Most practices don’t fire their billing company over one big screwup. It’s slower than that. A report that never quite answers your question. A denial nobody can explain. A line on the invoice you are pretty sure never came up on the sales call. After a year of that, you start shopping.
And every company you talk to sounds great. That’s the point of a pitch. The real differences only show up when you dig into the boring stuff: scope, fees, reports, and how hard it is to leave.
So think of this as the list I'd hand a friend who was interviewing us. Or anyone else.
What a Medical Billing Company Actually Does
Some companies code. Some only check your coding. Some won’t touch it at all. Eligibility checks, prior auths, patient statements, old A/R, credentialing… these get bundled in, sold as add-ons, or left out entirely, and the proposal won’t always make it obvious which.
1. Experience With Your Specialty
A psychiatry practice billing 90837s to a Medicaid MCO has almost nothing in common with an anesthesia group arguing over time units. Different codes, different modifiers, different ways to get denied.
A team that already lives in your specialty spots trouble in week one. One that doesn’t will learn on your claims, and you’ll be the one paying for the lessons.
When you ask about experience, push past “we do all specialties.” Which ones do they bill every single week? What do the top three denials look like in your specialty, and what do they do about them? Then ask to talk to a client who looks like you, same size and same kind of practice.
2. Exactly What's Included
Here’s what I’d want spelled out, one way or the other:
- coding and charge entry
- eligibility and benefits checks
- prior authorizations
- corrected claims and appeals
- payment posting
- patient billing calls
- A/R left over from before the switch
- credentialing and enrollment
People forget that last one until it bites them. Bring on a new provider, miss an enrollment step, and every claim they touch comes back denied. How sharp the billing team is doesn’t matter at that point. Ask whether credentialing is part of the deal or a separate invoice.
And get clear on what stays with your own staff. Appeals need records, and somebody on your side has to send them. When nobody wrote down whose job that was, it quietly becomes no one’s.
A one-page proposal that says “end-to-end RCM” and lists nothing underneath? That’s a proposal written to avoid commitments.
3. Coding Accuracy and Quality Checks
Clean claims start with codes that match the chart. Simple idea, easy to get wrong.
First, figure out what you’re actually buying. Are they assigning codes, reviewing yours, or just submitting whatever you send? Three very different services, and they sometimes go by the same name.
If coding’s included, ask who’s doing it. Certified coders, CPC or CCS? In your specialty? When a coder has a question, how does it get back to your clinicians: a ticket, an email, a weekly call? How do they keep up with payer edits like Medicare’s National Correct Coding Initiative (NCCI)? And do they audit their own coders? Most good shops do, regularly.
One thing that should make you nervous is any talk of "optimizing" codes past what the documentation supports. That isn't a revenue strategy. It's an audit waiting to happen.
4. How They Handle Denials
I know anyone can submit a claim. I care about what happens when the claim comes back.
A good denial process is not complicated. It is disciplined. Find the cause of the denial. Decide whether the denial needs a corrected claim or an appeal. Put a name and a deadline on the denial. Then tell the desk what went wrong so the denial does not happen again next month. That last step is the one most companies skip.
Ask to see a sample denial report, with info stripped out. I want denials broken down by reason, payer and dollars; what was done about each denial and what denials are still sitting open. If the denial report cannot tell you who owns a denial, that is a problem.
When a vendor quotes you a denial rate, ask how they count it. Per claim? Per line? Per dollar? Over what period? The same month of work can produce three very different numbers depending on the math. And ask how long, on average, it takes them to touch a denial after it lands. If they don’t know, they aren’t tracking it.
5. Total Cost, Not Just the Percentage
Most billing companies charge a percentage of what they collect for you. Physicians Side Gigs puts the usual range at 4% to 10%, with most practices landing around 5% to 7%. A few charge per claim or a flat monthly fee instead.
The percentage is just the headline, though. The real bill hides in the extras. Ask about setup fees, monthly minimums, clearinghouse and software charges, and postage on patient statements. Ask whether appeals, coding, credentialing, or old A/R cost extra. And ask what it costs to leave and get your data back. People forget that one.
Quick example. Company A quotes 4%, Company B quotes 6%. A looks cheaper. But if A bills separately for appeals, statements, and A/R cleanup, B could easily come out ahead by year-end. The only fair comparison is to give everyone the same numbers from your practice and ask for an all-in monthly estimate.
Since you’ll ask: we charge a flat 3% of monthly collections, with no setup fee and no long-term contract. A low rate only means something if the scope behind it is real, so hold our quote up against that list from #2, the same way you would anyone else’s.
What I’d steer clear of is a cheap percentage bolted onto a three-year contract, with a fee schedule you have to ask for twice.
6. Fit With Your EHR and PM System
Your billing partner should work in your system, not drag you into theirs. Changing software to suit a vendor means new licenses, retraining, and a few rough months your staff won’t thank you for.
So ask directly. Have they worked in your EHR and PM before, or will they be learning it on the job? Will you need extra licenses or a data migration? What will your staff still have to key in by hand?
Then ask them to show you instead of telling you. How does your office manager check a claim’s status? Where do documentation requests show up? Where do the reports live? And when an employee leaves, how fast does their access get shut off?
If moving to their platform is a condition of the contract, I’d think hard about why.
7. HIPAA Compliance and Data Security
Your billing company will see protected health information every day. Under HIPAA, that makes them a business associate, which means a signed business associate agreement before they touch anything. HHS has a plain-English rundown on business associates that covers what the agreement needs to include.
“We’re HIPAA compliant” is a slogan, not an answer. Ask how often staff get trained. Ask who can see what, and how access gets revoked. How do files move between you and them? If there’s a breach, what happens step by step, and how fast would you hear about it? Do any subcontractors touch your data?
If you want to check their answers against the source, the HHS Security Rule pages lay out what’s expected for electronic records. Remote teams are normal in this industry now, and that’s fine. Location isn’t really the issue. Controls are. Ask how devices, networks, and workspaces are locked down.
And if a company drags its feet on signing a BAA, or won't let you read it first, I'd end the conversation right there.
8. Clear Reporting Against Real Benchmarks
You can’t manage what you can’t see. Before you sign, get a sample monthly report and have them walk you through it line by line. If they struggle to explain their own report, that tells you plenty.
These are the numbers I’d watch, and roughly where a healthy practice sits:
| Metric | What it tells you | Target |
|---|---|---|
| Net collection rate | Of what you’re owed after contractual adjustments, how much you actually collect | 95% or higher |
| Days in A/R | How long it takes, on average, to get paid | Under 35 days |
| A/R in 0–30 days | How much of what you’re owed is still fresh | 70% or more |
| A/R over 120 days | How much is at risk of never coming in | 10% or less |
| Clean claim rate | Claims accepted on first submission without edits | 95% or higher (common industry target) |
| Denial rate | Share of claims denied on first pass | As low as possible; count it the same way every month |
The targets for net collections, A/R days, and aging come from ACAAI’s practice benchmark guide, which draws on MGMA data. Slow payers or a complex specialty can push A/R days past 35 without anything actually being broken.
Two warnings. First, get the formulas in writing. Two companies can report a metric with the same name and calculate it completely differently. Second, write down your own numbers before the switch, and keep old A/R separate from new claims. Otherwise you’ll never really know whether the new company is doing better.
9. Communication and Patient Support
Billing problems get fixed in conversation. Your front desk needs an answer, their biller needs a record, and the faster that loop closes, the faster you get paid. Find out who your account manager is, by name, and who takes the call when that person is away on vacation. Ask what response time they promise and whether that promise is in the contract. How do requests for documentation get to your team? How do they keep track of the ones that are not answered? When there is something who do you reach out to?
If they’ll be taking calls from your patients, pay extra attention. To a patient, that voice on the phone is your practice. Ask for a sample statement. Ask how they handle someone who’s upset about a balance, and what happens when a patient asks a clinical question. A generic support inbox where an actual person should be is not a great sign.
10. References, Onboarding, and Exit Terms
Call at least two references and choose practices that look like yours. Ask references how the transition really went. Ask how long it took to fix the big problem. Ask whether the reports ended up matching the sales deck. Then read the onboarding plan. A real onboarding plan covers system access, data transfer, claims in progress, staff training and a check‑in somewhere, between 30 and 90 days to see how it is going. The exit terms deserve as much attention, even if nobody likes planning the breakup on the first date.
- how long the contract runs, and whether it auto-renews
- how much notice you have to give, and what leaving early costs
- who keeps working your open claims after you go
- how you get your data back, how fast, and whether they charge for it
And remember that outsourcing billing doesn’t outsource your compliance responsibility. OIG’s physician education resources are worth a skim on what stays on your plate. Personally, I’m wary of multi-year contracts with heavy termination fees. A company that’s confident in its work doesn’t need to trap you.
Does Your Billing Company Need to Be Local?
Plenty of people start by googling “medical billing companies near me,” and that’s fine if face time matters to you. But nearly all billing work happens in software and payer portals now. Being across town doesn’t make anyone faster at appeals.
I’d care more about whether they know your payers and your state’s Medicaid quirks, whether they’re reachable during your office hours, and whether a real person answers the phone. Put local and remote companies through the same ten questions and see who holds up.
Signs It's Time to Switch Billing Companies
Already outsourcing? Keep an eye out for these:
A/R days keep creeping up, or more than 10% of your A/R is older than 120 days.
The same denials show up month after month, like nobody's fixing the cause.
You ask what's happening with open claims and get a vague answer.
The reports show collections and not much else.
Your staff is still doing billing work you're paying someone else to do.
If two or more of those sound familiar, it’s worth getting a second opinion.
Your Comparison Checklist
Give every company on your shortlist the same practice details and ask them the same questions. Then line up their answers in a table like this one. You’d be surprised how quickly the differences jump out.
| Factor | Evidence to request |
|---|---|
| Specialty experience | References from similar practices; common denials in your specialty |
| Service scope | Written list of what’s included, excluded, and what your staff still owns |
| Coding | Coder certifications and audit process |
| Denial management | Sample denial report; time from denial to first action |
| Pricing | Full fee schedule and an all-in monthly estimate on your numbers |
| Systems | Experience with your EHR/PM; any new software required |
| Security | Signed BAA and a description of safeguards |
| Reporting | Sample report with metric definitions |
| Support | Named account manager and escalation path |
| Contract | Term length, termination terms, and data return process |
Put Swift Billing Solutions to the Test
Everything above applies to us too, so here’s how we’d answer.
We charge a flat 3% of monthly collections. No setup fee, no long-term contract, which means we have to earn the next month every month. Our team knows behavioral health, psychiatry, physical therapy, anesthesiology, DME, infusion, and speech therapy billing inside and out. We cover the whole cycle, from eligibility and prior auths through coding, claims, posting, denials, and A/R recovery. We also help with credentialing, so new providers don’t start out buried in denials. And you get reports on the metrics above, as often as you want them.
Not sure how your current setup compares? Start with our free Practice Revenue Audit. We’ll benchmark your numbers and show you where the money is slipping, no strings attached.
Frequently Asked Questions
No. Some code for you, some review what your team codes, and some just submit what you hand them. Ask which one you're actually getting.
It depends on your volume and your team. Outsourcing tends to make sense once denials pile up, A/R starts aging, or you keep losing billers and starting over. A larger practice with a stable, experienced team can do fine in-house.
No, and be wary of anyone who hints otherwise. Payment depends on coverage, documentation, and payer decisions. What a company can commit to is response times, follow-up timelines, and honest reporting.
Usually 30 to 60 days, depending on system access, data transfer, and how many open claims are in flight. Keep your old company working the existing A/R during the handoff so nothing falls through.
