What to Do If Your Medical Billing Company Underperforms

Choosing the right medical billing company is essential to the financial health of any healthcare practice. When your billing partner is effective, you see streamlined operations, faster reimbursements, and fewer denied claims. But when your billing partner underperforms, the consequences can be dire from delayed payments and compliance risks to frustrated patients and a tarnished reputation.

If you suspect or have confirmed that your medical billing company is not delivering the results your practice needs, its crucial to take action. In this guide, well explore the signs of an underperforming billing partner, the steps to address the issue, and how trusted providers like Thrive Medical Billing can help restore your confidence and revenue cycle performance.

Signs Your Medical Billing Company Is Underperforming

Recognizing underperformance is the first step. While no company is perfect, consistent or severe issues are red flags. Here are some common signs that your medical billing company may be falling short:

1. Frequent Denials or Rejected Claims

If your claim rejection rate is higher than average, this may signal poor coding, incorrect patient information, or failure to follow payer rules all of which should be caught and corrected by a competent billing partner.

2. Slow Reimbursement Rates

A noticeable delay between the time of service and when payments are received can point to issues with timely claim submission or follow-up procedures.

3. Lack of Transparency

Are you receiving regular reports? Do you have access to billing performance data? If your current provider avoids sharing performance metrics, this lack of transparency can hide serious problems.

4. Poor Communication

Your billing company should act like an extension of your office. If you struggle to get responses to your questions, or updates are vague and unhelpful, youre not getting the service you deserve.

5. Patient Complaints

Unhappy patients calling about unclear or incorrect billing statements can harm your practices reputation. If billing errors are common, the issue may lie with your billing partner.

6. Non-Compliance with Regulations

HIPAA compliance and up-to-date knowledge of payer rules are non-negotiables. A reputable medical billing company must ensure legal and ethical billing practices at all times.

Immediate Actions to Take

Once you notice these signs, taking immediate action is essential to minimize financial loss and protect patient trust.

1. Conduct an Internal Audit

Start by reviewing your recent claim activity, reimbursement reports, and outstanding accounts receivable (A/R). This helps you pinpoint where the problems lie is it coding, follow-ups, claim submissions, or patient communication?

2. Request a Performance Review

Approach your current medical billing company and ask for a detailed performance review. Any professional billing firm should be able to provide data on:

• Claim submission timeliness

• Denial and rejection rates

• Payment turnaround times

• Collection rates and aged A/R breakdown

If the company is unwilling or unable to provide this information, its a major red flag.

3. Schedule a Meeting

Set up a formal meeting to discuss your concerns. Be specific about the issues, present your audit findings, and give them an opportunity to respond. A competent company will take feedback seriously and offer solutions.

4. Set a Performance Improvement Plan (PIP)

If youre not ready to switch billing companies just yet, you can establish a 3090-day improvement plan. Define clear metrics they need to meet, such as:

• Reducing denial rates by X%

• Submitting all claims within 48 hours

• Clearing outstanding A/R over 90 days

Track progress weekly. If the company fails to meet the goals, its time to move on.

How to Transition to a New Billing Partner

When improvement isnt seen, the best course of action may be to transition to a more capable and trustworthy partner like Thrive Medical Billing. Heres how to switch effectively and safely:

1. Review Your Contract

Check your existing contract for termination clauses. Note the required notice period and any penalties for early termination. Have your legal advisor review the agreement to avoid complications.

2. Secure Your Data

Ensure you have full access to patient records, billing history, and claim documentation. Request data backups and system access before giving notice to your current provider.

3. Notify Stakeholders

Inform your internal team and key stakeholders, including front desk staff, practice managers, and providers. They will play a crucial role in making the transition smooth.

4. Choose the Right Replacement

Dont rush into a new contract. Evaluate potential partners like Thrive Medical Billing based on the following criteria:

• Industry experience and specialty knowledge

• Compliance with HIPAA and payer rules

• Transparent reporting and communication practices

• Use of advanced technology and automation

• Positive client reviews and references

5. Plan a Smooth Onboarding Process

Once youve selected a new provider, work closely with them to transfer all data and documents. A quality medical billing company will assign a dedicated onboarding specialist and set up integrations with your EHR system, train your team, and start work without major disruptions.

Why Practices Trust Thrive Medical Billing to Deliver Results

At Thrive Medical Billing, we understand how damaging underperformance can be. Thats why weve built a reputation for excellence, transparency, and results-driven service.

Heres how Thrive Medical Billing goes above and beyond:

Transparent Reporting and Dashboards

We offer clients real-time access to dashboards that show key performance indicators (KPIs), including claims submitted, denial rates, revenue collected, and A/R aging.

Proactive Communication

We treat your practice like a partner not just a client. Our team provides regular updates, answers questions promptly, and flags potential issues before they grow.

Highly Trained Experts

Our billing team is trained in over 20+ medical specialties, ensuring claims are coded and submitted correctly based on the latest payer rules and industry guidelines.

Automation and Accuracy

We use leading billing technologies and robotic process automation (RPA) to speed up claim submission, reduce errors, and improve payment accuracy.

Fast Onboarding

Switching to Thrive Medical Billing is simple. We handle the entire transition process, integrate seamlessly with your systems, and ensure continuity of service.

Dedicated Support

Every client receives a dedicated account manager who monitors your account, provides guidance, and ensures you receive the personalized attention you deserve.

Long-Term Lessons: Preventing Billing Issues in the Future

After dealing with an underperforming billing partner, its important to set up systems that help avoid future setbacks.

Set Clear Expectations

When hiring a new billing partner, outline expectations upfront including SLAs, communication frequency, and performance metrics.

Schedule Regular Check-ins

Meet monthly or quarterly to review billing reports, discuss concerns, and plan improvements. This keeps both parties accountable and proactive.

Monitor KPIs Consistently

Dont wait until theres a serious problem to check your billing performance. Regularly review key metrics like:

• First-pass claim acceptance rate

• Denial and rejection trends

• Days in A/R

• Patient collections

Maintain Control

Even with a trusted medical billing company, its important to stay involved. Ensure your practice understands the revenue cycle and participates in financial decisions.

Final Thoughts

When a medical billing company underperforms, it can shake the foundation of your healthcare practice. But with decisive action and the right replacement, recovery is not only possible its a chance to thrive.

Thrive Medical Billing is here to help you turn setbacks into success. With our industry expertise, technology-driven solutions, and unwavering commitment to transparency, were the trusted choice for healthcare practices that want billing done right.