Before signing for medical billing software, ask the vendor to prove specialty workflow, claim exception handling, integrations, reporting, implementation, support, security, pricing, data ownership and termination terms in writing. The contract should match the demonstrated product and assigned responsibilities.
What exact medical billing package are we buying?
Ask the vendor to list every included product, module, provider, user, location, transaction and service. Identify optional tools shown during the demonstration that are not included in the quote. Clarify whether the purchase is software, EHR plus billing, managed billing service or a combination.
Attach the final scope and order form to the evaluation. Marketing pages and verbal explanations should not be used to fill gaps in the signed agreement.
Can you demonstrate our specialty workflow?
Provide common services, payers, authorizations, modifiers and documentation dependencies. Ask the vendor to process a routine claim, coverage change, corrected claim, rejection, denial, secondary claim, patient balance and refund. Watch how ownership, due dates and account history appear.
A gastroenterology practice can prepare test cases with the gastroenterology billing guide. An anesthesia group should use the anesthesia billing workflow. Request references with a comparable specialty, provider count and payer mix.
Which tasks remain with our practice?
If services are included, assign eligibility, coding, charge entry, claim submission, rejection correction, denial appeals, payment posting, accounts-receivable follow-up, statements, patient calls, refunds and credentialing. Define shared handoffs, deadlines and escalation.
If staff operate the software, document required roles and estimated workload. A product may automate selected steps without replacing judgment, documentation or payer follow-up. The practice needs a realistic staffing plan.
How do integrations and reconciliation work?
Name the exact EHR, clearinghouse, payment processor, laboratory, portal, scheduling and reporting tools. Ask whether each connection is native, partner-supported or custom, plus setup cost, recurring cost, data direction and support owner.
Require encounter-to-charge, claim-to-acknowledgment and remittance-to-posting reconciliation. Ask where failed or duplicate messages appear. Define which system owns demographics, coverage, charges, claims, payments, adjustments and balances.
What reporting and data access do managers receive?
Request samples for unbilled encounters, rejections, denials, aging, payments, adjustments, patient balances, credits and refunds. Every total should trace to accounts, transactions, original payer responses and notes. Ask how assignments and overdue work are displayed.
Obtain definitions for clean-claim rate, denial rate, days in accounts receivable and net collection rate. Confirm date logic, exclusions, custom-report fees and export capability.
What does implementation and support include?
Request a plan with owners and dates for conversion, configuration, user roles, interfaces, training, testing, cutoff and stabilization. Ask what history remains searchable, how active claims are protected and what acceptance criteria apply before launch.
Identify support channels, hours, response targets and escalation for software, billing and interface problems. Determine whether onboarding and ongoing support are included or billed separately. Interview references about their first 90 days and a difficult incident.
How will the vendor protect health information?
Review the business associate agreement, subcontractors, role permissions, multifactor authentication, audit logs, encryption, backups, incident response, retention and termination. Ask how user access is approved, reviewed and removed and how security incidents are communicated.
The practice should complete its own risk analysis and configuration review. A statement that the platform is HIPAA compliant does not replace agreements, controls, procedures and training.
What is the full price and how can we leave?
Price subscriptions, providers, users, setup, migration, training, interfaces, transactions, statements, payment processing, support, optional modules and services. Calculate first-year and renewal-year totals using the practice’s actual volume.
Read minimums, term, automatic renewal, price changes, cancellation notice and termination assistance. Ask for sample exports of patients, claims, payments, denials, notes and documents. Use the medical billing contract guide and data export checklist. Then compare medical billing software prices with the same written scope before signing.