Choosing the right biller can feel like a high-stakes decision. The wrong choice can stall claims, delay payments, and disrupt your entire revenue cycle. It’s not just about who can “get claims out.” It’s about whether your agency can stay financially stable, compliant, and focused on patient care instead of billing breakdowns.
At The Home Health Consultant, we work with agencies across California and beyond to strengthen compliance and operational systems year-round. This article breaks down the key questions to ask before hiring or switching billers.
In this first part, we’ll focus on three core areas:
- Cost
- Insurance types
- Turnaround time
By the end of this article, you’ll know the first essential questions to ask before hiring a biller for your home health or hospice agency.
*This article was written in consultation with Mariam Treystman.
How Can Billing Costs Impact Your Agency’s Bottom Line?
When most people ask a potential biller, “What’s your price?” they’re asking the wrong question.
The better question is:
“How do your minimum and maximum cost limits work?”
Most billers charge a percentage of total claims billed, often between one and two percent. But here’s what many agencies overlook: billers usually have a monthly minimum, often around $500.
That minimum exists because even processing a few claims involves significant administrative time such as monitoring accounts, handling rejections, and reconciling payments.
For smaller agencies or those just starting out, that minimum can feel high, but it’s standard across the industry.
On the other hand, larger agencies billing hundreds or thousands of claims each month should ask whether there’s a maximum. A one or two percent rate on millions of dollars in claims can become excessive, especially if your biller’s role is limited to submission and follow-up.
The key takeaway is to clarify both the floor and ceiling of your billing arrangement. It’s also worth asking exactly what’s included in that rate:
- whether the biller provides error correction
- compliance reviews
- reporting
- reconciling
- if all of the above is included, or an additional cost
Understanding these terms up front protects your margins and keeps expectations clear.
What Insurance Types Should Your Biller Be Able to Handle?
Every payer comes with its own quirks, timelines, and submission rules.
That’s why one of the first questions to ask is:
“What insurance types do you currently bill for,
and what do you charge for each?”
Many home health billers specialize in Medicare only, which works well for agencies focused exclusively on traditional Medicare patients.
Hospice billers often cover a wider range of payers, including Medicaid, Medicare Advantage, HMOs, and PPOs.
Because each category of insurance involves different workflows, you’ll want to verify the biller’s real experience. Asking what they currently do, rather than whether they can bill a specific insurance, helps you get the real answer instead of the “fake it till you make it” response many entrepreneurs default to. You can also ask for references from other agencies with a similar insurance mix to verify their experience.
A qualified biller should be able to provide references for each payer type they handle, not just general client names. If you bill Medicare Advantage, ask for proof that they’ve successfully managed claims for that category. Inquire in detail about the processes around each insurance type you work with.
Again, this helps you avoid the “fake it till you make it” problem that’s common in billing. There’s nothing wrong with a biller learning on the job, but when your agency’s revenue is at stake, you need someone who already understands the systems, deadlines, and requirements of each payer.
How Fast Should a Biller Process Claims and Handle Rejections?
Timeliness can make or break your cash flow. Before signing any contract, ask:
“If I send you a claim today, when will it be billed,
and what’s the latest it could go out?”
The word latest matters. Most billers will tell you their “average” turnaround time. But averages can change with workload, staffing, or seasonal surges. What you really need to know is the maximum timeframe, meaning the longest it might take them to send a claim under normal conditions.
Beyond that, you’ll also want to understand their process for special situations:
- Deadline management: How do they handle NOAs or hospice elections submitted on the same day they’re due? Do they have an urgent claim protocol?
- Cutoff times: When is the last window for same-day submission if they use a software to submit? Some systems queue claims and send them in batches, meaning a claim entered later in the day might not transmit until the next morning.
- Error correction and rejections: Ask about their workflow for rejected or problematic claims. Do they have a dedicated department for reprocessing? How do they handle denials by payer type?
How Do These Questions Help You Choose the Right Fit?
These early conversations aren’t just about gathering information. They show how organized, experienced, and transparent a potential biller really is. When you ask detailed questions, you’re testing how well they understand the home health and hospice industry and how proactive they’ll be in protecting your agency’s financial stability. You are also showing them that they can’t snooze on your claims.
The best billers don’t just process claims. They think strategically about compliance, timeliness, and how your billing connects to your overall operations. Those are the partners who will help you grow, not just stay afloat.
In Part 2 (coming soon), we’ll dive deeper into operational and relationship-based questions: how to assess a home health or hospice agency biller’s overall process.
Until then, explore the Billing section in our Learning Center for more helpful articles and free resources.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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