The practices that regret a billing company usually signed on price alone. The ones that stay happy can name who works their claims, how denials get handled, and how they leave if it is not working. Use this checklist before you sign.
Start with the work, not the percentage
A 4% quote that only submits claims is more expensive than a 6% quote that also works denials and aged insurance balances. Ask for a written list of what is included. At a minimum, that list should cover claim scrubbing, electronic submission, rejection correction, payment posting, insurance A/R follow-up, and a monthly report. Credentialing, old A/R cleanup, and patient collections are often extra. Our pricing guide walks through the common models.
Seven checks before you sign
- Specialty fit. Behavioral health is not primary-care billing. Ask how they handle time-based codes, authorizations, and telehealth place-of-service rules. A company that cannot talk about 90837 and visit-capped authorizations will learn on your money.
- Named people. You want a specialist who knows your payers, not a rotating queue. Ask who works the account when that person is out.
- Your EHR stays. You should not migrate clinical notes to get billing help. We work inside the system you already use, including SimplePractice and TherapyNotes.
- Money stays in your account. Payer deposits go to your bank. The biller posts and reconciles. They should never be the payee.
- Denial work has a clock. "We follow up" is not a service level. Ask how fast rejections and denials are touched, and what the appeal process is. See how we define denial management.
- Reporting you can read. You should see collections, denial rate by payer, and days in A/R without requesting a custom spreadsheet.
- An exit that is boring. Notice period, how your data is returned, and any termination fee. A 12-month lock-in with an exit penalty is a warning, not a commitment to quality.
Questions to ask on the sales call
- What is your clean-claim rate and denial rate for a practice like mine, and how do you measure them?
- How do you define "collections" in the fee? Are front-desk patient payments included?
- Who calls the payer when a claim sits unpaid past 30 days?
- Can I keep my clearinghouse and payer contracts?
- What happens in the first 30 days, and when is the first claim submitted under your team?
If the answers are vague, keep looking. A useful next step is to compare your current cost with a quote using the billing cost calculator, then have someone review a sample of recent denials before you move the whole book of business. That is what the free revenue audit is for.