Seven questions your billing company should be able to answer this week

1. What was our first-pass payment rate last quarter?

The percentage of claims paid on first submission, without correction or appeal, is the single clearest measure of revenue cycle health. A biller who can't produce it — or hasn't shown it to you unprompted — is managing your revenue without a speedometer. Follow-up: how has it trended over the past year, and what moved it?

2. What share of our denials came from eligibility, authorization, and coordination of benefits?

These categories are largely preventable, because the information needed to avoid them existed before each claim was submitted. If they make up a meaningful share of your denials, your revenue problem lives at the front end. A billing partner who works these denials month after month without flagging the pattern is billing you for the same fire twice.

3. What have you changed upstream because of our denial data?

This is the question that separates claim processors from revenue cycle partners. Denial reports are a diagnostic: every preventable denial names the process that failed. A strong partner reviews that data monthly, traces recurring denials to their root cause, and fixes the workflow. If your biller's answer describes appeals and resubmissions but no upstream changes, they're mopping the floor and leaving the pipe.

4. How do you verify eligibility — and to which date?

The right answer: electronically, against the payer's records, for the exact date of service, with re-verification before high-dollar visits. The wrong answers include "the front desk handles that" (a handoff is not a workflow) and anything implying the insurance card is the source of truth. Cards go stale; the payer's eligibility response is the record that matters.

5. How are authorizations tracked after approval?

An authorization is only valid when the claim matches it on payer and plan, codes and units, provider and location, and date range. Someone has to track expirations, watch unit depletion, and re-check when the plan of care changes. Ask where that tracking lives and who owns it. "In the chart somewhere" is how practices discover authorization problems on remittance advices — the most expensive place to find them.

6. When did you last update our Medicare assumptions?

Traditional Medicare's "no prior authorization" era is ending; CMS has been expanding pre-service and pre-payment review, including pilot programs in selected states. Medicare Secondary Payer screening and QMB status checks carry compliance weight, not just billing consequences. A biller still operating on 2020's Medicare assumptions is exposing you in ways a denial report only partially reveals.

7. What would you need from us to raise our clean-claim rate?

Good billing partners have a list — front-desk workflows, registration questions, verification timing — because clean claims are built collaboratively. A partner with no requests is a partner with no plan.

What to do with the answers

Score them honestly. Crisp answers with numbers attached: you're in good hands, and this exercise cost you one email. Vague answers, defensive answers, or a week of silence: you've learned that your revenue is being processed, not managed — and the gap between those two words is coming out of your margins every month.

If you'd like a second opinion, that's exactly what our free revenue cycle assessment is for. MD Billing will review your denial patterns, your front-end workflows, and your first-pass rate, and show you specifically where revenue is leaking — no obligation, no hard sell. Start with the free revenue cycle assessment, or contact us with the answers you got.