8 Warning Signs Your Medical Billing Company
Is Quietly Costing You Money
Most practices don't fire their billing company. They stay in a deteriorating relationship for years — tolerating rising denial rates, shrinking collections, and unanswered questions — because switching feels risky and the cost of staying seems invisible. It isn't invisible. It's just slow.
The average practice that is underserved by its billing vendor loses $47,000–$180,000 per year in preventable revenue leakage, depending on specialty and volume. That money doesn't disappear in a single dramatic failure. It drains away in small increments: a 2% rise in write-offs, claims that weren't appealed, authorizations that lapsed, and performance reviews that never happened.
Here are the eight warning signs that your billing company has crossed from suboptimal to genuinely costly — and what to look for in each.
Your Denial Rate Has Been Climbing for Two or More Quarters
A denial rate that is trending upward over two or more consecutive quarters is not bad luck — it is a process failure. Best-in-class billing companies maintain denial rates below 4%. Industry average sits at 14–17%. If your denial rate is above 10% and has risen over the past six months, your billing company is submitting claims that are failing on the first pass and not fixing the upstream causes.
The critical question is whether your billing company is showing you denial trend data at all. If you are not receiving monthly denial reports broken down by payer and root cause (CARC/RARC codes), you cannot manage what is happening — and neither can they.
Your Days in A/R Has Exceeded 45 Days and Is Not Improving
Days in A/R — the average number of days between rendering service and receiving payment — should be below 35 for most specialties, and below 28 for high-volume primary care. Best-in-class practices achieve 18–22 days. A practice sitting above 45 days has a structural problem: claims are either being submitted late, denied and not quickly appealed, or simply not being followed up on.
More concerning than a high Days in A/R figure is one that has been high for multiple quarters with no downward trend. That indicates your billing company has accepted the situation as normal rather than treating it as a performance deficiency to resolve.
Write-Offs Are Growing Without Explanation
Write-offs fall into two categories: legitimate contractual adjustments (the difference between your billed charge and the payer's contracted rate) and operational write-offs (claims written off because they weren't followed up, appeals weren't filed, or timely filing windows passed). The first category is normal. The second is a billing failure.
If your total write-offs as a percentage of gross charges have increased over the past year without a corresponding increase in contractual adjustment rates, your billing company is likely writing off claims that could have been recovered. Common patterns include: aged AR written off at 120 days without appeal attempts, small-balance claims below $50 written off without effort, and medical necessity denials written off instead of being appealed with documentation.
You Don't Receive Regular, Specific Performance Reports
A billing company managing your revenue cycle should proactively provide monthly performance reports covering at minimum: clean claim rate, denial rate with root cause breakdown, Days in A/R, net collection rate, and AR aging by bucket (0–30, 31–60, 61–90, 90+ days). If you are receiving a summary report with totals only — or no report at all unless you request one — your billing company is not managing your practice as a performance-accountable client.
The absence of proactive reporting is particularly telling. A billing company that knows your numbers are good will show you your numbers. One that withholds or summarizes away from specifics often does so because the specifics are unflattering.
You Have a New Dedicated Contact Every Few Months
High staff turnover at billing companies is a direct revenue risk for your practice. Every time a new account manager is assigned, there is a knowledge transfer gap during which your nuances — your payer mix, your authorization quirks, your prior auth workflows, your documentation patterns — are unknown to the person submitting and following up on your claims. Denials rise during transitions. Claims fall through cracks.
If you have had more than two dedicated account contacts in a 12-month period, or if you regularly deal with a different person each time you call, this is a red flag about the underlying business health and stability of your billing vendor.
Prior Authorization Lapses Are Causing Denials
Prior authorization denials are almost entirely preventable with the right process. If you are regularly seeing denials with the message "service requires prior authorization" or "authorization not obtained," your billing company's pre-authorization workflow is broken. This is not a payer problem — it is a process problem on the billing side.
For specialties with high auth burden (cardiology, orthopedics, pain management, oncology), auth-related denials can represent 20–35% of all denials. Each one represents a procedure your practice performed and may not be paid for, plus the administrative cost of the appeal process. The fix is a systematic prior auth management workflow — not case-by-case scrambling.
Aged AR Is Growing Without Active Recovery Efforts
Claims that reach 90+ days outstanding are not dead — but they require specific, escalated action. Medical necessity denials need peer-to-peer physician review. Coordination of benefits disputes need documentation. Some payers require formal appeal letters with clinical attachments. If your billing company's response to 90-day-aged claims is simply to mark them for write-off rather than work them through appropriate escalation channels, you are losing recoverable revenue.
Industry data shows that 60–80% of claims in the 90–180 day bucket are still recoverable through appeals, peer-to-peer reviews, or corrected submissions — if they are worked proactively before timely filing windows close.
Your Collections Haven't Grown Proportionally with Your Volume
This is the most important warning sign because it is the hardest to see. If your patient volume has grown 15% over the past two years but your net collections have grown only 6%, the gap represents revenue that was billed but not collected. Some of that difference may be legitimate (write-offs for uncollectable patient balances, contracted rate adjustments), but a material portion almost certainly reflects billing performance deficiencies.
Run this calculation: take your total gross charges from two years ago and today. Calculate the ratio. Now do the same for net collections. If the collections ratio is more than 5 percentage points below the charges ratio, you have a revenue capture gap that needs explanation — and likely, a billing company that isn't performing.
What Switching Actually Looks Like
The most common reason practices stay with an underperforming billing company is fear of the transition. "What happens to our current AR?" and "Won't collections drop during the switch?" are legitimate concerns — but they are also frequently used by incumbent vendors to discourage practices from leaving.
Here is what a well-managed billing company transition actually involves:
- Parallel billing period (Days 1–14): The incoming vendor completes EHR integration and learns your specialty workflows while you continue with your current vendor. New claims transition; existing AR continues to be worked.
- AR transfer protocol: All open claims — including aged AR — are documented and transferred. A responsible incoming vendor will audit your aged AR within the first week and identify recovery opportunities your current vendor missed.
- Zero gap in collections: Because new claims begin transitioning immediately and aged AR is actively worked from day one, there is typically no revenue gap during a well-managed transition.
- 30-day performance baseline: Within 30 days of transition, your new vendor should be able to show you a clean claim rate comparison and a denial rate comparison against your prior vendor's numbers.
Before You Decide: Give Them One Chance to Respond
If you've identified warning signs above, the right first step is a direct performance conversation with your current billing company — not an immediate switch. Present the specific numbers. Ask the specific questions. Give them 30 days to show a measurable improvement plan. This does two things: it sometimes fixes the problem (good outcome), and it gives you clear documentation that you tried to resolve the situation before transitioning (important if you're in a contract).
If the conversation produces defensiveness rather than a concrete action plan — or if the action plan isn't followed through within 30 days — you have your answer.
Performance Conversation Checklist: Bring This to the Meeting
- Current denial rate vs. specialty benchmark (MGMA/HFMA data)
- Current Days in A/R vs. 12-months-ago figure
- Write-off breakdown: contractual vs. operational, last 6 months
- AR aging report: breakdown of 90+ day bucket by claim
- Prior auth denial rate for last 90 days
- Net collection rate compared to industry benchmark for your specialty
- List of claims over $500 in 90+ day bucket with last action date
At RCMAXIS, we routinely perform free 90-day claims audits for practices evaluating a switch. This gives you an objective third-party assessment of your current billing performance — with specific numbers, not estimates — before you make any commitment. If your current vendor is performing adequately, we'll tell you that too. If they're not, you'll have the data to make an informed decision.
Get an objective assessment of your current billing performance.
Our free 90-day revenue assessment audits your existing claims, identifies recoverable revenue, and gives you a specific comparison against specialty benchmarks — at no cost and no commitment.
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References
- Black Book Research. (2025). Revenue Cycle Management Outsourcing Market Survey. Black Book.
- MGMA. (2025). Outsourced Billing Performance Report. Medical Group Management Association.
- HFMA. (2025). Revenue Cycle Benchmarking Survey. Healthcare Financial Management Association.
- Advisory Board. (2025). Revenue Cycle Performance Benchmarks: Specialty Practices. Advisory Board Company.
- AMA. (2025). Physician Practice Benchmark Survey. American Medical Association.