Performance
- What is your first-pass claim acceptance rate? This is the share of claims accepted the first time they are submitted. Higher means faster payment and less rework.
- What are typical days in accounts receivable for practices like mine?
- What is your denial rate, and how quickly are denials worked and appealed?
- Do you have experience in my specialty and with my EHR?
Visibility
- How do I see my numbers? Ask for a live dashboard login, not only a monthly PDF.
- Can I ask questions and get answers the same day, and who is my named account manager?
- Which reports are standard: collections by provider, by payer, aging, denial reasons?
Scope and fees
- What exactly is included? Eligibility checks, coding, prior authorization, payment posting, patient statements and credentialing are sometimes extra.
- How is the fee calculated, and on what base? A percentage of collections is common; check whether it applies to patient payments collected at your front desk.
- What are the contract length, the notice period and the exit terms?
Data and security
- Who owns the data and the payer enrollments if we part ways, and how do I get everything back?
- Are you HIPAA compliant with a signed Business Associate Agreement, and do you hold an independent audit such as SOC 2 Type II? Where does my data physically live?
A simple test
Ask for a free review of your last few months of billing. A good company will show you specific claims that were underpaid, denied or never followed up, and explain what they would have done differently.