Questions to Ask a Medical Biller
These are questions to ask a medical biller before you trust one with your practice's claims, written for a physician, practice owner or office manager hiring either an employee or an outside billing company. They run in the order the interview tends to go: experience with your specialty and payers, how a claim is built and sent, denials and aging receivables, working together week to week, security and who can touch the money, then fees, the contract and the exit. Some apply only to a billing company and some only to an employee, so skip whichever half does not match your hire.
The questions
Each question, and why to ask it
Experience
How long have you been billing, and how much of that has been in our specialty?
Why ask it
Years alone say little, because a therapy session, a surgery with modifiers and an anesthesia case billed in time units have almost nothing in common. Ask what share of their work today is in your field: one client three years ago is not fluency. If your specialty is new to them, ask which of your ten most used codes they would have to learn.
Which payers do you bill most often, and which of ours have you never billed?
Why ask it
Hand over your payer mix first: the handful of plans that make up most of your revenue. Each plan has its own portal, its own edits and its own habits around authorizations, so the ones they have never billed are where your first rejections will come from. Name government programs, workers' compensation and auto claims separately, since each runs on its own rules.
Do you hold a billing or coding certification, and who chooses the codes on the claims you send?
Why ask it
Billing and coding are two jobs, and a certificate in one says little about the other. The second half matters more: the codes may come from your clinicians, from a certified coder on their side, or from the biller reading the note. Whether a credential is required depends on the employer and the payer, so treat it as evidence of training and ask what it took to earn.
How many providers and how many claims a month are you handling right now?
Why ask it
Set the number beside your own volume. A candidate from a two-provider office may be stretched by twelve, and a service that gives each biller a long list of practices will get to yours late in the week. With a company, ask how many accounts the person assigned to you already carries.
Tell me about a practice whose collections you turned around. What was wrong, and what did you change?
Why ask it
A real story has a cause in it: charges entered a week late, an authorization step nobody owned, a payer underpaying one code for a year. Be wary of a story that is only a bigger number at the end. Ask how long the fix took to show up in the deposits, because that is roughly what you would be waiting for.
Who would work our claims day to day, and where are they based?
Why ask it
This one is for a billing company. The owner on the sales call is often not the person keying your charges, and some firms send part of the work to staff in another country. Neither rules them out, but you should know who can open your patient records, and you should have ten minutes on the phone with the person assigned to you before signing.
How do you find out about code updates and payer policy changes before they start costing us claims?
Why ask it
Code sets are revised on a regular cycle and payers announce policy changes in bulletins that are easy to miss. A believable answer names sources: the payer newsletters they read, a coding association, the update notes from the software. Then ask for the last change that affected a client and what they did the week it took effect.
Have you handled payer enrollment and credentialing, or would that stay with us?
Why ask it
Claims for a clinician a plan has not yet enrolled tend to come back unpaid or paid at the wrong rate, and the cause sits outside billing. Decide now who tracks applications and renewal dates. If you are about to add a provider, ask how long each of your main plans took the last time they did it.
Tell me about a billing mistake of your own. How was it caught, and what did it cost?
Why ask it
Anyone who has billed for long has one: a batch sent to the wrong payer ID, a modifier left off for a month, payments posted to the wrong patient. The parts to listen for are who noticed, how fast the claims were corrected, and whether the practice was told without having to ask. An applicant with no example has either done little billing or would not tell you about the next one.
Can we call a practice like ours that you bill for now, and one that stopped using you?
Why ask it
Current clients are chosen for their goodwill, so the former one is the call that tells you something. Ask both how long payments took to settle after the switch and what the monthly report looked like in practice. For an in-house candidate, the equivalent is a previous office manager or physician, not a coworker.
Claims
Walk me through one claim, from the patient checking in to the payment being posted.
Why ask it
Someone who does this daily gives you the steps without pausing: eligibility, charge entry, scrubbing, submission, the clearinghouse response, the remittance, posting, then any balance moved to the patient or a second plan. Note which steps they hurry past. That is usually the part they hand to someone else, and you need to know who.
How soon after a visit does the claim go out?
Why ask it
You want a number of business days and what it depends on. Most of the delay is normally upstream, in notes that are not signed or charges that sit unentered, so a good biller will turn the question back on your providers. Write the figure down: it belongs in the contract or the job description.
What share of your claims are accepted the first time, and how do you work that figure out?
Why ask it
This is the clean-claim rate, and the definition changes the number. Some count a claim that got past the clearinghouse, others only one that was paid without being touched again. Ask which they mean, over what period, and for a client of your specialty, then ask to see it on a report and not on a brochure.
What do you check on a claim before it leaves?
Why ask it
Listen for the specifics of scrubbing: that coverage was active on the date of service, that the diagnosis supports the procedure, that modifiers and place of service are right, that an authorization number is attached where one was needed. A reply that amounts to 'the software catches it' means nobody is reading the claims the software passes.
Who verifies eligibility and gets prior authorizations: you or our front desk?
Why ask it
Many avoidable denials start before the patient is seen, and this question settles who owns that. Either answer can work; what fails is each side assuming the other does it. If it stays with your staff, ask what the biller needs recorded in the chart so the claim can carry it.
What do you need from our providers and front desk so that claims go out right the first time?
Why ask it
The experienced ones have a list ready: insurance cards scanned at every visit, notes signed within a set number of days, authorizations recorded where the biller can find them. Ask who would tell a doctor that late documentation is holding up payment. If that person turns out to be you, it is better to know today.
When the note does not support the code the provider picked, what do you do?
Why ask it
Ask this slowly, because it is the compliance question on the page. The answer to hope for is that they send it back to the provider with a query and change nothing on their own. A biller who quietly raises or lowers codes to get claims paid is creating a problem the practice may have to answer for.
How do you catch a visit that never became a claim?
Why ask it
A missed charge produces no denial and no error, so nothing flags it unless someone compares the schedule with the charges entered. Ask how often they run that comparison and what they do about the gaps. Practices with procedures, hospital rounds or supplies lose the most here, so say so if that is you.
After the primary plan pays, how do the secondary claim and the patient balance get handled?
Why ask it
Secondary claims are fiddly and easy to let drop, since each is small. Ask whether they are sent automatically or by hand and how long that usually takes. Then find out when the patient first hears what they owe, because a statement that arrives four months after the visit is rarely paid quickly.
How do you know when a plan has paid less than our contract says it should?
Why ask it
Posting whatever arrives and adjusting off the rest is the quiet way money is lost. To catch an underpayment the biller needs your fee schedules for each contract loaded somewhere and a habit of comparing. If the answer is that payers generally pay correctly, ask when they last recovered an underpayment and how they found it.
Denials and A/R
What is your denial rate, and what are the three reasons you see most?
Why ask it
The rate needs the same care as any figure quoted in a sales call: denied on first pass, or still unpaid after rework? The reasons are the more useful half. Someone who can list eligibility, missing authorization and a coding edit without looking it up is tracking causes, which is how the rate comes down.
What happens on the day a denial comes in?
Why ask it
Look for a queue and a clock: who sees the denial, how many days before it is touched, and where the reason is logged. A good answer also separates the simple fix, a corrected claim sent back, from the formal appeal with records attached. 'We resubmit it' as the whole reply is how the same claim gets denied twice.
Tell me about an appeal you won that looked lost at first.
Why ask it
You are testing whether they will argue with a payer or just accept the first no. The story should include what they sent, such as the clinical note, the plan's own policy or a letter from the provider, and how many rounds it took. It also shows you how much of your doctors' time their appeals tend to need.
What are days in A/R at the practices you bill for, and how much of the total is older than 90 days?
Why ask it
Days in A/R is shorthand for how long money takes to arrive, and the share past 90 days shows how much may never arrive. Both swing with specialty and payer mix, so ask for a practice like yours and set the answer beside your own aging report. An in-house candidate can tell you what the two numbers were at their last office when they started and when they left.
How often do you go through the aging report, and which accounts do you start with?
Why ask it
Receivables get harder to collect the longer they sit, so you are listening for a rhythm (weekly is common) and a rule for the order, such as the largest balances or the claims closest to a payer's deadline. 'I start at the top of the list' usually means the bottom of the list never gets worked.
How do you make sure a filing or appeal deadline is not missed?
Why ask it
Every plan sets its own window for submitting a claim and for disputing a denial, and the lengths differ by payer and by contract, so ask how they know yours. A claim that misses the window is usually money gone for good. You are hoping for a tracked date per payer, not a general sense of urgency.
What do you write off, and who has to approve it?
Why ask it
There is a difference between the contractual adjustment a plan requires and a balance someone gave up chasing. The first is routine; the second should need your sign-off above an amount you set, and it should appear on a report you read. A biller who can zero any balance alone can make the receivables look healthier than they are.
What do you do when a payer asks for money back or requests records on a batch of claims?
Why ask it
Refund demands and audits come with response dates, and ignoring one tends to end with the payer taking the money out of a later payment. Ask who tells you, how fast, and whether they have ever disputed one. The rules for government programs are their own subject, so have them explain how they handle those for your plans.
How do you find credit balances, such as a patient who paid twice, and what happens to the money?
Why ask it
Credit balances pile up unnoticed: a copay collected twice, two plans that both paid as primary. How and when an overpayment has to be returned depends on the payer, the program and the state, so ask what they do for each of yours and who approves the refund. A biller who has never raised one with a client is not looking for them.
How do you handle patient statements, payment plans and calls from patients about a bill?
Why ask it
For most patients the bill is the last contact with your practice, and the person who answers that call is speaking as you. Ask how many statements go out before anything else happens and whether they can set up a payment plan. Rules on patient billing and on sending accounts to a collection agency vary by state, so agree that the decision to send one stays with you.
Working together
Which billing software and clearinghouse do you use, and would you work inside our system?
Why ask it
An outside service that insists on its own platform is asking you to move your data into a place it controls, which makes leaving harder. Working in your practice management system keeps the records with you. For an employee, ask how long they took to get comfortable in the last system that was new to them.
Can you show me the monthly report a practice our size would get?
Why ask it
Ask for a real one with the names removed. A useful pack shows charges, payments, adjustments, receivables by age and by payer, and denials by reason. If what arrives is a single page of totals, you will not be able to tell a good month from a month in which a lot was adjusted away.
Which numbers should we judge your work on six months from now?
Why ask it
Let them choose, and see whether they pick measures that could embarrass them: days in receivables, the share of receivables older than 90 days, net collection rate, denial rate. Total dollars collected is the weakest of the lot, since it rises with patient volume whatever the biller does. Record where each number stands before they start.
Could I look up where a particular claim stands without having to ask you?
Why ask it
Your own login to the billing system and the clearinghouse is the difference between oversight and trust. A patient will phone the front desk about a bill one day, and someone there needs to see the claim's history. Reluctance here is worth a follow-up about what exactly they would prefer you did not see.
When our front desk has a question about a claim or a patient's balance, who do they call, and how soon do they hear back?
Why ask it
Billing questions reach the front desk at the window, with the patient standing there, so a reply three days later is no reply. Ask for a named contact, a usual response time, and whether there is a standing call each month to go through the report together. For an in-house hire the same question is about where they sit and when they can be interrupted.
What would the first 60 days look like, and what happens to the claims that are already outstanding?
Why ask it
A handover has an awkward middle, when the old biller has stopped and the new one is still being set up with your payers and clearinghouse. Ask for a week-by-week plan and for the dip in deposits they would expect. Old receivables are a separate job: some services decline them, some charge a different rate, and an employee will need hours set aside.
When you are away for a week or two, who sends our claims and posts the payments?
Why ask it
A lone biller with no cover is the main weakness of hiring in-house, and the gap shows up in the deposits some weeks later. Someone on your staff should at least know how to submit claims and post payments. With a company, ask whether the stand-in has ever worked your account or would be seeing it cold.
Security
Will you sign a business associate agreement, and does anyone outside your company see our patient information?
Why ask it
In the United States an outside biller handles protected health information on your behalf, and a written agreement about that is the normal starting point under HIPAA. Have your attorney or compliance adviser confirm what yours has to say. The second half is about subcontractors, coders and overseas staff: each one is another party holding your patients' records.
How would your staff sign in to our system: each with their own login, on which devices, and from where?
Why ask it
One shared password for a whole billing team means nobody can tell who opened a chart. You are listening for a named login per person, two-step sign-in, and work done on company machines and not a family laptop. Ask also how fast an account is closed when one of their staff leaves.
What privacy training do your staff get, and have you ever had an incident with patient data?
Why ask it
Ask for dates, since 'everyone is trained' usually means once, at hiring. An incident in their past need not rule them out. What you are judging is whether they tell you plainly what happened, who was notified and what changed, because that is how they would treat one involving your patients.
Where do insurance and patient payments land, and who is able to change that?
Why ask it
The safer arrangement is for payments to arrive in a bank account the practice owns, with the biller posting them and not receiving them. Ask who can redirect an electronic deposit, issue a refund or edit bank details with a payer, and whether a second person sees the change. If money would ever pass through the billing company's own account, stop and get advice first, since some programs have their own rules about who may be paid.
Which parts of billing would you want someone else to check, so that no one person does it all?
Why ask it
This suits an in-house candidate best. When one person enters charges, posts payments and makes adjustments, an error or a theft can sit hidden for a long time. A candidate who suggests that you review the adjustment report and reconcile deposits to the bank is describing sound controls, and is not offended by them.
What insurance does your company carry for billing errors or a data breach?
Why ask it
Ask to see the certificate, not just hear the answer. Then read what the service agreement says about a mistake on their side, since contracts often cap what the company will pay. For an employee the parallel step is a background check, and what an employer may check differs by state, so find out what applies where you are.
Fees and exit
How do you charge: a percentage of collections, a fee per claim, or a flat monthly rate?
Why ask it
Each one pulls behavior a different way. A percentage rewards chasing money but can make small claims not worth the biller's time, and a per-claim fee pays for sending and not for collecting. Rules on percentage arrangements are not the same in every state or for every program, so have your attorney or state medical society confirm what is allowed for you.
What exactly is the percentage a percentage of?
Why ask it
The base matters as much as the rate. Find out whether it includes copays your own front desk collects, patient payments made online, and money from claims the previous biller sent. Have them work the fee on last month's deposits in front of you, since that is the quickest way to see what a quoted rate means in dollars.
What would show up on an invoice besides the main fee?
Why ask it
Setup, clearinghouse charges, patient statements and postage, credentialing, cleaning up old receivables and software seats are the usual extras. None is unreasonable, but together they can make a low headline rate the expensive choice. Ask for a recent invoice from a practice of your size with the name blacked out.
What are you looking for in pay and hours, and how much of the work could be done remotely?
Why ask it
This is the in-house version of the fee question. Compare the full cost with a service's quote: salary and benefits, plus software, a clearinghouse account and training that a company would have covered itself. Remote billing is common, and it raises the same questions about devices and patient data as an outside firm does.
How long is the agreement, does it renew by itself, and what does leaving early cost?
Why ask it
Terms run from month to month up to several years, sometimes with a renewal that takes effect unless you object by a set date. Note the objection date somewhere you will see it a month ahead. A service confident in its results seldom needs a long lock-in, so an insistence on one is worth a question about why.
Which of the figures you have quoted today would you put in writing?
Why ask it
Days to submission, time to first touch on a denial and report dates can all be written into a service agreement or a job description. Whoever quoted them freely and then hesitates has shown you how firm they were. Leave collection amounts out of it: no biller controls what a payer decides to pay.
If we part ways, who finishes the claims in progress, and for how long?
Why ask it
Claims submitted before the end date can keep paying for weeks or months afterward. Some agreements have the service work them for a set period and take its fee on what comes in, and others stop on the last day and leave the follow-up to you. Either can be fair once it is on paper, and neither is fair as a surprise.
Whose name are the clearinghouse and payer portal accounts in, and how would we get our data back if we left?
Why ask it
All of them, and the electronic payment enrollments too, should belong to the practice, with the biller added as a user. When a service has set these up under its own name, leaving can mean re-enrolling with every payer while payments stall. Ask what format an export of your claims history comes in and whether there is a charge for it.
Looking at our specialty and payer mix, where do you think we are losing money today?
Why ask it
Keep this for the end, once they have heard your numbers. A strong biller offers a guess you can check: a code that is often denied for your specialty, a plan known for underpaying, visits that look undercoded. No guess at all, or a promise to raise collections by a round figure, tells you they were pitching and not listening.
How to interview a medical biller or billing service
Practical guidance for the conversation itself
Pull your own numbers first
List your payers and your most used codes
Before the first call, print the plans that account for most of your revenue and the twenty or so procedure codes you bill most. Every question under Experience gets a sharper answer when the biller is looking at that sheet. It also lets you hear straight away which of your plans they have never worked.
Run an aging report the same week
Know your total receivables, how much is older than 90 days and which payer holds most of it. Anyone quoting you a fee or promising an improvement should be reacting to those figures, and you will need them as the starting line if you later want to judge the work.
Write down who does what today
Eligibility checks, authorizations, charge entry, posting, patient calls: note who handles each now, even if the answer is 'nobody, really'. A new biller takes over some of that list and not all of it. The tasks left unassigned after the handover are where the denials will come from.
Decide what kind of help you are hiring
An employee sits in your office, works in your system and answers the front desk's questions, but has no cover and needs supervising by someone who understands billing. A service brings depth and cover, charges a fee that is often a share of what it collects, and sits one step further from your front desk. Several questions on this page fit only one of the two, and the notes say which.
Getting answers you can check
Ask for the definition behind every rate
Clean-claim rate, denial rate and collection rate each have more than one definition in use, and a sales sheet will pick the kindest. When a percentage is quoted, ask what was counted, over which months, and for which client. Two services quoting different numbers may be describing the same performance.
Bring a denial from your own files
Take a recent denial, remove anything that identifies the patient, and ask what they would do with it. Ten minutes on a real remittance shows more than an hour of general questions under Denials and A/R. Do the same with one aged claim and ask whether it can still be collected.
Talk to the person who will touch the claims
With a billing company, the interview is often with an owner or a salesperson. Ask for a second, shorter call with the biller or account lead who would be assigned to you, and put the walk-through question from Claims to that person. Their answer is the one you will be living with.
Sort the list by who is across the table
For an in-house candidate, lean on Claims and on Denials and A/R, where the walk-through, the mistake and the appeal show whether they can do the work, and leave the contract questions out. For a billing company, start with who would be assigned to you and the sample report, then keep a third of the hour for Security and for Fees and exit. Ten or twelve questions is about what one conversation holds either way.
The first three months after you hand over
Keep every account in the practice name
Clearinghouse, payer portals, electronic payment enrollments and the billing software should all be registered to the practice, with the biller added as a user who can be removed. It is more paperwork in the first weeks and far less untangling if the arrangement ends.
Agree a one-page scorecard
Pick four or five measures from the answer to the six-month question under Working together and ask for them on the same day each month. Read it with the biller for the first few months. A figure that moves the wrong way is easier to talk about in month two than in month eight.
Spot-check a handful of claims
Once a month, pull five or ten visits from the schedule and follow each one: was it billed, when, was it paid, and was anything adjusted off. It takes half an hour and it is one of the few checks that do not depend on the biller's own report.
Expect a dip, and ask how long
Deposits often slow for a few weeks while enrollments move and the new person learns your payers. Ask at the start what they expect, then compare. A dip that was forecast and ends on time is a handover. One that nobody mentioned and nobody can explain needs a conversation.
Where practices get this wrong
Choosing on the lowest percentage
A point saved on the fee is small beside a few points lost in collections. Compare what each candidate would be likely to bring in after the fee, using your own aging report, and count the extras from the invoice question before deciding which quote is cheaper.
Handing it over and looking away
Outsourcing the work does not take the practice's name off the claims: they still go out under its providers' numbers, and how much of the responsibility stays with you is a question for your attorney or compliance adviser. Whatever the answer, someone in the practice has to read the monthly report and ask about what looks odd, even when a trusted person is doing the billing.
Letting one person hold every step
Charges, payments, adjustments and refunds in a single pair of hands is convenient and hard to audit. Splitting off even one piece, such as having the owner approve write-offs or the office manager match deposits to the bank, changes what can go unnoticed.
Signing without reading the ending
The clauses about notice, data return and work on claims in progress get read for the first time when things have already gone sour. Read them before you sign, and ask the three exit questions under Fees and exit while everyone is still on good terms.