How to Switch Medical Billing Companies Without Losing a Claim

Step 1: Know what your contract says

Most billing agreements have a notice period (thirty to ninety days), a clause about who works claims filed before termination and for how long, and a statement about data. If your billing was done in the company’s software, the data question is the important one: can you export patient demographics, charges, payments and AR, and in what format? Ask in writing before giving notice.

Step 2: Pick a cut-over date and define the split

The cleanest split is by date of service: the outgoing company owns every claim with a date of service before the cut-over, through to payment or final denial; the incoming company owns everything after. Agree how long the outgoing company will keep working the old AR (sixty to ninety days is common) and what happens to what remains, which usually transfers to the new company as a defined project.

Step 3: Inventory what has to transfer

• Payer enrollments. EDI, ERA and EFT enrollments are often tied to the submitter. New enrollments with each payer and clearinghouse take time; start them the day the decision is made so remittances do not go to the old biller’s clearinghouse after cut-over.
• Logins. Payer portals, clearinghouse, practice management system, CAQH and PECOS. Change passwords and update contact emails on the day the old company’s access ends.
• Credentialing records. Every approval letter, provider ID, effective date, contract, fee schedule and revalidation due date. If the old company handled credentialing, this is the record most likely to be lost.
• Fee schedules and contracts. Needed to verify payments and find underpayments.
• Reports. Final AR aging by payer, denial log, unbilled encounters, credit balances and refunds owed.
• Patient balances. Who sends the next statement and where payments are posted during the overlap.

Step 4: The parallel period

For the first month or two, both companies are active. The new company needs: access to the practice management system, the clearinghouse, payer portals and the EHR; payer-specific rules the old company learned; the fee schedules; and a daily channel to the front desk for eligibility and registration questions. Reconcile weekly during this period: charges entered versus visits, claims accepted versus submitted, payments posted versus deposits.

Step 5: Watch these numbers in the first ninety days

• Days from visit to claim submission
• Clearinghouse rejection rate and time to rework
• Claims with no response at thirty days
• Denial rate by payer and code, compared with the last three months under the old biller
• AR over ninety days, which should fall as the old AR is worked down
• Credit balances and refunds, which often surface during a transition

Moving billing in-house instead

Everything above applies, with the addition that you are hiring and training the people, buying or configuring the software and clearinghouse, and building the follow-up discipline from scratch. Budget the manager’s time for the first quarter honestly. Our in-house versus outsourced comparison sets out the trade-offs.

How Core MB runs a transition

We take new charges from the agreed date, run alongside your current biller until their claims close, and bring the open AR across as a defined project with its own report. Credentialing records are rebuilt in the client portal so every payer’s status and effective date is visible from the start. Read about the medical billing service or request a transition plan for your practice.