A billing proposal should tell your agency what work changes hands, what stays with your staff, and what you will pay. Before comparing promises, ask each company to put the same five answers in writing.
1. Are you taking over billing, or selling a tool?
Ask for a list of the work included in the agreement. Does the company prepare and submit claims, follow responses, and track payments? Is it reviewing work that your existing biller will still perform? Or are you buying software your own team must operate?
These are different arrangements. Name who owns each step, including follow-up when something needs attention. If two companies are involved, ask which one answers your staff's questions.
2. How is the fee calculated, and when is it due?
Ask for a written example showing the charge and its calculation. If the fee is a percentage, establish what amount the percentage applies to. Ask about setup charges, minimum charges, work on older unpaid claims, and services outside the base agreement. Do not assume any of these charges apply; have the provider state what does and does not apply.
A low headline rate is difficult to compare with another offer until both proposals describe the same scope and calculation.
3. What happens to our existing billing work during the change?
Ask what the new company needs from your agency and current biller, who coordinates the handoff, and when each party's responsibility begins and ends. Ask specifically who follows claims already submitted and who keeps the record of work still open.
Have your staff review the proposed handoff alongside any existing agreement. Do not assume that hiring a new company ends your current contract or moves every outstanding item automatically.
4. What will we see when a claim needs attention?
Request an example report with fictional information or a demonstration without patient details. Can your team see what needs action, who owns it, and what happens next? Ask how an unresolved question reaches the person who can answer it.
A useful report distinguishes a claim being received from a payer deciding what to pay. CMS treats claim acknowledgments and payment advice as separate transactions. CMS Claims Processing Manual, chapter 24. A payment forecast should also be clearly identified as an estimate. Ask the company to explain its labels before relying on a dashboard total.
5. What remains our agency's responsibility?
Ask the billing company to describe the information and approvals it needs from your team. Ask which clinical and documentation responsibilities remain with your agency, and put those responsibilities in writing. Agree on who answers billing questions and how those requests will reach them.
Establish an appropriate business associate agreement where applicable and a secure process before sharing patient information. HHS business associate guidance. Do not put patient records into a public website form or ordinary email to request a quote.
Bring the answers to one conversation
Invite the owner or administrator and the person who currently handles billing. Compare the written answers, identify any responsibility that has no owner, and resolve that gap before making a decision.
Related guides
See Medicare home health billing for how periods, certification and deadlines work, and why home health claims come back for the difference between returned, rejected and denied claims.