What to decide first
- Which services you need included
- Which systems and reporting expectations are non-negotiable
- Who will own denials, AR follow-up, and escalation
- How pricing will change as your volume or scope changes
Sales-call question scorecard
Use the same prompts on each call so answers are easier to compare after the conversation.
Services
Start with scope so each vendor is responding to the same set of needs.
- Which billing, coding, denials, credentialing, and patient billing tasks are included?
- Which services are handled by your internal team versus outsourced partners?
- Do you support our specialty and payer mix?
- What does onboarding require from our staff?
Specialty Fit
Specialty experience should be verified before a practice treats a vendor as a serious shortlist candidate. Public profile fields can show specialty mentions, but the sales call still needs to confirm workflow depth, payer mix, and handoff responsibilities.
- Which specialties similar to ours have you supported, and what billing workflows were involved?
- Which payer mix, documentation patterns, coding handoffs, or denial patterns should we discuss for our specialty?
- Can you explain what work stays with our staff when specialty-specific questions come up?
- If a profile does not list our specialty, should we treat that as missing public detail rather than a confirmed mismatch?
Pricing And Contract Terms
Ask pricing questions in a way that exposes exclusions, minimums, and future cost changes.
- What pricing model do you use: percentage of collections, flat fee, per-claim, monthly, or hybrid?
- Are there setup fees, monthly minimums, software fees, or implementation charges?
- Which services are excluded from the base price or billed separately?
- What contract length, cancellation terms, and renewal terms should we expect?
Systems
Software fit affects implementation time, reporting quality, and day-to-day coordination.
- Can you work inside our current EHR or practice management system?
- Do you need direct system access, file exports, or integration work?
- How are missing documents, coding questions, and claim issues routed?
- What happens if our system is not one you commonly support?
Reporting
Reporting should make performance and accountability easier to review.
- Which reports do we receive and how often?
- Do reports include denials, aging AR, collections, payer follow-up, and trends?
- Who reviews performance with our practice?
- What metrics trigger escalation or process changes?
Denial Ownership
Denial management questions should expose who owns each step after a rejection or denial appears. The goal is not to ask for a promised reduction rate; it is to understand follow-up, reporting, appeal workflow, and unresolved-claim escalation.
- Who identifies denied claims, sorts root causes, corrects claim issues, and decides when an appeal is needed?
- Which denial trend reports do we receive, and how often are they reviewed with our practice?
- Which denial tasks stay with our internal team, such as clinical documentation, coding clarification, or payer-specific follow-up?
- How are recurring payer issues, eligibility problems, payment posting gaps, and old AR handoffs documented?
Credentialing Scope
Credentialing and enrollment work can involve document collection, CAQH maintenance, payer enrollment, recredentialing, rejection follow-up, and practice handoffs. Ask vendors to define the exact scope before comparing them with billing-only quotes.
- Which provider documents, payer forms, CAQH updates, and enrollment steps do you manage?
- Who tracks recredentialing dates, payer follow-up, rejected applications, and missing information requests?
- Which steps require our providers, owners, or office staff to respond directly?
- How is credentialing status reported while payer enrollment or recredentialing is still open?
Onboarding And Ownership
Implementation should make responsibilities clear before the vendor starts touching claims, payments, or patient balances.
- Who owns implementation and what is the expected timeline?
- What access, files, payer information, and workflow documentation do you need from us?
- Who owns denials, aging AR, payer follow-up, and unresolved billing questions?
- How are recurring problems escalated and documented?
Compliance, Security, And References
Billing vendors may handle sensitive operational and patient-related information, so confirm process maturity before signing.
- How do you handle HIPAA-related requirements, including BAA documentation for billing work?
- How is system access managed when staff change or a contract ends?
- Can you share references from practices with similar specialty, size, or payer mix?
- What happens to reports, work queues, and historical data if we leave?