Edition four.
Last edition promised the vendor questions, so here they are: the seven we'd ask any billing company before signing, including ours. Plus something new this issue, a short wire of real news that matters to YOUR practice, because three things happened this summer that deserve five minutes of your attention!
THE FIELD: THE VENDOR QUESTIONS
Whether you're evaluating a new billing partner or taking a fresh look at the one you have. Ask all seven. Any company doing the work well enjoys these questions.
1. Who exactly works my account? Names, roles, and direct lines. A good answer sounds like an org chart recited from memory. A vague answer means your account is a queue, and queues have no memory of your practice.
2. Where does the work happen? Their system or yours, and what can you see daily? The good answer: inside your own system, visible to you at any hour. Work you can't watch is work you're taking on faith.
3. What happens after submission? Who owns follow-up, and how long does a denial sit before a human touches it? Good operations know their denial-touch time cold, because they manage to it. Hesitation here tells you where claims go to age.
4. Who decides write-offs? The only right answer: you do. Every abandoned dollar should require your sign-off, because ending the chase on your money is your decision, nobody else's.
5. What exactly does the fee cover? Appeals, patient calls, secondary claims, reports: included, or extra? Get the scope in writing. Two companies can quote the same percentage for completely different halves of the job.
6. Define the transition period, step by step. Starting with what happens to live claims on day one. The good answer includes parallel running, your aged receivables worked as their own stream, named owners, and an honest settling-in timeline. Anyone promising instant results is selling.
7. How does leaving work? Notice period, your data, transition-out support. Watch how they answer, because a company that makes leaving easy is telling you how it plans to keep you: by the work, not the lock.
Seven questions, one meeting, and you'll know more about a billing company than any brochure will ever tell you.
THE WIRE
Three things that actually happened this summer, and what each one means for your practice.
Medicare proposed next year's physician rates, and they're lower again.
On July 14, CMS released the proposed 2027 Physician Fee Schedule. The conversion factor would drop to $32.84 for most physicians, about 1.7% below this year, mostly because 2026's one-time 2.5% boost from Congress expires. The rule also proposes cutting payment roughly in half for office E/M visits billed the same day as a procedure by the same practice.
Why it matters: budget 2027 on the lower number, and if same-day visits with procedures are part of how your practice works, that proposal deserves your specialty society's comment letter. Comments close September 14.
Prior auth deadlines became enforceable this year. Most practices aren't using them.
Since January 1, federal rules require Medicare Advantage, Medicaid, and marketplace plans to answer standard prior auth requests within 7 calendar days, urgent ones within 72 hours, and to give a specific reason with every denial. And a striking statistic from the Medicare Advantage data: when denials get appealed, roughly four out of five are at least partially overturned, yet only about one denial in nine ever gets appealed.
Why it matters: timestamp every auth request, escalate the moment a payer blows the window, and appeal more. The deadlines only protect practices that track them.
Telehealth finally has a runway.
After years of cliff-to-cliff extensions, Congress extended the major Medicare telehealth flexibilities through December 31, 2027. Practices can plan virtual care into next year without watching a countdown clock. One footnote: the separate DEA flexibility allowing controlled-substance prescribing via telehealth currently runs only through the end of 2026.
Why it matters: telehealth is safe to build into 2027 planning. If your providers prescribe controlled substances virtually, watch for DEA news as the year closes.
“IS IT NORMAL?”
One real question from a practice operator, answered straight. Identities stay out of it.
“Is it normal that leaving our billing company feels impossible? Everything runs through their software, and I honestly don't know what we'd even take with us.”
Normal, and worth understanding precisely, because that trapped feeling usually has two different causes wearing one costume.
The first is contractual: notice periods, termination terms, sometimes fees. Those live in your agreement, and most owners have never reread it since signing. Pull it this week and find three things: how much notice you owe, what the contract says about your data, and what the company is obligated to do during a transition out. Knowing is calming, whatever it says.
The second is architectural, and it's the one you're describing. When years of claims, notes, and history live inside a vendor's platform, leaving means losing your own operational memory, and that dependency grows every month by default. Two moves shrink it. Ask now, on friendly terms, what data exports the platform provides and in what format. A routine question, and you're entitled to the answer. Then start keeping your own copies of the documents that matter most: payer contracts, fee schedules, enrollment records, and monthly summary reports, somewhere you control.
And a principle worth keeping for every vendor relationship, in billing and beyond: the ease of leaving is the honest measure of a partnership. A company that works to be kept makes the exit simple, because it plans to earn next month rather than lock it in. Do this homework while you're not going anywhere. It's the cheapest time to do it, and it changes how every future conversation with any vendor feels.
Have one of these questions yourself, the kind you've been staring at alone? Hit reply. Every edition answers one, and nobody will know it was yours.
Talk soon,
Dr. Tarek Shahbandar
President, Expert Medical Billing · Practicing physician, 25+ years
NEXT EDITION: The Q4 rush. Your busiest billing quarter starts in September. The prep list.