Questions to Ask Before Hiring a Primary Care Billing Company in California

The most important question to ask before hiring a primary care billing company in California is whether they can name the specific Medi-Cal managed care plans and IPAs active in your county, because a vendor who can’t answer that specifically doesn’t have the California-specific experience your practice needs.

We covered California’s payer landscape in depth in Looking for the Best Primary Care Billing Company in California? Start Here. This piece is built for the evaluation call itself — the exact questions to ask, in order, before you sign.

Key Takeaways

• California’s Medi-Cal managed care structure varies by county and IPA, so a generic RCM vendor’s experience elsewhere may not transfer.
• CCM and AWV code capture track record is one of the clearest indicators of whether a vendor understands primary care specifically, not just billing generally.
• Fee structure (percentage-of-collections vs. flat fee) affects incentive alignment and should be confirmed before any contract discussion.
• A vendor unable to produce a sample AR aging report by payer is processing claims, not managing revenue cycle.
• System-agnostic integration means your practice shouldn’t need to migrate EHRs to switch billing partners.

Questions to Ask Before Hiring a Primary Care Billing Company in California

1. Do You Have Documented Experience With Medi-Cal Managed Care in My County?

California’s Medi-Cal managed care structure is delegated differently by county and IPA. A vendor with strong results in Los Angeles County may have no experience with a Central Valley IPA’s specific authorization rules. Ask for county-specific reference clients, not statewide claims.

2. What Is Your Documented CCM and AWV Code Capture Rate for Primary Care Clients?

Chronic care management and annual wellness visit codes are two of the most under-billed categories in primary care nationally. A vendor who can’t provide a specific capture rate for these codes likely isn’t tracking them closely enough to improve them.

3. What Is Your Fee Structure, and How Does It Align With My Practice’s Growth?

Percentage-of-collections models align vendor incentives with practice revenue; flat-fee models do not scale the same way. Ask for the exact percentage and whether it changes based on collection volume tiers.

4. Can You Produce a Sample AR Aging Report by Payer?

A vendor who cannot show you a clean 30/60/90/120-plus day aging report by payer is not actively managing AR, they are submitting claims and leaving follow-up to chance. This single question separates a full revenue cycle partner from a claims-processing vendor.

5. Do You Perform Payer Variance Analysis Against My Contracted Rates?

Most billing companies process claims without checking whether payers are actually reimbursing at contracted rates. Ask specifically whether they compare payments received against your fee schedule, not just whether claims were paid.

6. Will I Need to Change My EHR to Work With You?

A billing partner should integrate with the EHR your practice already runs, whether that’s Epic, athenahealth, eClinicalWorks, or another system. Requiring a migration is a red flag, not a feature.

7. Who Is My Dedicated Point of Contact, and What Is Their Response Time?

Vague answers about “a team” instead of a named dedicated account manager signal you’ll be routed through a call queue when problems arise. Ask specifically who handles escalations and how quickly.

8. What Denial Rate Do You Maintain, and How Is It Broken Down by Category?

Industry benchmark for preventable denials is below 5 percent. A vendor unwilling to share denial rates by category, or who reports only an aggregate number, is not being transparent about where the gaps are.

9. How Do You Handle Old AR That’s Already Past 90 Days?

Ask specifically what percentage of aged AR they typically recover in the first 90 days of a new engagement. This tells you whether they have a real recovery process or simply take over new claims going forward.

10. Can You Provide References From Other California Primary Care Practices?

California’s regulatory and payer environment is distinct enough that references from practices in other states carry limited relevance. Ask for at least three current California primary care clients you can contact directly.

MBC’s California Primary Care Billing Services

MBC’s primary care clients in California get a dedicated account manager with direct knowledge of county-specific Medi-Cal and IPA requirements, system-agnostic integration with whatever EHR the practice already runs, and a percentage-of-collections fee structure that aligns incentives with recovered revenue. MBC’s denial management and old AR recovery processes are built to answer every question above with a specific, documented track record rather than a general claim.

Request Your Free Revenue Diagnostic — get a Complimentary 90-Day AR Diagnostic that answers these questions with your own practice’s data before you sign with any vendor.

FAQ

Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.