What to look for in a medical billing company: a practical checklist
The most useful things to look for in a medical billing company are easy to verify: a signed Business Associate Agreement (BAA), clear monthly reporting with the metrics that matter, real experience in your specialty, the ability to work inside your existing EHR and practice management system, a pricing model you understand, and contract terms that let you leave without losing control of your receivables. Credentialing support and a clear plan for open A/R at the end of the relationship round out the list. A polished sales presentation tells you very little. The contract, the sample reports and the answers to specific questions tell you a lot.
This checklist is written for owners and office managers of small and mid-size practices comparing two or three vendors. Use it to structure your calls and to compare proposals line by line.
The checklist at a glance
| Item | What to ask for | What a good answer looks like |
|---|---|---|
| BAA and HIPAA | A copy of their BAA and a description of their safeguards | Signs a BAA before access, describes staff training and access controls in plain terms |
| Reporting | A sample monthly report | Collections, days in A/R, aging buckets, denial rate by payer, with someone to explain it |
| Specialty experience | Specialties they bill for now | Can talk through your common codes, modifiers and payer edits without notes |
| EHR fit | Whether they work in your EHR and PM | Works inside your system using access you grant and can revoke |
| Pricing | The full fee structure in writing | Clear base rate, clear list of anything billed separately |
| Contract terms | Term length, notice period, termination fees | Short or month-to-month terms with a defined notice period |
| A/R on exit | Who works open claims after termination | A written run-out plan and a commitment to return reports and data |
| Credentialing | Whether enrollment and revalidation are included | A clear answer on scope and cost |
1. A signed Business Associate Agreement
Under HIPAA, a billing company that handles protected health information on your behalf is a business associate, and you need a signed BAA with it before it gets access to your systems. Ask for the vendor's BAA early and have it reviewed. Then ask how they protect access in practice: whether staff receive HIPAA training, whether they use multi-factor authentication, and whether they work inside your systems or copy data into their own. Be cautious with claims like "HIPAA certified", since there is no official HIPAA certification for billing companies.
2. Reporting you can act on
Ask for a sample monthly report with names removed. At minimum it should show charges, payments and adjustments for the month, days in A/R, A/R by aging bucket (0 to 30, 31 to 60, 61 to 90, 91 to 120, over 120), denial rate by payer and top denial reasons. Better reports compare the month to prior months and explain what changed. Ask who will walk you through the numbers and how often. A report nobody explains does not help you run the practice. Our practice financial reporting page shows the kind of reporting we think practices should expect.
3. Experience in your specialty
Billing rules vary a lot by specialty. Behavioral health deals with time-based psychotherapy codes and carved-out benefits. Dermatology deals with modifier 25 and lesion destruction codes. Anesthesia billing uses base units and time. Ask which specialties the vendor bills for today and ask a few specific questions about your own: your most common CPT codes, the payer edits you run into, and how they handle your authorization requirements. Specific answers suggest real experience. If they answer only in general terms, the experience may be thin. Our specialties page lists the areas we work in.
4. Fit with your EHR and practice management system
Switching EHRs to suit a billing vendor is expensive and disruptive. Ask whether the vendor can work in your current system, and how much experience they have with it. A vendor that works inside your system keeps your data where it already lives, and you control access by creating and removing user accounts. Also ask which clearinghouse they plan to use and whether that requires new enrollments with your payers. If it does, ask who completes the paperwork and how claims will be handled while those enrollments are pending.
5. A pricing model you understand
Most billing companies charge a percentage of monthly collections. Others charge per claim or a flat monthly fee. Whatever the model, get answers to these:
- What exactly is the percentage applied to (insurance payments only, or patient payments too)
- Whether there are setup fees, minimum monthly fees or software fees
- Whether credentialing, patient statements, old A/R cleanup or coding audits cost extra
- How the fee is handled on refunds and recoupments
Our guide to what medical billing companies charge explains the pricing models in more detail.
6. Contract terms
Read the term, renewal and termination sections closely. Look for the length of the initial term, whether it renews automatically, how much notice you must give to leave, and whether there are early termination fees. A long term with an auto-renewal and a short window to cancel can lock you in for years. Month-to-month service with a defined notice period gives you more flexibility. Also check who owns the data and reports created during the relationship.
7. What happens to your A/R when you leave
This is the item practices most often skip. When you end a billing relationship, there will be open claims and balances still being worked. The contract should say whether the outgoing vendor keeps working claims for dates of service before the cutoff (a run-out period), for how long, how they are paid for that work, and what reports and data they hand back at the end. Without this, open A/R can sit untouched while each side assumes the other is handling it. Our guide on how to switch medical billing companies covers the run-out process step by step.
8. Credentialing support
New providers, new locations and payer revalidations all require enrollment work. If credentialing is late, claims for that provider deny or have to be held. Ask whether the vendor handles initial enrollment, CAQH profile upkeep, revalidations and re-credentialing, and whether there is an extra charge. See our credentialing services page for what that scope usually includes.
Other things worth checking
- A named point of contact. Ask who you will call and how quickly they typically respond.
- Front-end scope. Ask whether eligibility checks and authorization tracking are included or left to your staff.
- Denial handling. Ask how denials are categorized and whether root causes are reported back to you.
- Use of technology. If the vendor uses AI-assisted tools, ask what those tools do and who reviews the work before claims go out.
- Onboarding plan. Ask for a written timeline covering access, payer setup and the first month of claims.
Questions to ask on the call
- Will you sign our BAA, or can we review yours before any access is granted
- Can you send a sample monthly report
- Which specialties and EHR systems do you work with today
- What is included in your fee, and what is billed separately
- What is the contract term, notice period and any termination fee
- If we leave, who works the open claims, for how long, and what do we get back
- Is credentialing included, and does it cover revalidations
- Who reviews claims before submission, and how are coding questions sent back to providers
- How do you measure your results, and how will we see them
How SFA can help
SFA signs a BAA with every client, works inside your existing EHR, offers month-to-month service with 60 days' written notice, and includes credentialing with every billing plan. You can compare our scope against this checklist on our medical billing services page, or request a free practice audit where we review your billing and walk you through where revenue may be slipping.
Frequently asked questions
Does a medical billing company need to sign a BAA?
Yes. A billing company that handles protected health information for your practice is a business associate under HIPAA, and you need a signed Business Associate Agreement before it gets access to your systems or data.
What should a monthly billing report include?
At minimum: charges, payments and adjustments for the month, days in A/R, A/R by aging bucket, denial rate by payer and the top denial reasons. A useful report also compares results to prior months and comes with someone who explains the changes.
What happens to my open claims if I change billing companies?
That depends on your contract. Many agreements include a run-out period where the outgoing company keeps working claims for dates of service before the cutoff. Get the run-out terms and the list of reports and data to be returned in writing before you sign.
Member of the SFA Solutions revenue cycle team.