You already outsourced your billing. You were promised results. So why does revenue still feel off — and why does your billing company keep making excuses?
We asked the questions every provider is too polite to ask. Here are the honest answers — and what good RCM actually looks like.
Click any question to read the honest answer — and what RCMAXIS does differently.
A sub-90% clean claim rate almost always points to one of three root causes: incorrect or unspecified ICD-10 codes, missing or expired prior authorizations, or data entry errors in patient demographics and insurance information.
The industry benchmark is 95%+. Anything below that means your billing team is spending significant time reworking claims that should never have been rejected — costing you both cash flow and staff time.
The deeper problem: most billing companies treat rejections as something to fix after the fact rather than prevent upfront. A pre-submission claim scrubbing process should catch 95%+ of these errors before a claim ever leaves your system.
Days in AR above 45 usually reflects one or more of these problems: slow claim submission (claims going out days after service instead of within 24 hours), a lack of systematic follow-up on unpaid claims past 30 days, or a high initial denial rate creating a rework backlog.
Most payers process clean claims within 14–21 days. If you are waiting 60+, your claims are either being submitted late, rejected and resubmitted multiple times, or sitting unworked in an AR queue.
Payers do cause delays. But a competent RCM partner anticipates payer behaviour, knows each payer's quirks, and builds workflows around them.
If your billing company consistently blames payers without showing you denial trend data, appeal outcomes, or root cause analysis — that is a performance management problem, not a payer problem.
You should be receiving monthly reports showing exactly which payers are causing issues, what denial reason codes are driving it, and what specific steps are being taken. "The payer is slow" without data to back it up is not an acceptable answer.
Repeat denials on the same claim types are the clearest signal that your RCM company is reactive instead of proactive. They are working each denial individually rather than identifying the systemic root cause and fixing the upstream process.
Good denial management has two parts: resolving the current denied claim AND implementing a process change that prevents the same denial from recurring. If you are seeing the same denial reason codes month after month, the root cause has not been addressed.
Aged AR over 90 days grows when claims are not worked aggressively within the 30–60 day window. Many billing companies prioritise new claims over older ones because new claims are easier and faster to process.
Claims past 90 days require investigation, appeal letters, and persistence — work that is harder and less efficient for companies optimising for volume. A healthy AR portfolio should have less than 15–20% of balances in the 90+ day bucket.
Vague or infrequent reporting is a red flag. You are entitled to — and should demand — regular reports showing: clean claim rate, denial rate by payer and reason code, days in AR by aging bucket, net collection rate, and month-over-month trends.
If your current company cannot produce these reports, or gives you numbers without context or comparison to benchmarks, you are flying blind. Transparent reporting is not optional — it is how you hold your billing partner accountable for their performance.
This is one of the most common frustrations we hear. The problem is usually underpayments and inappropriate write-offs.
Payers routinely pay less than the contracted rate, and many billing companies accept the payment without checking it against your fee schedule. Additionally, claims that are difficult to collect are sometimes written off to keep collection percentage metrics looking good — at your expense.
Ask your billing company to show you your contractual adjustment rate and write-off amounts by payer for the last 12 months. If they can't or won't produce this data, that is your answer.
Consider switching if any of these are true:
Switching feels disruptive — but staying with an underperforming partner costs more every month. Most practices that switch to RCMAXIS recover their switching costs within 90 days from improved collections alone.
We will audit your current billing performance — clean claim rate, AR aging, denial patterns — and show you exactly what better billing looks like for your practice. No pitch. Just data.