ChatGPT's shortlist: medical billing companies in the United States

There isn’t one objectively “best” medical billing company—the right choice depends heavily on your specialty, practice size, EHR, payer mix, and whether you want outsourced billing, RCM software, or both. Based on current 2026 information, these are companies I’d put on a serious U.S. shortlist:

Company	Particularly suited for	Notable strengths
****	Hospitals, health systems, large physician groups	Large-scale end-to-end RCM, denials, coding, revenue recovery, automation
****	Independent & mid-size practices; larger organizations	Integrated EHR + billing/RCM, claims, coding, denials, eligibility and automation
****	Hospitals and physician organizations	Outsourced RCM, coding, A/R, denials, patient access and analytics
AdvancedMD	Small-to-medium physician practices	Practice management, EHR and integrated medical billing
CareCloud	Physician practices and specialty groups	RCM, practice management and patient engagement
Tebra	Independent/smaller practices	Practice management, billing, patient engagement and EHR
CureMD	Small-to-medium practices	EHR + practice management + billing/RCM
Medical Billers and Coders (MBC)	Practices wanting outsourced billing/coding	Medical billing, coding and specialty-focused services
Neolytix	Physician groups and healthcare organizations	Outsourced RCM and back-office services
Outsource Strategies International (OSI)	Practices seeking outsourced billing/coding	Billing, coding, A/R and administrative outsourcing

A 2026 independent buyer's guide also identifies several of these providers—including AdvancedMD, athenahealth, CareCloud, Tebra, Medical Billers and Coders, CureMD, Neolytix and OSI—as major U.S. options, while noting that pricing and suitability vary substantially by practice.

A few distinctions matter

For a large hospital or health system: R1 and AGS Health are worth examining. R1 says it works with 95 of the 100 largest U.S. health systems and provides end-to-end revenue-cycle services; its offerings include revenue recovery, coding/clinical integrity and automation. AGS Health provides patient access, HIM/coding, A/R, claims, denials, self-pay and analytics, with more than 10,000 coders and A/R specialists according to its site.

For an independent physician practice: athenahealth is particularly worth evaluating if you want billing tightly integrated with your practice-management/EHR system. Its RCM offering covers eligibility, authorization, coding, claim scrubbing, submission, payment posting and denial resolution.

For a complex specialty or multi-site organization: athenahealth's athenaIDX is specifically designed for enterprise-scale RCM across multiple providers, specialties and locations.

What I would compare before signing

Don't choose based simply on the company's advertised collection rate. Ask each vendor for:

• Percentage of collections or per-claim fee and every additional fee
• Contract length and termination provisions
• Whether coding is included
• Denial-management process and average denial turnaround
• Days in A/R and net collection rate
• Whether they handle prior authorizations and eligibility
• Who owns the billing data and how you can export it
• EHR/PM integrations
• HIPAA/security practices
• Dedicated account management
• Whether billing is performed domestically, offshore, or through a hybrid model
• References from practices with your exact specialty and approximate size

If you tell me your specialty (e.g., cardiology, behavioral health, dermatology, DME, anesthesia), number of providers, approximate monthly claims, and which EHR/PM you use, I can narrow this to 3–5 companies that fit your practice and compare their pricing models, services, and contract considerations.

For small and mid-size U.S. medical practices, I’d put the shortlist around Tebra, AdvancedMD, athenahealth, CareCloud, and Medical Billers and Coders (MBC). The right choice depends heavily on whether you want outsourced RCM only or an all-in-one EHR/practice-management/billing platform.

Company	Best fit	Billing/RCM approach	Notable consideration
Tebra	Solo practices and small independent groups	In-house or outsourced billing; integrated with EHR	Particularly designed around independent practices; subscription pricing rather than percentage of collections
AdvancedMD	Growing small/midsize groups	Software or managed RCM	Broad specialty support and fairly transparent published pricing
athenahealth	Practices wanting heavily managed RCM	Outsourced/managed RCM integrated with athenaOne	Strong emphasis on network-based claims and revenue-cycle services
CareCloud	Small-to-midsize groups wanting dedicated RCM	Managed RCM + practice-management/EHR options	Worth considering when you want more hands-on revenue-cycle support
Medical Billers and Coders (MBC)	Practices wanting a specialized billing company	Outsourced billing/RCM	More of a traditional billing-services model than an EHR-first platform

1\. Tebra

Tebra is particularly oriented toward independent practices. Its billing system handles eligibility, claims, denials, payment posting, patient billing and collections reporting, while its broader platform combines EHR, billing, telehealth and patient-engagement functions.

One interesting difference is pricing: Tebra publishes subscription pricing rather than charging a percentage of collections. Its current published physician pricing starts at $199/month for Billing Starter for practices submitting fewer than 100 claims/month, while broader bundles cost more.

Consider Tebra if: you're an independent 1–10 provider practice and would like billing and clinical/practice-management functions in one ecosystem.

2\. AdvancedMD

AdvancedMD is a strong option for practices that are growing beyond a very simple billing operation. It provides EHR, practice management, patient engagement and RCM, and you can either operate billing yourself or use its managed RCM service.

AdvancedMD currently publishes 4–8% of collections for RCM services, while its software and billing-service pricing varies by specialty and configuration.

Consider AdvancedMD if: you have multiple providers, multiple locations, more complicated workflows, or expect significant growth.

3\. athenahealth

athenahealth is another major option, particularly if you want the vendor to take substantial responsibility for the revenue cycle. athenaOne combines EHR, practice management and RCM, and athenahealth specifically markets its services to small independent practices.

The tradeoff is that pricing is generally customized rather than presented as a simple public price list; its RCM model is generally tied to collections.

Consider athenahealth if: you want sophisticated managed billing and are comfortable with a larger, more comprehensive platform.

4\. CareCloud

CareCloud is worth including in an RCM-focused evaluation, particularly for practices that want outsourced billing rather than simply purchasing billing software. It offers practice-management, EHR and revenue-cycle services.

Consider CareCloud if: your priority is outsourcing a meaningful portion of billing operations and getting a more traditional RCM relationship.

5\. Medical Billers and Coders

Medical Billers and Coders is a more traditional outsourced medical-billing/RCM company rather than an EHR-first platform. It appears frequently in current industry comparisons of U.S. billing companies.

Consider MBC if: you already like your EHR/practice-management system and primarily need an outside company to handle billing, coding, claims and collections.

How I'd narrow the field

Rather than choosing solely by a generic "best company" list, I'd match the company to your situation:

• 1–3 providers, independent practice: Tebra or a specialized local/national billing firm.
• 4–15 providers and growing: Tebra or AdvancedMD; compare their managed RCM proposals.
• 10–50+ providers / multiple locations: AdvancedMD, athenahealth or CareCloud become particularly relevant.
• You want to keep your existing EHR: Look first at standalone RCM/billing companies rather than vendors that require an EHR change.
• You want to outsource virtually everything: Compare managed RCM proposals from athenahealth, AdvancedMD, CareCloud and traditional billing firms.
• You want predictable software costs and may keep billing in-house: Tebra's subscription model is notable because it isn't based on a percentage of collections.

One important caveat: specialty matters enormously. A primary-care practice, dermatology group, behavioral-health practice, orthopedic practice and DME-heavy practice can have very different coding, authorization and denial-management requirements.

If you tell me (1) your specialty, (2) number of providers, (3) approximate monthly claims/collections, and (4) whether you want to keep your current EHR, I can narrow this to 3–5 companies and compare their likely pricing, contract structure, RCM scope, and integration options.

If your priority is specialty-practice billing plus aggressive denial management, I’d focus on firms with demonstrated specialty expertise, dedicated A/R and appeals teams, and the ability to handle payer-specific rules—not simply general medical billing.

Based on current offerings and specialty coverage, these are companies I would put on a shortlist for evaluation:

Company	Specialty / denial-management fit	Best suited for
Coronis Health	Strong specialty focus; end-to-end RCM, denial prevention, A/R and analytics	Specialty physician groups, multi-specialty, complex billing
R1 RCM	Large-scale RCM with dedicated coding, billing and denial-management capabilities; reports 70+ physician specialties	Larger physician groups and organizations needing scale
athenahealth	Strong technology + outsourced denial resolution through its ECR service; extensive specialty support	Practices already using athenahealth or wanting integrated RCM
Experian Health	Particularly strong in denial prevention, claims workflow, analytics and automated follow-up	Organizations wanting technology-heavy denial management
Tebra	Designed around independent practices; specialty billing partners, denial tracking and automated claim workflows	Small/midsize specialty practices
ClearClaim RCM	Specialty practices, surgery centers, credentialing, payer enrollment and denial management	Independent specialty practices wanting a hands-on billing partner
MedPrecision	Full-service billing, denial management, prior authorization and A/R follow-up across numerous specialties	Smaller practices seeking a traditional outsourced billing company

The standouts by use case

For a specialty practice that wants a hands-on outsourced billing partner: Coronis Health is particularly worth investigating. Its model is explicitly built around specialty medicine, with specialty-specific teams and services spanning the revenue cycle. It lists anesthesia, pathology, behavioral health, emergency medicine, FQHCs, physician/multi-specialty groups and other specialties among its focus areas.

For a larger physician organization: R1 RCM says it serves 50,000+ physicians and more than 70 physician specialties, with billing, coding, claims and denial-management expertise.

For particularly difficult denied claims: athenahealth has an Enhanced Claim Resolution service in which its billing teams actually rework denied claims and pursue payment, rather than merely giving the practice denial-management software. Its enterprise RCM offering also specifically discusses complex specialty billing and denial resolution across areas such as anesthesia, radiology, oncology, pathology and surgical/imaging centers.

For denial analytics/automation: Experian Health is worth considering. Its Denial Workflow Manager identifies denied, suspended and pending claims, prioritizes follow-up, supports appeals and analyzes denial root causes. It also offers AI-based identification of high-risk claims before submission.

For smaller independent specialty practices: Tebra is interesting because it connects practices with specialty-aware billing partners while providing visibility into denials, reimbursements and collections. Its platform also handles eligibility, claim scrubbing and denial workflows.

What I would require in an RFP

For specialty billing, I wouldn't choose based on the headline "percentage of collections" alone. Ask each company for these metrics specifically for practices similar to yours:

• Initial clean-claim rate
• Denial rate, separated by payer and denial reason
• Days in A/R
• A/R >90 and >120 days
• Denial overturn/appeal success rate
• Average time from denial to resolution
• Net collection rate
• Percentage of A/R worked each month
• Underpayment identification and recovery
• Prior-authorization and eligibility-denial performance
• Coding audit process
• Specialty-specific experience
• Payer-specific expertise
• Whether denials are handled in-house or offshore
• Whether you receive claim-level visibility into every denial and appeal
• How they handle recurring/root-cause denials, rather than simply reworking individual claims

One especially important question is: "Show me a sample monthly denial report for a practice in my specialty." A good RCM company should be able to demonstrate exactly how it identifies root causes, assigns responsibility, tracks appeals and measures recovered revenue.

If you tell me your specialty (e.g., cardiology, dermatology, oncology, behavioral health, anesthesia, orthopedics), approximate annual collections/claim volume, and whether you're looking for full-service billing or primarily denial/A/R cleanup, I can narrow this to a more targeted U.S. shortlist and compare their specialty capabilities, pricing models, and denial-management approaches.

If by “collect fastest” you mean shortest days in A/R plus strong net collections, and by “lowest denial rates” you mean low initial denial/clean-claim failure rates, there is no authoritative U.S. ranking of billing companies. Most firms publish their own client metrics, often without independent audits, so the numbers are not directly comparable.

Based on publicly reported 2026 metrics, these are companies I would put on a due-diligence shortlist, rather than declaring a winner:

Company	Publicly reported performance	What to verify
Adam Medical Billing	98.4% clean claims, 3.6% denial rate, 34 days A/R, +28.4% net collections vs. baseline	Whether these are audited/representative across your specialty
Getz Healthcare Solutions	98.4% clean claims, <3% reported denial rate, <28 days A/R, 97% net collection rate	Actual denial rate definition and claim volume
EverCare RCM	98% clean claims, 1.8% reported denial rate, 18-day average payment, 94.6% on-time collection	Payer mix and whether the 1.8% is initial denials or all denials
AMS Solutions	95%+ clean claims, <5% denials, 30–40 days A/R, 96% net collection rate	Client-level results and specialty breakdown
Helix Billing	Reports 98%+ clean-claim target; one pain-group case reports denial rate falling 71%, A/R from 58 to 23 days	Whether its headline metrics are targets versus measured averages

These figures come from the companies' own published materials, so I'd treat them as claims to validate, not independent league-table statistics.

The numbers I'd actually use to select a billing company

Don't focus on the advertised “98% clean claims” number alone. Ask each company for the same 12-month, specialty-specific metrics:

• Initial denial rate: ideally broken out by payer and denial reason.
• Clean-claim rate: define whether this means accepted by the clearinghouse or actually accepted by the payer.
• Days in A/R: preferably median as well as average.
• A/R >90 days: one of the best indicators of whether they actually work old receivables.
• Net collection rate: preferably excluding contractual adjustments.
• First-pass resolution rate.
• Denial overturn/recovery rate.
• Average time from charge capture → claim submission.
• Average time from payer adjudication → payment posting.
• Underpayment recovery rate.
• Write-off rate.
• Results specifically for your specialty and payer mix.

For context, one 2026 benchmark report puts overall claim denials around 9% and average A/R around 42 days, although specialty differences are substantial.

One important distinction

A company can advertise a very low denial rate while still collecting slowly. Conversely, a company can have more denials but recover them aggressively. For cash flow, I'd therefore examine the combination:

Days in A/R + net collection rate + >90-day A/R + initial denial rate + denial recovery rate.

If you tell me your specialty (e.g., primary care, behavioral health, cardiology, pain, orthopedics), approximate monthly collections/claim volume, and whether you're looking for full RCM or billing-only, I can research the U.S. market more deeply and build a side-by-side, source-cited comparison of 8–12 firms using those exact metrics.

Places ChatGPT showed

• Bell MedEx Medical Billing · 4.8★ · Medical billing service

If by “locations across the United States” you mean medical billing/RCM companies that can serve practices in many states, rather than companies that literally maintain a physical office in every state, there are quite a few.

Some examples I found:

• Bell MedEx — based in Washington and advertises medical billing/RCM services across all 50 states. Bell MedEx Medical Billing
• RCM Matter — says it provides medical billing and coding services across all U.S. states, with state-by-state coverage listed on its site.
• MediBill RCM — explicitly advertises RCM, billing, coding and credentialing across all 50 states.
• Medical Billing Inc. / Medical RCM Group — lists remote locations in Phoenix, Orlando, Maryland, Minneapolis, Montana, New York and Texas and says it serves providers nationwide.
• Med Xpert Services — advertises nationwide RCM and lists coverage in a large number of individual states.
• RevenueES — advertises U.S.-wide billing solutions and lists numerous state markets, including NY, NJ, CA, TX, FL, PA and many others.
• CareMedox — advertises RCM coverage in all 50 states plus Washington, D.C.

If you mean companies with actual physical offices/locations in multiple states, rather than remote nationwide service, that's a narrower group. For example, Medical RCM Group lists physical/remote offices in Arizona, Florida, Maryland, Minnesota, Montana, New York and Texas.

If you're looking for vendors for a large medical group or health system, I can also give you a list of the largest established U.S. medical billing/RCM companies with offices in multiple states, including their headquarters, office states, specialties served, and approximate company size.

For small and mid-size U.S. medical practices, I’d put the initial shortlist around AdvancedMD, Tebra, CareCloud, athenahealth, and CureMD, with specialized outsourced RCM firms worth considering if you want a service provider rather than an integrated billing platform.

There isn't one objectively “best” company—the right choice depends heavily on specialty, provider count, existing EHR, and whether you want to outsource the entire revenue cycle. Current 2026 buyer guides similarly emphasize matching the vendor to practice size and workflow rather than relying on a universal ranking.

Shortlist

Company	Particularly suited to	Model	Key consideration
AdvancedMD RCM	~5–50 provider independent practices	Integrated PM/EHR + managed RCM	Strong reporting, specialty workflows, and full-service billing
Tebra	Solo and small independent practices	Integrated practice platform + billing/RCM	Designed around independent practices; generally simpler than enterprise RCM
CareCloud RCM	Small/mid-size specialty groups	RCM + PM/EHR	Good specialty and analytics capabilities
athenahealth	Growing ambulatory/multi-specialty practices	Integrated EHR + managed RCM	Particularly useful if you want a large payer/network infrastructure
CureMD	Small practices wanting a cloud-based platform	EHR/PM + billing	Broad specialty coverage and relatively cost-conscious positioning
Medical Billers and Coders (MBC)	Practices wanting outsourced billing rather than a new platform	Outsourced RCM	Broad specialty/coding services
Transcure	Practices interested in technology-heavy RCM	Outsourced RCM	Emphasis on automation/AI and denial management

Current industry comparisons consistently put AdvancedMD, Tebra, CareCloud, athenahealth, CureMD, and Transcure among the vendors worth evaluating for independent and mid-sized practices.

How I'd narrow it down

• 1–5 providers: Tebra, CureMD, or a boutique outsourced RCM company are worth investigating. Tebra is specifically positioned toward solo/small independent practices.
• 5–20 providers: AdvancedMD, CareCloud, Tebra, and athenahealth are reasonable companies to put into an RFP.
• 20–50 providers: AdvancedMD, CareCloud, athenahealth, and specialized RCM firms become more relevant because reporting, denial management, specialty coding, and multi-location workflows matter more.
• Already happy with your EHR: Don't automatically switch systems. An independent RCM company that can work inside your existing EHR may be financially and operationally preferable.
• Highly specialized practice: Specialty expertise can matter more than the vendor's overall size. For example, cardiology, orthopedics, behavioral health, dermatology, GI, and anesthesia have substantially different billing requirements.

One important distinction

Be careful when comparing these companies because “medical billing company” can mean two very different things:

1. Software + billing: You use the vendor's EHR/practice-management system and may have them perform some or all RCM work.
2. Outsourced RCM: You retain your existing EHR and hand billing, coding, A/R, denials, eligibility, etc. to an outside company.

Those aren't directly comparable. AdvancedMD, Tebra, CareCloud, and athenahealth are particularly relevant to the first model, while firms such as MBC and Transcure are more directly relevant to outsourced RCM.

What I'd ask every vendor before signing

Don't focus only on their percentage-of-collections quote. Ask for:

• Net collection rate, not just “clean claim rate”
• Days in A/R
• A/R over 90 days
• Denial rate and denial overturn rate
• First-pass acceptance rate
• Who actually works your claims and where they are located
• Dedicated account manager vs. shared support
• Coding included or charged separately
• Credentialing included or charged separately
• Prior authorization/eligibility responsibilities
• Integration with your current EHR
• Contract length and termination provisions
• Whether fees apply to all collections or only collections attributable to their work
• References from practices with the same specialty and similar provider count

Pricing commonly falls somewhere around 4–10% of collections for outsourced billing, although the actual economics vary substantially with specialty, claim volume, services included, and practice size.

If you tell me your specialty, number of providers, approximate monthly collections/claims, and which EHR/PM you use (e.g., Epic, eClinicalWorks, athena, Tebra, AdvancedMD, NextGen), I can narrow this to 3–5 companies and compare their pricing model, services, integrations, and likely fit.

If by “reasonable” you mean a competitive percentage of actual collections without sacrificing full-cycle RCM, the current U.S. market is roughly 4%–8%, with 5%–7% being common. Tebra’s 2025 industry benchmark found that 63% of percentage-based billing companies charged 7.99% or less, including 12% at ≤4.99%, 19% at 5–5.99%, and 16% at 6–6.99%.

Here are companies I would put on your quote-request list based specifically on their publicly stated pricing, rather than calling any one of them “best”:

Company	Published percentage	Notes
Vizora	3%–6%	Says pricing starts at 3% of net collections; rate varies with size, specialty and volume.
Medical Billing United	4.5%	Publishes 4.5% for full billing/RCM, including claims, payment posting, denials, A/R and patient statements.
Revenant Care	4%–6%	4%–6% for 1–5 providers; 4%–5% for 6–20 providers; based on net collections.
Accurate Medical Bills	3%–6%+	6% or higher under $50K monthly collections, falling to 3% above $1M.
Vector MB	4%–9% typical	Says its pricing depends on volume, specialty and scope; charges on net collections and has no setup fee/long-term contract.
AdvancedMD	Reported around 4%–8%	More of a technology + billing/RCM platform; software costs can be additional.
CareCloud	Reported around 3%–7%	Published third-party pricing estimates vary; verify the actual quote and what services are included.

What I'd consider a reasonable target

For a typical physician practice, I'd use these as negotiation benchmarks, not hard rules:

• 3%–4.5%: unusually competitive; investigate exactly what's included.
• 4.5%–6%: generally a very competitive range for full-service billing.
• 6%–7%: quite normal, particularly for smaller practices or more complicated specialties.
• 7%–9%: can be reasonable for difficult specialties, low volume, substantial A/R cleanup, or unusually comprehensive services.
• 10%+: deserves a particularly careful comparison with alternatives.

The important point is that the percentage by itself can be misleading. A 4% company that excludes coding, denial appeals and A/R follow-up can cost more than a 6% company handling the entire revenue cycle. One 2026 industry analysis specifically notes that the denominator—what the percentage is actually applied to—can matter more than the headline rate.

One thing I'd insist on in the contract

Make sure the percentage is calculated on net collections, not gross charges.

For example, if your practice bills $200,000 but collects $100,000:

• 6% of collections = $6,000
• 6% of charges = $12,000

That's a huge difference.

I'd also require the proposal to specify whether the percentage includes coding, charge entry, claim submission, payment posting, eligibility, prior authorization, denial management, appeals, A/R follow-up, patient statements, and credentialing.

If you tell me your specialty, number of providers, and approximate monthly collections (e.g. “3 dermatologists, $300K/month”), I can narrow this down to 5–7 companies and calculate what each pricing level would actually cost you per year, including which ones appear to have the most transparent pricing.

Places ChatGPT showed

• AK Medical Billing Services · 5.0★ · Medical billing service
• Capital Billing Services and Practice Management · 4.8★ · Medical billing service

Yes. If by “trusted” you mean independent/family-owned firms with evidence of long-term practice relationships, physician/practice-owner testimonials, strong public reviews, or physician ownership, there are several worth putting on a due-diligence list.

I would not treat any one company as universally “most trusted”—billing performance varies substantially by specialty, payer mix, practice size, and EHR. But these are interesting smaller alternatives to the large national RCM companies.

Family-owned / locally owned companies to investigate

• AK Medical Billing Services — Family-owned and operated by a husband-and-wife team, founded in 2018. It provides full-service billing and RCM and has a 5.0/5 public rating from 5 reviews in the business data I found.
• AMBS (Medical Billing & Revenue Enhancement) — Explicitly describes itself as family owned and locally operated in the USA, with roots going back to 1988. It focuses on independent practices and says it has worked with hundreds of new practices.
• 2 Lee's Billing — A Nevada-based, nationwide family-owned and operated billing company founded in 2004 by a mother-daughter team. It emphasizes keeping billing work in-house rather than offshore.
• Hands On Medical Billing — A family-owned company founded by a husband-and-wife team in 2004, with a stated focus on personalized billing, coding, claims processing, and RCM.
• Emotive Medical Solutions — Tampa-based, family-owned and family-operated, with more than 20 years in business. It provides RCM, coding, credentialing, and practice-management services throughout Florida.
• Capital Billing Services and Practice Management — Family-owned Atlanta firm providing billing, credentialing, practice management, and RCM. Its public business profile shows 4.8/5 from 35 reviews.
• Entrust Medical Billing — Particularly interesting if you're a surgeon or ASC. It is locally owned and surgeon-founded; the founders say they have dealt with the same billing issues in their own practices.
• Velocity Billing — Physician-owned and U.S.-based, founded by physicians who had experience operating medical practices themselves. It reports managing more than $30 million in revenue and serves a broad range of specialties.
• Prairie Specialty Billing — Physician-owned and operated, with a 100% U.S.-based team and service across all 50 states. It specifically positions itself around provider-owned practices.
• Fusion Medical Billing & Consulting — Minority family-owned, U.S.-based and focused on independent practices. It specifically says it does not offshore billing and focuses on behavioral health, PT, primary care, urgent care and several other specialties.

A particularly interesting Michigan option

If you're looking for a company with a long local history rather than a national call-center model, I'd also investigate IMB (Independent Medical Billers) in the Detroit area. It was founded in 1984 and remains independently operated. Its site publishes testimonials from physicians describing relationships lasting 10–30 years, including multispecialty, surgical and ophthalmology practices.

That kind of long client tenure is more meaningful to me than a generic “5-star service” claim.

What I'd actually ask these companies before hiring one

Rather than relying on testimonials, I'd ask each candidate for these practice-level metrics from comparable clients:

• Clean-claim rate
• Initial denial rate
• Net collection rate
• Days in A/R
• A/R over 90 days
• Average time from charge entry to claim submission
• Percentage of denials actually appealed
• Average appeal turnaround
• Patient-balance collection rate
• Staff turnover on your account
• Exact specialty experience
• Whether coding is performed by certified coders
• Whether work is entirely U.S.-based
• Who owns your account relationship
• Whether you can speak with 2–3 current physician/practice-owner clients

I'd be especially cautious about companies that advertise impressive collection percentages without defining net collection rate, payer mix, specialty, and the measurement period.

One important distinction

There are actually three different types of “small trusted” billing companies worth separating:

1. Family-owned/local boutique — highest-touch relationship, usually smaller client base.
2. Physician-owned — particularly attractive when the owners actually operate medical practices and understand the clinical workflow.
3. Independent regional RCM company — larger operational infrastructure while still avoiding a PE/public-company/national-chain model.

For a practice owner, the third category can sometimes be a useful middle ground between a one- or two-person biller and a huge national RCM company.

If you tell me your specialty, number of providers, approximate monthly collections/claims, and state, I can narrow this to 5–8 companies that specifically serve practices like yours, and compare ownership, specialty expertise, client reviews, U.S./offshore staffing, pricing model, and publicly documented results.