At some point, many practices wonder whether billing is worth doing in-house. Claims are piling up, denials are eating hours and someone on the team is spending half their week on the phone with payers. Outsourcing can be a good answer. It can also be an expensive disappointment if you sign up without asking the right questions.
Whoever you talk to, including us, these are worth asking.
What exactly is included?
Billing covers a lot of ground, and companies draw the lines differently. Ask whether the price includes claim submission, payment posting, denial follow-up and appeals, patient statements, and reporting. If something is not included, find out what it costs, and who does it.
How are you paid?
Some billing companies charge a percentage of collections, some a flat fee and some a mix. None is automatically better. What matters is that you understand it, and that it does not reward the wrong behavior. Ask for an example using your own numbers, so you can see what a typical month would cost.
Who actually touches our claims?
It is fair to ask who will be working on your account, whether it is the same person each time and how to reach them. A good billing relationship feels like having a team member, not sending claims into a void.
What will I see, and how often?
Ask what reports you will get. You want to be able to see what was billed, what was paid, what was denied and why, and how old your unpaid claims are. If you cannot see the numbers, you cannot tell whether it is working.
Who owns the data and the payer access?
Make sure your data stays yours, and that you can get it if you leave. Ask how access to your payer portals is set up, and whether those logins stay under your control.
What happens when something goes wrong?
Every billing operation has problems now and then. Ask how errors are found and fixed, who pays for resubmission when the mistake was theirs, and how quickly you will hear about a problem.
How do I leave if it does not work out?
Read the contract for the notice period, any minimum term and what happens to open claims when it ends. You hope you will never need that clause. Read it anyway.
Does billing depend on enrollment being right?
This is a question people rarely think to ask. A claim can be perfect and still be denied if the provider's enrollment with the payer is not in place or effective. A billing partner who also understands credentialing and enrollment can catch that early, and it is one reason we offer these services together.
If you want to see how we think about it, start with our services, try the billing calculator, or schedule a short meeting. We are happy to answer every question on this list.
This article is general information, not legal or financial advice. Requirements vary by state and payer.
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