Write down the problem before you take a call
The most useful questions to ask a practice management company come from your own list of what is going wrong. Claims aging past your comfort. A credentialing application nobody has checked in a month. A care program that enrolled patients and then stalled. Put the problems on paper, with numbers where you have them.
The questions below apply to any outside firm, from a single-function billing service to a company running most of your back office.
What exactly will you do, and what stays with us?
Ask for the scope as a task list, not a brochure.
- Which steps does your team perform, and which remain with our staff?
- What is excluded, such as old accounts, patient statements or appeals?
- What do you need from us, and how quickly?
- Who makes the final call on coding, and who is responsible for the claim?
The answer to the last question should be you. Clinical decisions, medical necessity and final coding belong to the practice, and a firm that offers to take them off your hands is offering something you cannot hand over.
Who does the work, and how do we reach them?
Ask to meet the person who would manage your account, not only the person selling it. Then ask:
- Who is our named contact, and who covers when that person is out?
- Who touches our accounts day to day, where are they located and how are they trained?
- Have you worked with our specialty, our main payers and our record system?
- What response times will you put in writing?
Who owns the data and the accounts?
These answers matter most if the relationship ends.
- Do we own all of our data, and can we export it at any time in a usable format?
- Are payer portals, clearinghouse enrollments and bank accounts in the practice’s name? Payments should land in an account you control.
- Does each of your staff have an individual login to our systems, with access limited to what the job requires?
- Will you sign a business associate agreement, and how would you notify us of a security incident?
- Do you use subcontractors or automated tools on our records, and under what safeguards?
How will we know it is working?
Agree on measures before work starts and record where you stand today. For billing, that usually means days in accounts receivable, aging by payer, denials by reason and the share of claims paid on first submission. For credentialing or prior authorization tracking, it means the status of every open item and how long each has been open.
Ask for a sample report, how often you will meet to review results and whether you can see the underlying data. A firm that reports only totals is asking you to trust the totals. Good workflow and reporting shows the open items behind them.
How are fees set, and what else are you paid for?
Fee models vary: a flat amount, a charge per claim or per clinician, or a share of collections. Each one rewards something different. A fee tied to collections encourages effort on large balances and may leave small ones untouched.
Ask what is included, what costs extra, whether there are minimums or setup charges and how increases are handled. Then ask whether the firm earns money from any product, device, laboratory or software it recommends to you. That is not disqualifying, but you should know.
Some fee structures raise legal questions under state and federal rules. Have a healthcare attorney read the agreement before you sign.
How do we leave?
Ask this while everyone is still friendly.
- What is the initial term, and does it renew automatically?
- Can we end the agreement without cause, and with how much notice?
- What happens to claims in progress when we give notice?
- How and when do we get our data, logins and documents back?
- Are there restrictions on hiring your staff or using another firm?
A company confident in its work does not need a long lock-in.
Compare the answers side by side
Send every firm the same questions and ask for written answers. Call references from practices of your size, and ask to speak with one that left. Where you can, begin with one function and expand once you have seen the reports.
Gateway offers practice support for independent practices in Greater St. Louis and the Metro East, including medical billing support and credentialing and payer enrollment. We expect these questions and will answer them in writing. Start with the practice support inquiry form or call 314-325-0126.
Common questions
Should a small practice outsource billing or keep it in house?
Either can work. In-house billing gives you control and a person who knows your patients, but it often rests on one employee with no backup. An outside team brings coverage and depth, with less day-to-day visibility unless reporting is good. Either way, the owner still reads the numbers monthly.
What are the warning signs when evaluating a practice management company?
Be cautious about promises of specific revenue gains, vague scope, reluctance to share logins or raw data, long automatic renewals and any suggestion that the firm will choose or change codes for you. Fees connected to patient referrals are a serious concern.
Will we lose control of our practice by using an outside company?
You should not. Clinical decisions, hiring of clinicians, coding and responsibility for claims stay with the practice, and the agreement should say so in plain words. Read carefully any term that gives the firm authority over clinical matters, your bank accounts or your payer contracts.
Can we use different companies for different functions?
Yes, and many practices do. The cost is in the handoffs: a billing firm waiting on a credentialing firm, each pointing at the other. If you split functions, name one person inside the practice who owns the connections, and have each agreement say who supplies what.
Related pages
Updated October 2026