Money is arriving, so it looks like it is working. The real question is how much more should be arriving — and five questions will tell you.
Ask your billing company five things: what percentage of A/R is over 90 days, what your top three denial reasons are, how many claims have had no activity in 30 days, whether payments are checked against contracted rates, and what your submission lag is. Vague answers to these are themselves the finding.
A practice usually notices billing problems when collections drop. By then the issue is months old, because money that stops arriving today was lost in claims worked — or not worked — sixty to ninety days ago.
The useful question is never "are we collecting?" It is "are we collecting what we should be?" Those have very different answers, and only one is visible from the bank balance. The nine-point audit framework is the full version; this is the short one you can run in a single email.
They should know without looking it up. Under 15–20% is commonly cited as acceptable and under 5–10% as healthy, though where you should sit depends on payer mix and specialty. Noticeably above that range means claims are ageing because nobody is chasing them.
Listen for whether the number comes with an explanation. "About 18%, and most of it is two Medicaid plans we are appealing" is a good answer. "I would have to check" is not.
This is what separates a billing company from a claim submitter. Anyone can report a denial rate. Only someone actually working denials can give you the reasons, grouped and ranked.
If they cannot answer, nothing is being fixed upstream, which means the same denials recur every month and are resubmitted rather than prevented.
Then ask to see five of them, and what happened with each.
This is the most uncomfortable question on the list and the most revealing. Aggregate reporting hides individual claims that have simply stopped moving. Five specific claims cannot be hidden.
Not "are we getting paid" — are the amounts correct, compared line by line at CPT level against what the payer agreed?
Most operations do not do this. A payer paying 80% of the contracted rate looks identical to one paying correctly. The difference never appears as a denial or an aged claim; it simply never arrives.
From complete documentation, not from date of service. One to two business days is a reasonable expectation.
If the figure is measured from date of service, it includes however long your providers took to close their notes — which conveniently hides the billing lag inside the clinical one.
Confident, specific answers to all five mean your billing is being actively managed, whatever the numbers happen to be. You may still have problems, but somebody is watching them.
Vague answers to questions 2 and 3 specifically mean claims are being submitted and then left. That is the most common failure in this industry and the most expensive, because the loss compounds quietly until timely filing closes the door.
An inability to answer question 4 is near-universal and worth knowing rather than resenting. Underpayment detection is specialised work that most operations genuinely do not perform.
For the month-to-month version of this, see the seven warning signs.
Send us your A/R aging report and three months of denials and we will tell you what we see. If your billing company is doing a good job, we will say so — that is a common outcome.
Request a free A/R review