Whether you’re outsourcing medical transcription for the first time or switching vendors, the decision comes down to four things: who handles your patients’ audio, how you’re billed, how fast reports come back, and how easily you can leave. These 12 questions cover all four. Ask every vendor the same ones and get the answers in writing.
- Will you sign a business associate agreement before we send anything?
- Who listens to our audio, and where do they work?
- How long have you been in business, and what happens to our reports if you close?
- How exactly do you count a line?
- What do you charge outside the line rate?
- What turnaround will you put in writing, including weekends?
- How do finished reports get into our EMR?
- How will our providers dictate, and can they keep their current setup?
- Who edits our reports, and how do you check quality?
- Have you worked with our specialty, and can we talk to a reference?
- Can you use our templates, macros and letterhead?
- What’s the contract, and how do we get our data if we leave?
This is for the physicians, practice managers and health information directors who make this call. We’re a transcription company ourselves, so after each question we say how we answer it. Hold us to the same standard as everyone else.
Should you outsource medical transcription?
For most small and mid-size practices, yes. A full-time medical transcriptionist earned a median of $40,410 a year in May 2025, according to the Bureau of Labor Statistics, before benefits, software and vacation cover. Outsourcing turns that into a per-line cost, and with no minimums you pay nothing in a quiet month. A practice with two busy providers might spend $1,200 to $1,500 a month. We show the math in what medical transcription costs in 2026.
Large hospitals with steady, high volume and several transcriptionists sometimes keep the work in-house. For everyone else, the risk is coverage. When your only transcriptionist is out, unsigned notes pile up fast.
1. Will you sign a business associate agreement before we send anything?
This one isn’t optional. Under HIPAA, a company that creates, receives, stores or sends protected health information on your behalf is a business associate (45 CFR 160.103). A transcription company is one. You need a signed business associate agreement (BAA) before the first audio file leaves your office.
A proper BAA does more than say “we’re HIPAA compliant.” Under 45 CFR 164.504(e), the vendor has to agree to use appropriate safeguards, report any improper use or breach of your data, hold its own subcontractors to the same rules, and return or destroy your patients’ information when the contract ends, where feasible. The rule requires other terms too, so have your compliance lead read the full agreement.
Red flag: a “HIPAA certified” badge. No government agency certifies HIPAA compliance. A vendor can be compliant and can sign a BAA, but a certificate from a training company doesn’t prove much.
Also ask: Do you carry cyber liability insurance, and can we be named on it? Has your system passed an outside security test, such as a penetration test?
Our answer: we sign a BAA before you send anything. We can name your practice on our liability insurance, up to $1 million with a cyber rider, and our systems have passed third-party penetration testing.
2. Who listens to our audio, and where do they work?
The company you sign with may not be the company that does the work. Some vendors pass files to subcontractors, and some of those subcontractors work overseas. HIPAA doesn’t ban that, but every subcontractor has to accept the same restrictions as the vendor, and you should know who they are.
Ask directly:
- Are the transcriptionists your employees or contractors?
- Are they background-checked and bound by confidentiality agreements?
- Does any part of the work go to another company, or outside the U.S.?
- Who on your staff can access our audio and reports, and is that access logged?
If the answers are vague, ask for them in the contract.
Our answer: we don’t outsource transcription. Our own trained staff do the work, and every upload and download is logged.
3. How long have you been in business, and what happens to our reports if you close?
Few buyers ask this one, and it’s the one that hurts most when it goes wrong.
Transcription companies close, sell or quietly leave the business. When that happens, a practice has to move every provider to a new dictation system within weeks and find a way to get years of finished reports out of the old one. Ask how long the company has been operating, who owns it, and what written plan it has to return your documents if it ever stops.
Our answer: we’ve been in business since 1991 and have been owned by National Billing Center since 2013. Our dictation service is active and taking on new clients.
4. How exactly do you count a line?
Most companies bill per 65-character line, but they count characters differently. Some include spaces, while others count only visible black characters (VBC). Some round up each paragraph and some the whole document. Some bill for headers and template text, and others don’t.
A rate per VBC line and a rate per 65-character line aren’t the same price, even when the numbers match. The cleanest test is to send each vendor the same three reports and compare the invoices. We explain the counting methods in what medical transcription costs in 2026.
Our answer: we count every character including spaces, round each paragraph up to the next whole line, and don’t charge for template or letterhead text that stays the same. The full method is on our FAQ page.
5. What do you charge outside the line rate?
Ask for a written list of every other fee, starting with setup, monthly minimums, EMR delivery and early termination. We cover the rest in the cost guide. Watch the minimums. If a provider goes on leave for a month, a minimum means you pay for dictation nobody sent.
Our answer: no setup fees, no minimums and no termination fees. Faxing and emailing reports is included, and you aren’t charged in a month you don’t dictate.
6. What turnaround will you put in writing, including weekends?
Turnaround claims are easy to make. Get these in writing:
- Routine turnaround. Next business day is standard. Ask what time of day reports land, because “next day” at 5pm isn’t much use for a morning clinic.
- STAT turnaround for urgent reports, and what it costs.
- Weekends and holidays. Many doctors catch up on dictation on Sunday night. Find out whether that dictation is worked over the weekend or sits until Monday.
- Missed deadlines. What happens when they’re late, and who you call.
Our answer: routine reports are back by 9am Eastern (6am Pacific) the next business day, and STAT reports come back the same day. Our transcriptionists work weekends and holidays, so Sunday-night dictation is back Monday morning.
7. How do finished reports get into our EMR?
A report that’s finished but sitting in the wrong system still costs your staff time. Vendors usually deliver one of three ways:
- Secure website. Your staff log in, review, sign, print and download reports.
- Manual EMR entry. The vendor’s staff are set up as users in your EMR and file each report in the right chart.
- HL7 interface. Reports flow into the EMR automatically. This needs your EMR vendor and IT team on the other end, and they may charge for their side.
Ask which EMRs the vendor has already delivered into, and talk to a client on the same system as yours.
Our answer: we do all three. Reports can also be e-signed online or faxed and emailed straight to referring offices. Hospitals can get coded, billing-ready reports.
8. How will our providers dictate, and can they keep their current setup?
If dictating is a hassle, your providers won’t do it, and you’re back to charting at 9pm. Ask what the vendor supports:
- Phone dial-in with a personal dictation ID
- An iPhone and Android app
- Digital recorders, and whether the vendor supplies them
- Uploads from the recorders or software you already use
If you’re switching vendors, ask how long setup takes and whether providers can keep their current dictation ID. Every change to a doctor’s routine is a reason to stop dictating.
Our answer: providers can dictate by phone, by app, on a digital recorder (we can supply one) or by uploading files. Most start the same day, and providers switching from another service can usually keep the dictation ID they use now.
9. Who edits our reports, and how do you check quality?
Many transcription websites advertise 99% accuracy, ours included. Ask how it’s measured. Errors per line? Per report? Who checks, and how often?
Then ask about the workflow. Many companies now use speech recognition or AI for a first draft. That’s fine, if a trained person still reviews every report. Ask what share of your reports a person reads before you see them, and whether that changes for STAT work.
Our answer: our transcriptionists are trained in medical terminology and work in-house. We use speech recognition and AI tools to work faster, and a trained person finalizes every report.
10. Have you worked with our specialty, and can we talk to a reference?
Terminology isn’t the hard part. Every competent transcriptionist can spell “cholecystectomy.” Specialty experience shows in report structure. A psychiatric evaluation, an operative note and a radiology read are built differently, and a transcriptionist who knows your specialty formats them the way your doctors expect.
Ask for a reference in your specialty, ideally a practice your size. Then call them and ask what the vendor got wrong in the first month and how it was fixed.
Our answer: we work with many specialties, including behavioral health, podiatry, surgery centers and hospitals, and we can put you in touch with a reference.
11. Can you use our templates, macros and letterhead?
Your reports should look like your reports. Ask whether the vendor will load your existing templates, letterhead and logo, and whether it can build macros for phrases your doctors say every day. Then ask how template text is billed (see question 4).
Our answer: yes. We work from your templates and letterhead, build custom macros, and can supply standard phrase templates so doctors dictate less. We don’t charge for template text that stays the same.
12. What’s the contract, and how do we get our data if we leave?
Long contracts with termination fees mostly protect the vendor. Ask about:
- Contract length, and whether month to month is an option
- Notice period and any fee for leaving
- Data return: how you’ll get every report back, in what format, and how fast
- Retention: how long they keep your reports and audio after you leave, and how they destroy them
Our answer: you can go month to month and leave with 10 days’ notice by email, with no termination fee. If you’d rather lock in a price, we offer multi-year terms. Storage of your reports is unlimited while you’re with us.
Then test them on your own dictation
Answers on a call only go so far. The best test is a week of your own providers’ real dictation, which shows you turnaround, accuracy, formatting and real line counts on an invoice. Ask every vendor on your shortlist for a trial. If one won’t offer it, ask why.
If you’re also weighing AI scribes against people, read AI scribe, virtual scribe or transcription service: which fits your practice.
Put us through the same 12 questions
We’d rather you compare us properly than pick us on a sales call. Call 877-212-9841 and ask us any of these questions. Or start a 7-day free trial: we’ll transcribe a week of your providers’ dictation at no charge and send a sample invoice, so you can judge us on your own reports. Read more about our medical transcription services or who we work with.
Frequently asked questions
What makes medical transcription HIPAA compliant?
A signed business associate agreement, plus real safeguards: a security risk analysis, encryption, access controls and logging, staff training, and a process for reporting breaches. There’s no government HIPAA certification, so ask for the BAA and the details rather than a badge.
How long should medical transcription take?
Routine reports are usually back by the next business morning. Urgent STAT reports usually come back the same day, at a higher rate.
Should we use an offshore transcription company?
HIPAA allows it, as long as the vendor and every subcontractor accept the same protections. Some payer contracts restrict offshore handling of patient data, so check yours. Many practices prefer U.S.-based, in-house transcription for privacy and quality control. Either way, you should know where your audio goes.
How much does it cost to outsource medical transcription?
Most U.S. services charge about 7 to 16 cents per 65-character line in 2026. A practice with two busy providers might pay $1,200 to $1,500 a month at 8 to 10 cents a line. See what medical transcription costs in 2026 for a full breakdown.
Sources
- 45 CFR 160.103 (business associate definition) and 164.504(e) (business associate contracts), eCFR.
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Medical Transcriptionists, median pay May 2025.
