What Happens When Your Practice Outgrows Its Billing Partner?
Has your healthcare practice grown beyond the capabilities of your current billing company? Learn the warning signs, common challenges, and how to evaluate whether your billing partner still supports your goals.
Oswego Medical Billing Solutions
5 min read
What Happens When Your Practice Outgrows Its Billing Partner?
A medical billing company may have been the right choice when your practice was smaller.
As the practice adds providers, services, locations, payer relationships, and claim volume, expectations often change.
Practice leaders may need more than basic claim submission and payment posting. They may also need:
Faster communication
Clearer reporting
Consistent denial follow-up
Greater visibility into insurance A/R
Support for underpayments and appeals
Better coordination during provider growth
Capacity for additional claim volume
This does not necessarily mean the billing company is performing poorly.
The relationship may simply no longer match the size, complexity, or financial needs of the practice.
Growth Changes What a Practice Needs From Its Billing Partner
A smaller practice may initially need a billing company to:
Submit claims
Post payments
Correct rejections
Follow up on unpaid balances
Answer billing questions
As the practice grows, leadership may need answers to broader questions:
Are collections keeping pace with increased activity?
Which payers are delaying reimbursement?
Are denials increasing?
Is insurance A/R moving into older aging categories?
Are underpayments being identified?
Can the billing company support additional providers or locations?
Do reports explain where revenue remains unresolved?
The issue is no longer whether claims are being processed.
The issue is whether the billing relationship provides enough capacity, communication, and visibility for the practice’s current needs.
Sign 1: Reports Show Numbers but Do Not Explain Performance
Billing reports may list charges, payments, adjustments, and outstanding balances.
Those numbers are useful, but growing practices often need more context.
Leadership may need to understand:
Why collections changed
Which payers are creating delays
Whether recurring denial patterns are developing
What is causing older A/R to increase
Whether payment posting is current
Which balances require immediate action
Whether underpayments are being reviewed
Which issues require practice involvement
A report should help leadership identify what happened, why it happened, and what needs attention.
If reports consistently create more questions than answers, the practice may not have enough visibility to evaluate billing performance confidently.
Sign 2: Communication Has Become Reactive
A strong billing relationship depends on communication from both parties.
The concern arises when the practice must repeatedly request basic information about:
Collection changes
Unresolved denials
Payer delays
Outstanding balances
Follow-up activity
Billing backlogs
Provider setup
Issues requiring practice input
Communication should not occur only after a problem becomes urgent.
A billing partner should be able to identify matters requiring attention, explain what has already been done, and communicate what the practice needs to provide.
Reactive communication can allow small issues to become larger backlogs before leadership understands what is happening.
Sign 3: Unresolved Insurance A/R Continues to Grow
Increasing insurance A/R does not automatically mean the billing partner is failing.
Some balances may reflect payer-processing delays, documentation requests, complex denials, or matters requiring practice input.
However, continued growth in older aging categories deserves closer review.
Leadership should be able to determine:
Which claims remain outstanding
Why payment has been delayed
What follow-up has occurred
Whether denials have documented next actions
Whether underpayments are being investigated
Whether appeals are moving forward
Whether filing or appeal deadlines are approaching
Who owns the next step
If the billing company cannot clearly explain the status of unresolved balances, the practice may need a more detailed evaluation.
Current denials, underpaid claims, delayed payments, unresolved appeals, aging balances, and old or legacy A/R may require different types of follow-up.
Related reading: Aging Insurance A/R: Hidden Revenue That May Still Be Recoverable
Sign 4: The Practice Has Become More Complex Than the Original Arrangement
A billing relationship may begin with a limited scope based on the practice’s earlier needs.
Over time, the practice may add:
Providers
Specialties
Services
Locations
Payer relationships
Billing systems
Reporting requirements
Greater claim volume
The original agreement may no longer reflect the work required.
Practice leaders should review whether the current billing arrangement clearly addresses:
New-provider setup
Additional claim volume
Payment posting
Denial management
Insurance A/R
Provider credentialing coordination
Communication across locations
Reporting for leadership
Existing or inherited backlogs
A billing company may perform well within the original scope while still lacking the capacity or service structure required for the practice’s next stage.
Sign 5: The Practice Cannot See What Work Is Being Completed
Outsourcing billing should not mean losing visibility.
Practice leaders should be able to understand:
Which claims were submitted
Which claims were rejected
Which payments were posted
Which denials require attention
Which balances remain outstanding
What payer follow-up has occurred
Which accounts are approaching deadlines
What information the practice must provide
What action is scheduled next
Without this information, leadership may know that cash flow or collections feel inconsistent without being able to identify the cause.
Visibility is especially important when the practice depends on the billing company to manage daily revenue-cycle activity.
A dependable partner should provide enough information for leadership to understand performance without requiring practice managers to oversee every account.
Related reading: Financial Visibility in Healthcare: Can a Practice Grow Without Understanding Financial Performance?
Sign 6: New Providers and Services Are Not Receiving Enough Support
Practice expansion can create billing and credentialing requirements that did not exist when the original relationship began.
Adding providers may require:
Provider-information collection
Credentialing and payer enrollment
Approval and effective-date tracking
Billing-system configuration
Communication with scheduling staff
Claim-submission readiness
Continued payer follow-up
Adding services may also create new payer, documentation, and billing requirements.
The billing partner should be able to explain what support is included and what remains the practice’s responsibility.
If provider growth repeatedly produces confusion, claim delays, or reimbursement uncertainty, the practice may need stronger coordination among credentialing, scheduling, and billing functions.
Sign 7: The Billing Company Processes Transactions but Does Not Resolve Problems
Submitting claims and posting payments are important.
Growing practices may also need support identifying why revenue remains unresolved.
That may involve:
Correcting rejected claims
Reviewing denial reasons
Requesting missing information
Investigating underpayments
Managing appeals
Communicating with payers
Tracking follow-up activity
Escalating unresolved issues
Reporting recurring patterns
A billing relationship may no longer be sufficient if the company processes transactions but consistently leaves the practice to investigate and manage unresolved claims.
The practice should understand what level of follow-up is included and how complex issues are handled.
Before Changing Partners, Clarify the Current Problem
Not every frustration requires a billing-company change.
The practice should first determine whether the concern involves:
Communication
Reporting
Service scope
Claim volume
Staffing capacity
Practice responsiveness
Missing information
Technology
Denial follow-up
Payment posting
Existing A/R
Credentialing coordination
Some concerns may be resolved by changing communication expectations, updating workflows, clarifying responsibilities, or revising the service agreement.
A change may deserve consideration when concerns remain unresolved, responsibilities no longer match practice needs, or the billing company cannot support the practice’s present complexity.
The purpose of an evaluation is not to assign blame.
It is to determine whether the current relationship can still produce the support, visibility, and follow-through the practice requires.
Understand What Will Happen to Existing A/R
Changing billing companies does not automatically resolve outstanding accounts.
Before a transition, the practice should clarify:
Who will continue working current claims
Who will post payments received after the transition
How unresolved denials will be handled
Who will manage pending appeals
How existing A/R will be transferred
Whether claim history and notes will remain available
Which accounts require focused recovery
How responsibilities will be divided during the transition
Existing balances may include:
Current denials
Underpaid claims
Delayed insurance payments
Unresolved appeals
Aging insurance balances
Old and legacy A/R
Claims without a clear follow-up history
The new billing company’s ongoing services may not automatically include cleanup of every inherited account.
A separate Revenue Recovery & Insurance A/R Cleanup plan may be needed for unresolved revenue transferred from the prior billing arrangement.
Evaluate the Transition Plan, Not Only the New Company
A billing-company transition can create additional risk if responsibilities are unclear.
The transition plan should address:
Data access
Claim and payment history
Outstanding balances
Payment posting
Clearinghouse or system access
Open denials and appeals
Provider and payer information
Communication responsibilities
Transition dates
Reporting expectations
Issues requiring practice input
Both the outgoing and incoming billing workflows may remain active temporarily.
The practice should know who is responsible for each account and activity during that period.
A well-defined transition plan can help reduce confusion and prevent claims or payments from being overlooked.
Related reading: Portland Medical Billing Services: What Healthcare Practices Should Look for in a Billing Partner
Has Your Practice Outgrown Its Current Billing Partner?
A billing company does not need to fail completely before the relationship deserves review.
The more important question is whether the current partner still provides the communication, reporting, capacity, follow-up, and visibility the practice requires.
A Complimentary Practice Revenue Assessment from Oswego Medical Billing Solutions can help a healthcare practice review:
Billing performance
Collection trends
Reporting quality
Communication gaps
Denial and payer follow-up
Aging insurance A/R
Underpayment and appeal concerns
Billing-partner responsibilities
Existing workflow limitations
Transition considerations
Practices in Portland, Oregon, and across the United States can use the assessment to gain a clearer understanding of whether the current billing arrangement remains aligned with present needs and future plans.
Request Your Complimentary Practice Revenue Assessment
Practices ready to explore a different ongoing billing structure can also review:
Medical Billing Services for Healthcare Practices
Oswego Medical Billing Solutions
Oswego Medical Billing Solutions provides medical billing, provider credentialing, Revenue Recovery & Insurance A/R Cleanup, and revenue-cycle support for healthcare practices throughout Oregon and across the United States.
8405 SW BARBUR BLVD, SUITE B
PORTLAND, OR 97219
Phone: (503) 345-4987
Fax: (503) 345-4998
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