illustration of someone making a decision at a crossroads

How Do I Know It’s Time to Switch Billers?

When it comes to relationships, we yearn for the days when they finally feel comfortable. A point when the anxiety is gone. When you can breathe easy and know that everything is on track. 

These relationships happen in our personal and professional lives. As a practice owner, you’ve developed solid, comfortable relationships with your employees, patients and vendors. Your biller, too. 

Regardless of comfort level, your biller relationship is one of the most critical. Your business’ success relies on their performance within the healthcare revenue cycle. But what happens when the relationship isn’t working anymore? It can be challenging to notice the signs and know when to switch billers.

When to Switch Billers: 4 Signs It’s Time to Change

Sometimes, the signs you need to switch medical billers are spelled out clearly in your practice’s revenue cycle metrics. Your net collection rate may drop, or your accounts receivable (A/R) may skyrocket. In other words, your revenue takes a dive.

But knowing when to switch billers isn’t always as clear-cut as a negative balance sheet. There are other symptoms that you’ve outgrown a billing relationship, and you don’t need to be an accounting expert to spot them.

Your Claim Volume Increases

Have you recently added a clinician or two to your practice roster? Is your caseload increasing? More clinicians and cases translate into more claims. 

If you manage your practice’s billing independently or have a staff member handling billing part-time, a higher claim volume can cause significant strain. It will take time away from patient care and other critical administrative tasks that keep your practice running. You may also see delays in payment because of a backlog of claims. 

While you or your staff may have the billing knowledge to handle claims, you may hit a point where you simply outgrow this setup. Generally, we see this when claim volume doubles or more — but this threshold varies from practice to practice.

When your claim volume grows, bringing in additional support or a professional billing team can help ensure your practice stays on top of its billing and revenue cycle. 

Your Claims Become More Complex

Like increased claim volume, increased claim complexity can also put a strain on your billing workflow and signal its time to switch medical billers. This complexity can stem from:

  • Adding new testing options. You may decide to offer testing services that require multiple test sessions over several weeks. In many cases, payers require information from all the testing sessions, the assessment and the treatment plan before processing a claim.
  • Adding new treatment options. You may start to offer new treatment options that require more detailed or complex documentation with a payer.
  • More complex payer rules. You may add a new payer with complex claim requirements, or one of your existing payers may adjust its rules — either way, your claim filing process will be more time-consuming and tedious.

You’re Babysitting Your Biller

If you’re checking in often with your biller, making sure they’re filing claims and staying on top of their work, it’s time to find a new solution. While you may not want to be completely hands-off with your billing, it shouldn’t add to your workload. Having a good biller means you can spend time on your practice and your family without the burden of additional billing work.

You’re Not Getting the Right Support

Many billers tout transparency as a selling point for their services — they’ll provide detailed reports about your billing and revenue cycle. 

But getting these reports is one thing. Understanding the numbers and what action to take is another. 

A good biller should feel like an extension of your practice — a partner who works with you to find growth opportunities. Make sure your biller is not only providing you with reports but also walking through these numbers with you and helping you use them to improve your practice. 

Also, remember that a true partner will make the time to meet with you and answer your questions. If you find your biller is taking a long time to respond to your questions and concerns — or doesn’t respond at all — find someone who will make you a priority.

Switching Medical Billers Is a Big Change: Do I Have to Do It?

You know your billing relationship is on the rocks. But is it worth making a change? 

One perspective to remember is that the biller switching process isn’t nearly as frustrating as it once was. Years ago, you may have experienced a dip in revenue during the switch. But we don’t face the same issues today. These days, clearinghouses and insurance payers have greater flexibility in setting up enrollments — including electronic funds transfer (EFT) electronic remittance advice (ERA) and electronic data interchange (EDI).

Another important consideration: How will your revenue suffer if you stay with the under-performing biller? While the problems may be small now, they could snowball into a larger financial issue. The process of switching billers may be an inconvenience, but it will pay off in your practice’s financial health and longevity. 


Do you need a billing change at your practice? At Gentem, we help physicians spend less time on billing and reduce their time-to-reimbursement. That means you can focus on caring for patients and growing your practice, instead of worrying about paychecks and payers. Learn more about our revenue cycle expertise and tech-first billing solution.

WATCH: Revenue Cycle Tips for Staying Independent

Many physicians are leaving private practice due to rising costs, lower reimbursement rates and staffing shortages. But staying independent is possible with a healthy revenue cycle.

Learn how to run a successful private practice with tips from this 20-minute webinar session.

eBook Cover for 5-Must Know Metrics To Build A Thriving Medical Practice

5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

Subscribe To Our Newsletter

Related Articles

Eliminate your medical billing headaches today.