Your medical billing company submits claims. Reports arrive every month. Payments are coming in.
But you may still be wondering:
Why is A/R growing? Why do the same denials keep coming back? Why is our staff still spending so much time on billing issues?
If those questions sound familiar, you may already be considering whether it’s time to switch medical billing companies.
As your practice plans for 2027, this is a good time to evaluate whether your current billing relationship is providing the visibility, follow-up, and accountability your revenue cycle needs.
But don’t start by comparing prices.
Start with these 10 questions.
1. Can You Clearly See Why Claims Are Still Unpaid?
Knowing how much money is outstanding is only the beginning. Your practice should also understand why claims remain unresolved and what happens next.
For Medicare claims, CMS explains that electronic claims go through multiple levels of edits, including checks related to Medicare coverage and payment policies.
Ask your medical billing company:
Can you show us why our claims are still outstanding and what action is being taken?
2. How Is Aging A/R Being Worked—Not Just Reported?
An A/R report tells you what is outstanding. It doesn’t necessarily tell you what is being done about it.
Your billing partner should be able to explain how outstanding accounts are followed up and how unresolved issues are handled.
Ask:
Can you show us what is being done about our aging A/R—not just show us the aging report?
3. Are Recurring Denials Being Corrected—or Investigated?
Correcting one denied claim solves one problem.
But if the same denial keeps returning, your practice should be asking why it is happening repeatedly.
CMS maintains provider compliance guidance covering billing errors, documentation, coding, and other issues that may contribute to improper payments.
Ask:
Which denial reasons keep repeating, and have you identified where those patterns begin?
4. What Happens After a Claim Is Submitted?
Fast claim submission sounds good. But submission alone isn’t the finish line.
CMS describes multiple stages of electronic Medicare claim processing, where claims may encounter edits before processing is completed.
Your practice should know who monitors unresolved claims and what happens when a claim doesn’t move as expected.
Don’t ask only:
“How quickly are claims submitted?”
Also ask:
“Who follows them through after submission?”
5. Do Your Billing Reports Give You Answers—or Just Numbers?
Monthly reports should provide more than totals.
Can you easily understand:
- Which claims need attention?
- Which denial reasons are recurring?
- What is happening with aging A/R?
- Where payer follow-up is required?
If your report tells you that A/R increased but leaves you asking “Why?”, you may not have enough visibility.
Ask:
Does our reporting help us understand where the revenue cycle needs attention?
6. How Are Coding and Documentation Issues Communicated?
Billing, coding, and documentation are connected.
CMS states that medical record documentation should support the CPT, HCPCS, and ICD-10-CM codes reported on claims.
When recurring coding or documentation concerns are identified, your practice needs a clear communication process so the appropriate people can review them.
Ask:
How do you communicate recurring coding or documentation issues back to our practice?
7. Who Is Accountable When a Claim Gets Stuck?
When a claim remains unresolved, can you quickly determine who owns the next step?
Is the claim waiting for payer action? Does the practice need to provide information? Is billing follow-up required?
Your practice shouldn’t have to guess.
Ask:
Who owns unresolved claims, and how can we see what action is pending?
8. How Transparent Is Your Billing Partner?
Try asking your current billing company one simple question:
“What are the three biggest revenue cycle issues affecting our practice right now?”
Would you receive a clear answer?
Your billing partner should be able to discuss what is happening with claims, denials, A/R, payer issues, and follow-up—not simply send another spreadsheet.
Ask:
How often will we review performance, problems, and next actions together?
9. What Happens to Open Claims and Data If You Switch?
This is one question you should answer before ending your existing billing relationship.
HHS identifies billing and claims processing as activities that may make an outside organization a HIPAA business associate when protected health information (PHI) is involved. HIPAA requires appropriate business associate arrangements governing permitted PHI use and safeguards.
Before switching, establish how your practice will handle open claims, outstanding A/R, reports, data access, PHI, and responsibilities during the transition.
Ask your prospective billing company:
How will you manage onboarding and transition from our current billing company?
10. Does the Billing Company Understand Your Specialty?
Medical billing is not identical across every specialty.
The workflows and requirements encountered by cardiology, behavioral health, pediatrics, chiropractic, anesthesiology, pain management, DMEPOS, and other specialties can differ.
So don’t settle for:
“Yes, we provide medical billing.”
Ask:
What experience do you have with practices like ours?
How will you understand our workflow?
How will specialty-specific billing issues be handled?
The goal is not simply to find another company that can submit claims.
It is to find a billing partner that understands your revenue cycle.
Before You Switch, Know What You’re Trying to Fix
Switching medical billing companies should not be the first decision.
Diagnosing the problem should be.
Is your concern:
Growing A/R? Recurring denials? Poor follow-up? Limited reporting? Communication gaps? Staff spending too much time on billing?
Once you know what isn’t working, you can evaluate whether your existing billing relationship can improve—or whether it’s time for a change.
Thinking About Switching Medical Billing Companies?
Reenix Excellence supports U.S. healthcare providers with:
Medical Billing | Medical Coding | Eligibility Verification | Prior Authorization | Claim Follow-Up | Denial Management | Payment Posting | A/R Follow-Up | Revenue Cycle Management
But your first question doesn’t have to be:
“Should we switch to Reenix?”
Start with:
“What’s actually happening in our revenue cycle?”
Get a Complimentary Revenue Cycle Assessment
If you’re questioning your current billing arrangement, Reenix Excellence can review your existing billing and RCM workflow with you and discuss areas that may warrant closer attention.
You may need a new Medical billing company. You may need a better process. First, find out which.
FAQs
How do I know if I should switch medical billing companies?
Start by identifying why you are dissatisfied. Recurring denials, aging A/R, unclear follow-up, poor communication, or limited reporting visibility may be reasons to review your current billing relationship before deciding whether to switch.
What should I ask a new medical billing company?
Ask about claim follow-up, denial management, A/R processes, reporting, communication, specialty experience, data security, transition planning, and how responsibilities will be divided between the billing company and your practice.
Can a medical practice switch billing companies with outstanding A/R?
Yes, but the transition should account for open claims, outstanding A/R, data access, PHI, reporting, and responsibilities between the practice, outgoing billing company, and new billing partner.
References
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