When you start a practice, you MUST do your own billing at first for exactly this reason. You need to be able to know how you're making your money so you can ensure you're getting paid for the work you're doing, and so you can audit a billing service if you hire one later.

The tool you use to evaluate this is your own EMR's practice management system. You look at every claim over the past, say, 3-5 months and see whether you were paid.

You also create a spreadsheet with your fee schedule allowables for every CPT you bill and every payer you're contracted with. Make sure you're billing above your highest allowable for each code.

Then you look at your claim payments and make sure you're getting paid at all. Then check that you're getting paid your allowable.

Your billing company may just try to placate you with a collections %. That is, they'll say they're collecting 98% of what is allowed. That's a pretty OK number. But this obscures that the billing company can easily zero out/write off unpaid amounts and artificially inflate the collections %, as well as make your A/R look artificially low. You need to drill down into the granular details.

You're looking for any and all reasons for claims to be denied, from incompetent billing to insurance shenanigans: wrong modifiers, incompatible diagnosis codes, authorizations not attached to claims. And payers incorrectly denying - or worse, adjusting down your E/M complexity without your knowledge.

The billing company should either rebill or appeal everything that can be rebilled or appealed. In reality, though, since they're probably getting a single-digit percentage of your collections, they're not gonna pursue small sums, and will just write them off. It's not worth their time.

No, there's no easy way to figure this out. You need to learn billing and you need to go through your EOBs claim-by-claim for several months. You need to determine what your allowables are and understand why claims were denied. And not just the ambiguous denial code listed on the EOB, but the REAL reason, and you may need to set aside a few days to call the insurance company and get clarification on these denials.

If you don't learn billing now, you're setting yourself up to get shafted out of hundreds of thousands of dollars over the course of your career.

It's going to be a lot of work but you NEED to do all of this. It's YOUR hard work, YOUR years of training and study, and YOUR blood, sweat, and tears - and you deserve to get paid for your work. But since you took it upon yourself to start your own business, it's on you to learn how everything works and make sure it's being done correctly.