steps the company handles and which stay with your team:
- Eligibility checks and prior authorizations
- Coding, or billing only
- Claim submission and rejection handling
- Payment posting
- Denial management and appeals
- A/R follow-up, including the older A/R you already have
- Patient statements and patient calls
- Credentialing and enrollment
Gaps between what you assume and what the contract says cause most of the friction later.
Experience with your specialty and payers
Billing rules vary a lot between specialties and payers. Ask about experience with practices like yours, with your main payers and with your state’s Medicaid program. Ask for examples of problems they have solved for similar practices.
Reporting and transparency
You should never have to ask how your billing is going. Look for:
- Regular reports on the core KPIs: net collection rate, days in A/R, denial rate and A/R over 90 days.
- Denials broken down by reason and payer.
- A named contact who reviews the numbers with you.
- Continued access to your own practice management system and data.
Systems and access
Find out whether the company works in your existing EHR and practice management system or moves you to its own. Working in your systems usually means less disruption, and your data stays in your hands.
Security and compliance
A billing company handles protected health information, so it must sign a business associate agreement. Ask how it controls access to your systems, trains its staff, protects data on its devices and responds to incidents.
Pricing
Common models are a percentage of collections, a flat monthly fee or a fee per claim. Make sure you understand:
- What the percentage applies to, and whether it includes patient payments.
- What costs extra, such as old A/R, credentialing or patient calls.
- Minimum fees and contract length.
- What happens to work in progress if you leave.
The lowest quote is not the lowest cost if collections fall.
Transition plan
Ask how onboarding works: who does what in the first 30, 60 and 90 days, how existing A/R will be handled, and how your team will learn the new process. A clear plan avoids a dip in cash flow during the switch.
Questions to ask before you sign
- Who will work on our account, and where are they based?
- How soon are claims submitted after charges are entered?
- How often are denials worked, and how are appeals decided?
- What will we receive each month, and who reviews it with us?
- How do we get our data back if we end the contract?
Ace’s medical billing and revenue cycle management services work within your existing systems, with regular KPI reports. We are happy to walk through this checklist with you.