Somewhere right now, a practice manager is staring at denied claims like they’re personal affronts. Patients happy, doctors busy, but the bank account? Thirsty.
Medicare’s playing hard-to-get, private payers ghosting, and that one coder who “handles billing” just quit for a cruise ship gig. Time to outsource, they think. Medical outsourcing sounds clean. Except it isn’t…unless you ask the right questions first.
Outsourced medical billing can cut chaos and boost cash flow 20-30%. Or it can turn into a $50k headache. Remote Resource has watched practices ask the wrong questions and pay dearly. Here’s the shortlist of what actually matters when hiring medical billing services.
Ask these. Save your practice.
1. “What’s Your Claim Denial Rate, and Can I See Proof?”
Medical billing experts live or die by first-pass acceptance. Industry average hovers 85-90%. Top firms hit 98%+. Anything under 90% means you’re funding their learning curve.
- Ask for last 6 months’ stats, broken by payer (Medicare, Blue Cross, Medicaid, the works).
- Demand client references who can verify.
- Watch for red flags: “We’re usually good” or “It depends on your data.”
Why it matters: 10% denial rate on $2M annual claims = $200k chasing AR. Your AR days stretch from 45 to 90. Cash flow dies quietly.
Pro move: Remote Resource can benchmark any vendor’s claims before you sign.
2. “Which EHR/PM Systems Do You Actually Integrate With?”
Chart logic: “They do medical billing, we use Athena. Should be fine.” Reality: Athena export → vendor Excel roulette → coding errors → denials. LOL!
- List your EHR (Epic, Cerner, eClinicalWorks, Athenahealth).
- Ask: “Show me a live integration demo.”
- Confirm: “Do you handle patient demographics, charges, payments, EOBs—end-to-end?”
2026 reality: A medical biller specialist who can’t auto-post payments from 5 major EHRs is charging 2022 rates for 2018 work. Your staff manually keys what robots should handle.
Red flag: “We can make it work.” Translation: manual processes = your payroll.
3. “How Do You Handle Credentialing…and Who Pays For It?”
New practice? Expanding specialties? Outsourced medical billing lives or dies by payer contracts. No credentialing = no reimbursement = zero revenue.
Critical questions:
- “Which payers are you credentialed with in my state?”
- “Timeline for new enrollments? (CAQH, individual apps?)”
- “Do you handle re-credentialing? NPPES updates?”
- “Who covers application fees?”
Hidden gotcha: Firms charge $250-$750 per provider per payer for credentialing…after you sign. $20k surprise for 5 docs, 4 payers.
Smart ask: “Show me your credentialing tracker dashboard.” Silence = trouble.
4. “What’s Your Coding Audit Process…and Frequency?”
Medical billing services promising “we’re compliant” without audits are writing checks their coders can’t cash. HCC, risk adjustment, modifier 25 abuse—regulators don’t care about “good intentions.”
Ask:
- “How often do you audit coder work? (Monthly? Quarterly?)”
- “What’s your internal error rate target?”
- “Do you have certified coders (CPC, CCS) on staff or subcontracted?”
- “How do you handle OIG, CMS audits if they knock?”
2026 trend: AI coding assistance + human oversight. Firms without both are playing catch-up.
Test them: “Walk me through coding a level 4 E/M with 99214, mod 25, and X-ray read.” Vague answers = vague charges = vague revenue.
5. “Can You Show Me Your AR Aging – and Collection Strategy?”
AR over 90 days is dead money. Medical biller specialists who can’t shrink it shouldn’t touch your claims.
Demand:
- “What’s your average days in AR? (Target: <45)”
- “Percentage of AR >90 days? (Target: <15%)”
- “Show me last quarter’s AR aging report.”
- “How do you work denials? (Appeals? Refiles? Payer reps?)”
Warning: “We bill it, collections are your job” = you’re paying for half the service.
6. “Who Owns Patient Data? How Do You Secure It?”
HIPAA violations cost $50k minimum. Data breaches kill practices. Medical outsourcing touching PHI needs Fort Knox security.
Ask bluntly:
- “Where does data live? (Your servers? AWS? Multi-tenant?)”
- “BAA in place? Encrypt in transit + rest?”
- “Have you had breaches? HHS complaints?”
- “Business associate insurance? $2M+ coverage?”
2026 must-haves:
- SOC 2 Type II compliance
- MFA everywhere
- Annual pen testing
- Incident response playbook
Red flag: “We’re compliant.” Ask: “Compliant with what?”
7. “What Happens When You Make Errors? Who Pays Reversals?”
Even the best medical billing experts drop balls. Question is liability.
Get this in writing:
- “Who’s responsible for coding errors?”
- “Chargebacks? Refund processing?”
- “Payer overpayment demands?”
- “Do you carry E&O insurance?”
Industry standard: Vendor eats their mistakes. Period.
2026 shift: Firms offering “revenue guarantees” – X% collection rate or they rebate the difference. Rare, gold standard.
8. “Can You Scale With Our Growth? Or Just Our Current Volume?”
Summer 2026: You add 2 providers. Fall: New Medicare contract. Winter: Telehealth line launches. Outsourced medical billing that can’t flex = bottleneck.
Ask:
- “What’s your onboarding capacity monthly?”
- “Do you charge setup fees for new providers/locations?”
- “How do rates change at scale?”
- “24-48hr claim turnaround guaranteed?”
Remote Resource trick: Start with 3-month contract. Test scaling before year-long commitment.
9. “Walk Me Through Your Month-End Close – and Reporting Package”
Great billers don’t just submit claims. They deliver intelligence.
Demand sample reports:
- Revenue cycle KPIs (charge lag, payment lag, denial reasons)
- Payer mix analysis
- Provider productivity
- Cash forecasting (30-90 days)
Red flag: “We send claims to your PM system.” You’re paying for billing + analysis.
2026 expectation: Real-time dashboards, not PDF graveyards.
10. “Give Me 3 References: Same Size Practice, Same Specialty”
Skip “case studies.” Call peers.
Ask them:
- “Denial rate before/after?”
- “AR days improvement?”
- “Did they catch billing errors your old system missed?”
- “Would you re-sign tomorrow?”
Silent killer: References who hesitate, qualify answers, or say “they’re fine.”
Pricing Traps Nobody Warns You About
Medical billing services quote “4-7% of collections.” Fine print kills:
- Setup fees: $2k-$10k per provider
- Credentialing: $250-$750 per payer
- Small balance write-offs: They charge you to forgive $5 ER copays
- Minimums: $1k/month even if collections = $0
- Termination fees: 3 months’ notice or pay anyway
Get total Year 1 cost in writing. Compare apples-to-apples.
The Remote Resource Path (Because Chaos Is Optional)
Want this without the PhD in vendor management? Remote Resource specializes in medical outsourcing matchmaking.
- 30-minute needs assessment → perfect-fit shortlist
- Pre-negotiated contracts → no surprise clauses
- Performance guarantees → or your money back
- 24/7 US support → no “call Mumbai (or any other major metro) at 3am”
Hundreds of practices later, they know which firms actually move needles. Skip the homework. Get results.
Practice managers: Tired of claims roulette?
Remote Resource connects you to proven medical billing experts with verified track records. Book 15 minutes. Sleep better by Wednesday.
Your revenue cycle shouldn’t feel like gambling. Ask these questions…or let someone who knows them do it for you. Either way, 2026 is too short for bad billing!
