Most practices choose a medical billing company the same way: they get a few referrals, compare websites, sit through sales calls, and sign with whoever seemed most competent in the demo. The problem is that none of the things you evaluate in a sales process tell you how the company actually performs once they have your claims.
The questions that matter are the ones that reveal accountability structure — not the ones that reveal features. Features are easy to demo. Accountability is hard to fake when you ask directly.
The 7 Questions That Matter
1. “What is your clean claim rate — and is that benchmark in our contract?”
Every billing company will tell you their clean claim rate during the sales process. The number is meaningless unless it’s contractually committed. Ask specifically: “What happens in our agreement if your clean claim rate falls below that benchmark?” A vendor confident in their performance has an answer. A vendor making verbal claims doesn’t.
Industry benchmark: 95%+ first-pass resolution rate. Best-in-class: 97–98%. Below 90% indicates systematic pre-submission errors.
2. “Who specifically works on my account — and what is their name?”
The answer to this question tells you more about the vendor’s model than anything else in the sales process. A dedicated model has a specific person, a name, a specialty background, and an EHR proficiency. A shared model says “our team” or “your account manager” — meaning your claims are processed by whoever is available.
Follow-up: “What happens if that person leaves? What is the replacement timeline, and who manages the account during the gap?”
3. “Can you walk me through exactly how you handle a [CO-50 / your top denial code] in [your specialty]?”
This question cannot be answered generically by someone with real specialty experience. A biller who knows your specialty describes a specific workflow: which documentation to pull, what to include in the appeal, which payer portal to use, typical response timeline. A generalist says “we call the payer and appeal” — which is true of every denial and tells you nothing.
4. “What are your HIPAA compliance specifics — BAA, device encryption, VPN policy?”
A signed BAA is table stakes. Ask beyond it: Are billing staff devices encrypted? What VPN policy governs EHR access? Is PHI stored locally on staff devices? What is the breach notification protocol? Any vendor that can’t answer these specifically has compliance gaps — regardless of what their website says about HIPAA compliance.
5. “What reporting do I receive, how often, and without me having to ask?”
The right answer: weekly automated reports showing clean claim rate, denial rate by payer, AR aging distribution, and net collection rate. Without asking.
The red flag answer: “We can run reports whenever you need them.” This means you will never have proactive visibility into performance — you’ll find out about problems when they’ve already compounded for months.
6. “What does your exit process look like?”
Before you sign, understand exactly what happens when you leave. Who owns the historical claims data? What format is it exported in? How long does the transition take? What is the notice period? A vendor that makes exit difficult is a vendor that knows their performance won’t retain you voluntarily.
7. “Can we do a free pilot before committing?”
A vendor confident enough in their performance to offer a free trial on real claims before any commitment is making a different statement than a vendor who asks you to pay for a discovery period or sign a 12-month contract before seeing a billing cycle.
Dr. Billerz offers a 4-week free pilot — your dedicated biller works your real claims at no cost. This is not standard in the industry. It should be.
Pricing Models and What They Mean for Accountability
| Model | How It Works | Accountability Implication |
|---|---|---|
| Percentage of collections (4–10%) | Vendor takes a cut of everything collected | Aligned incentive on collections — but no penalty for slow AR or high denial rates that don’t affect final collections |
| Per-claim flat rate ($4–10/claim) | Fixed fee per submitted claim | Incentive to submit claims — but no incentive to work denials, which don’t generate new claims |
| Hourly flat rate ($7–35/hr) | Pay for biller time | Accountability depends entirely on performance tracking — without Time Doctor or equivalent, hours logged ≠ work done |
| Flat monthly fee | Fixed monthly regardless of volume | Good for predictability — but no built-in performance incentive unless contract includes benchmarks |
The dedicated hourly model with Time Doctor tracking and weekly performance reporting combines the accountability of a percentage model (you can see the clean claim rate every week) with the cost predictability of a flat fee. It’s the model Dr. Billerz uses — for exactly these reasons.
Red Flags That Should End the Conversation
No free trial or pilot. They want you to commit before proving anything.
Contract over 6 months. A vendor that needs 12 months to prove their value is planning to outlast your patience, not earn your renewal.
Vague answers on HIPAA specifics. “We’re fully HIPAA compliant” without documentation means nothing.
Can’t name who works your account. Shared service. Your AR is distributed across a team with no individual accountability.
Pricing not published. They need a discovery call before telling you costs because the price adjusts to what they think you’ll pay.
No weekly automated reporting. You will find out about billing problems in months, not weeks.
Frequently Asked Questions
How do I choose a medical billing company?
Ask the 7 questions above before signing anything. The most important: who specifically works your account, what is their specialty experience, is the clean claim rate benchmark in the contract, and can you pilot before committing. Vendors who answer these concretely earn evaluation. Vendors who deflect have structural accountability gaps.
What percentage do medical billing companies charge?
Percentage-based companies charge 4–10% of net collections. For a practice collecting $80,000/month, that’s $3,200–$8,000/month. A dedicated billing staff model at $7/hr costs $1,120/month for the same coverage — with more direct accountability because one person is exclusively working your account.
How long does it take to switch medical billing companies?
A dedicated staff placement takes 10–14 business days to go live — your new biller works inside your existing EHR, no new system setup required. Full-service outsourcing transitions take 30–90 days depending on payer enrollment and system integration. The faster path is always the dedicated staffing model.
Ready to compare with a free pilot? Book a 15-minute call — or start the 4-week free pilot directly.
Related Resources
Best medical billing companies 2026 | Complete outsourcing guide | How to audit your current billing performance