Jan 28, 2022 5:42:29 PM Karna Morrow, CPC, RCC, CCS-P, Implementation Manager

Medical Billing Services: How to Switch Without Leaving Money on the Table

Should you be looking into switching your medical billing services provider?  The relationship between medical practices and their medical billing company is like a marriage.  They are solid long-term relationships that often remain intact longer than they should because no one wants to deal with the painful separation.     

Each partner has a shared responsibility to make the practice successful.  If the practice is financially successful, the medical billing services company shares that benefit.  It is unreasonable to think that the billing company can efficiently submit claims without accurate patient demographics and insurance information.  Chart notes must be completed timely, and any changes to contracting issues or new providers to the practice should also be communicated timely.    Requests for medical records, appeals, and, when necessary, corrected claims should also be resolved in a timely manner.   Outsourcing the task of medical billing and collections can bring a higher skill level and dedicated resources to the team – but it still requires the active involvement of both partners. 

There are many factors to consider when determining if it is time to dissolve the current relationship.  The following are frequently forgotten or not given adequate attention. 

  • What is “broken” in the current relationship? It’s too easy to repeat the same mistakes if those scenarios and the contributing factors aren’t reviewed carefully. 
  • Is the medical billing software integrated into your existing electronic health record (EHR)?  Without an integration, additional thought must be put into the daily communication between the two partners
  • Each new billing relationship will mean a new enrollment with the payors.  Are you financially prepared to weather a window of delayed payments?
  • No one leaves a relationship without some baggage.  Who will be responsible for resolving the residual accounts receivable (AR)? 

Evaluate Reasons for Change 

When the revenue falls flat or even declines, it is easy to blame the medical billing services company.  The percentage of collections will always be advertised as so much higher somewhere else.  Be sure that the root problem lies solely with the billers and not, for example, with a change in your payor mix to plans with lower reimbursement rates.  If the dip in revenue results from a change in your service mix, patient mix, or even the financial demographics of your local area, it is unlikely that a new medical billing partner will restore the practice to the good old days. 

Remember, the EHR is there to bring more efficiency to the practice.  Scanning daily superbills/ charge tickets and excel sheets for the daily copayments for someone else to post undermines that efficiency.  When the front desk redirects the patient standing in front of them to call the billing office for the balance on their account, efficiency is undermined.  An integrated EHR software will provide the expected efficiency and transparency to the relationship. 

Consider the Reality of Transitions 

Most payors will accept a dual enrollment for claims submission, but few allow more than one clearinghouse of record for returning the ERA.  Even the best planning may leave a gap between ex-vendor and new vendor remits.  It is essential to anticipate the gap and have a contingency plan for receiving remits from a former vendor and posting remits received in the new clearinghouse to charges posted in the old system.  Enrollments may delay claim submission or require the billing team to wait for remits to reconcile with the EFTs in the bank.   

Don't Leave Money on the Table While Switching Medical Billing Providers

The ‘wind-down’ period defined within the contract may provide sufficient time to resolve all outstanding  receivables completely. Accept the reality that few billing services will adopt the existing accounts receivable.  Financial records are rarely migrated into a new system, and fewer vendors will allow unlimited access to their  system once the contract has been severed.  A detailed plan should be discussed to ensure that all revenue is  appropriately collected by someone. 

Every relationship has challenges, growing pains, and even minor annoyances.  Eyes wide open remains the best advice when searching for the best medical billing services company for the practice.  Honestly evaluate the needs and reasons to change; anticipate the realities of transitioning from one vendor to another, and don’t leave money on the table due to lack of planning.  

We would love to share more with you about Medical Billing best practices and how we can help your practice optimize your medical billing process.  Contact us today for a free demo on how we can help you streamline your medical billing practices, improve patient collections and help your medical practice not leave money on the table during the transition.   




Topics: Revenue Cycle Management, Medical Billing


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