1. What services are included in the scope?
Ask whether the written scope includes claim submission, Payment Posting, reconciliation support, payer follow-up, denial work, reporting and any separately contracted services. Confirm providers, locations, payers, systems, exclusions and reporting schedules.
2. How will protected health information be handled?
Ask how access is limited, how personnel are trained, how incidents are reported and whether subcontractors may receive or maintain protected information. Review Business Associate Agreement requirements with qualified counsel when appropriate.
3. How are billing and coding compliance questions handled?
The workflow should identify when incomplete documentation or an unsupported code requires clarification from the practice instead of allowing assumptions to move forward.
4. What reporting will the practice receive?
Confirm which reports are available, how often they are reviewed and who owns exceptions or pending items. Useful reporting makes the covered period and next action clear.
5. How are denials, rejections and filing limits handled?
Ask how the company distinguishes an electronic rejection from a payer denial, documents the reason, checks the filing limit and selects the appropriate next action. No vendor can guarantee payer reversal or payment.
6. What happens to existing or inherited A/R?
Do not assume ongoing billing includes every historical balance. Define the date range, account types, prioritization, evaluation of previous work and how accounts unable to proceed will be reported.
7. How will implementation and communication work?
Document system access, payer information, reports, approvals, handoffs, open items, escalation contacts and the process for ending or transferring services.
The appropriate arrangement depends on specialty, systems, payer mix, internal responsibilities, account condition and exact scope. This educational resource does not promise a particular operational or financial result.