17 Reference-Check Questions for Medical Billing Companies

Vendor-supplied references have been pre-briefed. Everyone knows this. The interesting question is what the reference will say once you get past the pre-brief. These 17 questions are designed to do that.

Budget 30 minutes per reference. Take notes. Look for candor, not enthusiasm.

The 17 questions

Performance and KPIs (5)

1. What are your current numbers on days-in-AR, first-pass acceptance rate, and denial rate? (Testing whether they know the numbers at all — many practices do not.)
2. How do those numbers compare to where you were with your previous billing vendor, or to your in-house baseline?
3. What was your first-pass acceptance rate 12 months into the relationship, and where is it now? (Trend matters more than current level.)
4. What is the single KPI where this vendor has most disappointed you?
5. What is the single KPI where this vendor has exceeded expectations?

Communication and responsiveness (4)

1. Describe the last three escalations you sent to this vendor. What was the issue, how quickly did they respond, and what was the resolution?
2. Do you have a dedicated account lead, or do you work with a rotating team?
3. Have you had turnover on your account, and if so, what was the impact?
4. What is your primary complaint about how this vendor communicates?

Transition experience (3)

1. Walk me through your onboarding experience with this vendor. Was it well-run, chaotic, or somewhere in between?
2. How long did it take to reach stable KPI performance after cutover?
3. If you have ever had to run a data export or explore switching vendors, how easy or painful was that?

Retrospective judgment (3)

1. What do you wish you had negotiated harder in your contract?
2. What has surprised you positively about working with this vendor?
3. What has surprised you negatively?

Renewal question (2)

1. Would you sign the same contract with this vendor today, knowing what you know now?
2. Would you recommend this vendor to a peer in your specialty and practice size?

Question-scoring rubric

After the call, score each reference on candor:

High-signal references dominate the decision even if they gave mixed feedback. Low-signal references (all positive, no specifics) provide little useful information.

Red-flag responses

• Reference cannot cite their own KPIs: they may be a customer who does not track performance, in which case they cannot really judge the vendor either
• Reference praises 'communication' but cannot describe a specific escalation experience: vendor may have never been tested
• Reference says onboarding was 'smooth' but cannot describe specific milestones: onboarding may have been rushed or skipped
• Reference volunteers zero negative feedback across 30 minutes: either the reference is pre-briefed or the vendor has not been in the relationship long enough for problems to surface

Positive-signal responses

• Reference cites specific KPI numbers and knows how they compare to MGMA benchmarks
• Reference describes escalation experiences with concrete outcomes
• Reference volunteers 1-2 negatives even when praising overall
• Reference distinguishes between vendor performance in year 1 vs year 2+ (indicates sustained relationship)
• Reference answers question 16 (would you sign again) with nuance rather than pure yes/no

Bottom line

One serious reference conversation beats three positive-adjective testimonial calls. Structure the calls, ask the 17 questions, take notes, and let candor rather than enthusiasm guide the decision.