27 Questions to Ask a Medical Billing Vendor Before Signing

The typical medical billing sales cycle looks like this: a 45-minute demo showing a slick dashboard, a proposal PDF with headline pricing, and three references that all sound the same. That process selects for good salespeople, not good billing operations.

Below is a 27-question RFP that inverts that dynamic. Send it in writing with a 5-business-day response deadline before agreeing to any demo.

Pricing structure (4)

1. What is your fee model, and how is it calculated on each specific claim type we submit?
2. What is included and excluded from your fee? List credentialing, prior authorization, patient statements, collections calls, and after-hours support explicitly.
3. What is your setup fee, if any, and what does it cover?
4. What is your minimum monthly fee, if any, and how does that interact with our variable claim volume?

Staffing and specialty depth (4)

1. Who exactly will work on our account: names, credentials, and years of experience in our specialty?
2. Is that team dedicated or pooled across multiple clients? If pooled, what is the average client-load per coder?
3. What is your annual turnover rate on account-facing staff over the last three years?
4. What percentage of your coding team holds AAPC or AHIMA certification, and how many carry specialty-specific credentials relevant to our specialty?

KPI transparency (5)

1. Provide your last four quarters of median performance across your client base on: days in A/R, first-pass acceptance rate, denial rate, net collection ratio, and clean claim rate.
2. What is your denial-recovery rate on appealed claims?
3. How do those numbers compare to MGMA and HFMA published benchmarks (median 47 days A/R, 90%+ first-pass, under 10% denial)?
4. Provide two current client references in our specialty and revenue band who we can call directly, without your team on the line.
5. What is the worst-performing client account in the last 12 months, why, and what did you change?

Technology and integration (3)

1. Which practice management and EHR systems do you operate in native mode versus via integration or manual re-entry?
2. What is your process for handling downtime, and what is the maximum acceptable claim-submission lag during vendor-side outages?
3. Do we retain ownership of all claim data in machine-readable format, and can we export it at any time without your assistance?

Security and compliance (4)

1. Provide your most recent SOC 2 Type II report and current HIPAA Business Associate Agreement.
2. Have you had a security incident or breach in the last five years? If so, what happened and what changed?
3. Where is your team located, and if any work is offshored, what specific safeguards protect PHI at the offshore location?
4. Who is your designated privacy officer, and what is their contact for security incidents?

Reporting and communication (3)

1. What reports do we receive, at what cadence, and in what format? Provide samples.
2. How quickly do you respond to internal support requests from our staff, and what is your SLA on that in writing?
3. Who is our escalation contact if the primary account manager is unresponsive?

Contract exit terms (4)

1. What is the contract term, notice period for termination, and any early-termination fee?
2. On termination, when do you return A/R receipts and all claim data, and what format?
3. Are there any post-termination fees, retention holds, or restrictions on us switching to another vendor?
4. Will you sign an audit-rights clause permitting an annual third-party review of your work against our data?

Scoring the responses

Vendors who answer 24+ in writing with specific numbers (not adjectives) are serious operational shops. Vendors who answer under 20 are betting you will not read the fine print. Vendors who push back on the RFP process itself are betting you will not push back.