Written by MedixCode Team
Your schedule is full, your providers are busy, and cash flow still feels tight. When that happens, the problem often sits in the revenue cycle, and your billing company is responsible for most of it. Billing problems rarely announce themselves. They show up slowly as more denials, older unpaid claims and reports that don’t explain what changed.
This guide covers five warning signs, the numbers to check, and what to plan for if you decide to switch.
Why Your Billing Partner Has a Bigger Impact Than You Think
Your billing company touches almost every step between the visit and the payment: eligibility checks, coding, charge entry, claim submission, payment posting, denial management and follow-up on unpaid claims. When those steps work, you get paid faster and more completely. When they don’t, money leaks out in small amounts that add up over a year.
Sign 1: Your Denial Rate Keeps Climbing
One denial is normal. A pattern is a problem. If more claims come back denied every month, your billing company should already know why and be fixing the cause, not just resubmitting the same claims. Common root causes include:
- Wrong or outdated patient and insurance information
- Missing prior authorizations
- Coding and modifier errors
- Missing documentation
- Eligibility problems that should have been caught before the visit
Ask your billing company three questions: What is our denial rate this month and last quarter? What are our top five denial reasons? What has changed to prevent them? If you don’t get clear answers backed by data, that is a warning sign. Strong denial management means tracking root causes, not only working appeals.
Sign 2: Your Unpaid Claims Keep Getting Older
Accounts receivable is money you have earned but not collected. Some open accounts receivable is normal. A growing share of claims older than 90 or 120 days usually means follow-up is not happening consistently.
Older claims are harder to collect, and some will eventually hit filing limits. For Medicare, claims must generally be filed within 12 months of the date of service under 42 CFR 424.44, and commercial payers often set shorter deadlines in their contracts. A claim that is never filed or never followed up is revenue you will not recover.
Ask for an aging report broken out by payer every month. If the 90+ day buckets keep growing, ask what is being done about each one.
Sign 3: Your Reports Don’t Answer Real Questions
If your billing company only tells you how much came in this month, you are seeing part of the picture. Good reporting should tell you why collections changed, which payers are slow, how many claims are pending and which denial reasons are rising. These are the core numbers to ask for:
| KPI | What it tells you |
|---|---|
| Denial rate | Share of claims denied. Shows whether problems are being prevented or just reworked. |
| Clean claim rate | Share of claims accepted without edits or rejections on first submission. |
| Days in accounts receivable | Average days to get paid. Usually total accounts receivable divided by average daily charges. |
| Net collection rate | Payments received divided by the amount you could collect after contractual adjustments. |
| Accounts receivable over 90 days | Share of accounts receivable older than 90 days. A rising share signals weak follow-up. |
| Underpayments | Payments below your contracted rate. Shows whether payer payments are checked against contracts. |
Ask for these numbers on a fixed schedule, with trends over time, not a single snapshot.
Sign 4: Communication Is Reactive Instead of Proactive
Do you only hear from your billing team when you ask a question? A good partner tells you about payer policy changes, recurring denials, credentialing problems and coding updates before they turn into lost revenue. Red flags include:
- Emails and calls that go unanswered for days
- No regular review meetings
- Vague answers about denied or unpaid claims
- Learning about problems from your bank balance instead of your billing team
Sign 5: Revenue Isn’t Growing With Patient Volume
This is often the clearest sign. Your providers are seeing more patients, but collections are flat. That gap usually points to one or more of these:
- Missed or late charge capture
- Underpayments that nobody compares with your payer contracts
- Slow or inaccurate payment posting
- Coding that doesn’t reflect the documented work
- Credentialing gaps that block payment for new providers
More visits should mean more collections. If they don’t, your billing company should be the one finding out why.
Quick Self-Check
Answer yes or no:
- Do you receive KPI reports on a regular schedule?
- Do you know your current denial rate and top denial reasons?
- Are your unpaid claims over 90 days tracked and shrinking?
- Does your billing company explain why collections changed?
- Are denied claims appealed when they should be?
- Do you have regular review meetings with your billing team?
If you answered no to several of these, your billing partner may be limiting your revenue. Want a second opinion? Book a Free Consultation.
When Is the Right Time to Switch?
Consider switching if revenue keeps falling without an explanation, denials stay high after repeated conversations, reporting is vague, communication is poor or your practice has outgrown your current company. Staying with an underperforming partner usually costs more than a planned transition.
How to Switch Billing Companies Without Losing Revenue
- Read your current contract. Check the notice period, termination terms and who keeps working claims already submitted.
- Secure your data. Make sure you can export patient, claim and accounts receivable data, and that you own it.
- Take control of access. Confirm you hold admin access to your EHR/PM system, clearinghouse and payer portals.
- Plan the handoff of unpaid claims. Agree in writing who works old unpaid claims and for how long.
- Update payer enrollments. Review ERA and EFT enrollments and any billing contact information with payers.
- Set a start date and watch the first 60 days. Track claim volume, rejections and payments closely during the transition.
How MedixCode Works With Practices
We focus on the basics that protect revenue: accurate coding by AAPC/CPC Certified Coders and Billers, consistent follow-up and clear reporting. Solo and small practice plans include a monthly performance report. Our group practice plan includes a weekly performance report: collections, denials, and unpaid claims, plus a monthly review call. Enterprise plans include reporting built around your organization. We work inside your existing EHR/PM system, so your staff doesn’t learn new software. MedixCode is HIPAA compliant.
There is no setup fee, no monthly minimum and no long-term contract. You can cancel with 30 days’ notice. See our pricing or learn more about our revenue cycle management services.
FAQs
How do I know if my medical billing company is costing me money?
Watch for rising denials, a growing share of unpaid claims over 90 days old, reports that don’t explain changes, slow communication and collections that stay flat while patient volume grows.
What reports should a medical billing company provide?
At a minimum, ask for denial rate and top denial reasons, clean claim rate, days in accounts receivable, net collection rate, accounts receivable aging by payer and underpayment tracking, with trends over time.
What is a good net collection rate?
It varies by specialty and payer mix. Track your own trend month over month and ask your billing company to explain any drop.
How long does it take to switch medical billing companies?
It depends on your current contract’s notice period and how quickly data and system access can be transferred. Plan the handoff of unpaid claims and payer updates before your start date.
Will switching billing companies disrupt my cash flow?
A planned transition reduces the risk. Agree on who works old unpaid claims, keep access to your systems and watch claims closely in the first weeks.
Final Thoughts
Your billing company should strengthen your practice’s finances, not quietly drain them. If you see rising denials, aging unpaid claims, thin reporting or flat revenue despite more visits, it is time to ask hard questions or make a change.
Book a Free Consultation to talk through your numbers.