Most practices that switch medical billing companies don’t lose revenue because of the new vendor. They lose it during the handoff. Across poorly managed billing transitions, practices can lose between 6% and 14% of revenue, and the damage is almost entirely preventable. Without a parallel billing window, some practices absorb a temporary monthly dip of 10% to 20% simply because no one planned for the claim submission gap that opens during cutover. If you need to know how to switch medical billing companies without losing revenue, this eight-step playbook is your starting point.
Every step has a clear owner, a defined deadline, and a specific outcome. Whether you’re making the switch because of mounting denials, poor communication, or a fee structure that’s draining your practice, the process is the same: document everything before you give notice, run claims in parallel during cutover, and monitor KPIs at defined checkpoints afterward. Get this right and your revenue won’t feel the switch at all.
What Is the Safest Way to Switch Medical Billing Companies?
The safest transition is one where you know what is moving, who owns each task, when it must happen, and how you will measure the result.
Before switching vendors, you should:
- Review your current billing contract.
- Establish a financial and operational baseline.
- Export and verify your billing data.
- Create a claim-by-claim A/R ownership list.
- Verify payer enrollment, EDI, ERA, and EFT requirements.
- Define the exact cutover date and responsibilities.
- Use a controlled overlap or parallel-processing plan where appropriate.
- Review KPIs at 30, 60, and 90 days.
The goal is not simply to switch medical billing companies. The goal is to make sure claims keep moving while responsibility changes hands.
When Should You Switch Medical Billing Companies?
Before you give notice, ask a more basic question: Is the problem actually the billing vendor, and have you documented it?
A practice may start considering a new billing company after seeing:
- Increasing claim denials
- Growing 90+ or 120+ day A/R
- Slow claim follow-up
- Poor communication
- Delayed payment posting
- Repeated eligibility-related denials
- Coding or documentation problems
- Missing reports
- Difficulty obtaining billing records
- Lack of specialty-specific experience
- Credentialing or payer enrollment problems
- Patient complaints about billing communication
- Lack of visibility into outstanding claims
One isolated problem does not automatically mean you need a new vendor. A repeated pattern is different.
Before making the switch, create a simple list with three columns:
| Problem | Evidence | What You Expect From the New Vendor |
| High denials | Current denial report | Weekly denial analysis |
| Aging A/R | 120+ day A/R report | Defined follow-up workflow |
| Slow reporting | Reports arrive late | Weekly dashboard |
| Poor communication | Missed responses | Dedicated contact |
| Data access issues | Missing claim history | Complete data handoff |
This turns a vague complaint into a measurable transition objective.
A Realistic Example: What a Billing Transition Can Put at Risk
Suppose your practice normally collects $180,000 per month, which averages approximately $6,000 per day. This does not mean that every day produces exactly $6,000 in cash, and it does not mean a delay automatically creates a permanent $6,000 loss. However, it provides management with a useful way to understand cash timing. If a transition creates a five-day disruption in expected collections, the practice could have roughly $6,000 × 5 = $30,000 of average collection volume moving later in the cash cycle. This is a planning example, not an industry benchmark or a claim of permanent revenue loss. The practical question for your practice is: “How much expected cash could be delayed if claims, posting, or follow-up are interrupted?” Calculate that before the transition, not after the first difficult month.
How to Switch Medical Billing Companies Without Losing Revenue: What Goes Wrong First
The revenue loss that follows a billing vendor change almost never comes from the new company being incompetent. It comes from three specific transition failures that happen in the gap between vendors. The first is a claims submission pause during cutover, when new claims stop briefly while the incoming vendor completes onboarding. The second is AR ownership confusion, where open claims go unworked because neither vendor is certain who’s responsible for follow-up. A third failure, ERA and EFT enrollment delays, allows payer remittances and payments to keep routing to the old vendor’s accounts for weeks after the switch.
Each of these problems is manageable on its own. The danger is that they typically happen simultaneously. When claim submission pauses, open AR stops being worked, and remittances route to the wrong address all at the same time, the effect multiplies. Practices don’t feel it immediately either. The cash flow hit shows up 30 to 60 days later, which is why many administrators don’t connect the revenue dip to the transition at all. By the time the problem is obvious, denied claims have aged, timely-filing windows have narrowed, and the outgoing vendor has already wound down their follow-up activity.
A structured migration eliminates all three failure modes before they start. The difference between a zero-disruption switch and a 10% revenue loss is documentation: a claim-by-claim ownership map, a parallel billing window, a signed data transfer agreement, and a credentialing audit before day one. None of these are optional. All of them are achievable with the right preparation.

Step 1: Audit Your Current Vendor Before You Give Notice
Before you contact anyone, pull your billing agreement. Identify the required notice period, typically 30 to 90 days, with many contracts landing at 60 days, along with data-return obligations, access termination timelines, and any runoff language covering claims submitted before the cutoff date. You can’t plan the transition without knowing the contractual boundaries, and knowing them in advance protects you if the outgoing vendor restricts system access the moment notice is given.
Once you’ve reviewed the contract, pull three months of billing performance data from your current vendor: denial rate by payer, AR aging buckets at 30, 60, 90, and 120-plus days, and your clean claim rate. This is your baseline. Any drop in these numbers after the switch signals a transition problem, not a coincidence. If you don’t know what normal looks like for your practice before you switch, you won’t recognize when something has gone wrong after.
The step most practices skip entirely is confirming which payers are enrolled under your Tax ID versus the vendor’s own entity. Ask your current billing company to provide a credentialing roster showing each provider, each payer, the enrolled Tax ID, and the effective date. If any enrollment is tied to the billing company’s group entity rather than your practice’s Tax ID and NPI, you’ll need to rebuild those enrollments from scratch under your own credentials. That process takes 60 to 180 days depending on the payer, which means you need to know about it now, not on go-live day.
Build a Payer and Enrollment Inventory
Create one spreadsheet containing:
| Payer | Provider | Tax ID | NPI | Enrollment Status | EDI | ERA | EFT | Notes |
| Medicare | Practice provider | Practice TIN | Practice NPI | Active | Yes | Yes | Yes | Verify |
| Medicaid | Practice provider | Practice TIN | Practice NPI | Active | Yes | Pending | Yes | Follow up |
| Commercial Payer | Practice provider | Practice TIN | Practice NPI | Active | Yes | Yes | Pending | Verify |
The NPI is a standard identifier used in HIPAA administrative transactions, and CMS notes that covered providers, health plans, and clearinghouses use NPIs in adopted transactions. The purpose of this spreadsheet is simple: You should know what exists before you ask a new company to manage it.
Step 2: Establish Baseline KPIs and Document Every Open Claim
Track five specific metrics through the transition: clean claim rate, days in AR, denial rate by payer, first-pass resolution rate, and weekly collections compared to your prior 90-day average. These are your guardrails. Set a threshold for each that triggers an escalation call if crossed. A greater than 5% drop in weekly collections or a denial rate that climbs more than 3 percentage points above baseline are two good starting thresholds. Without predefined triggers, you’re monitoring without a plan to act.
Before the cutover date, generate a complete AR aging report from your current vendor. List every open claim with the claim date, payer, submitted amount, current status, denial reason if applicable, and the next action required. Then assign a clear owner to every line item on that list. This document becomes your handoff master file, the single most important tool for preventing any claim from slipping through the gap between vendors. A claim without an assigned owner during a transition is a claim that won’t be worked.
Create Your Baseline
Record:
| KPI | Your Current Number | Date Measured |
| Monthly collections | Enter actual | Pre-switch date |
| Clean claim rate | Enter actual | Pre-switch date |
| Denial rate | Enter actual | Pre-switch date |
| Days in A/R | Enter actual | Pre-switch date |
| 90+ day A/R | Enter actual | Pre-switch date |
| 120+ day A/R | Enter actual | Pre-switch date |
| Open claims | Enter actual | Pre-switch date |
| Rejection volume | Enter actual | Pre-switch date |
| Payment posting lag | Enter actual | Pre-switch date |
These are your baseline numbers, not universal industry targets. That distinction matters. For example, if your practice begins at 91% clean claims and moves to 95% after a transition, that is a different story from a practice that begins at 98%.
Step 3: Build a Realistic Transition Timeline With the Right Partner
A standard billing migration, from notice to full operational transfer, takes 8 to 12 weeks when done correctly. The first four weeks cover the credentialing audit, data export request, and new vendor onboarding. Weeks five through eight are the parallel billing window, where both vendors operate simultaneously. Weeks nine through twelve are the post-cutover monitoring period, where the new vendor has full ownership and you’re reviewing KPIs weekly against your pre-transition benchmarks.
Not every billing company runs a structured migration. When evaluating candidates, ask specifically whether they assign a dedicated transition coordinator, whether they provide a written 30/60/90-day onboarding roadmap, and how they handle legacy AR from the previous vendor. At Revex Square, the onboarding process includes a formal transition plan built before day one: a claim inventory handoff, HIPAA-compliant data intake, and a credentialing audit so claim submission continues uninterrupted from the start. That structured intake is what separates a smooth cutover from a revenue disruption.
Your week-by-week framework should look like this:
- Weeks 1, 2: Serve notice, sign the new agreement, and begin the data export request.
- Weeks 3, 4: Complete the credentialing audit, submit ERA and EFT re-enrollment applications, and transfer data to the new vendor.
- Weeks 5, 8: Run parallel billing with the new vendor processing new claims and the old vendor working legacy AR.
- Weeks 9, 12: Execute the full cutover with the new vendor owning all claims, and begin weekly KPI reviews.
That calendar is the backbone of a zero-disruption switch.
Step 4: Transfer Your Billing Data Securely Between Systems
What to Export and From Where
A secure data migration requires exports from three distinct systems, and missing any one of them creates a reconciliation gap that takes weeks to resolve. From your EHR, you need patient demographics, insurance coverage, subscriber data, provider identifiers, and authorization records. From your practice management system, pull full claim history, open claims with status, payments, adjustments, fee schedules, and AR aging. From your clearinghouse, collect the payer enrollment list, submitter IDs, routing configuration, and 12 to 24 months of ERA and 835 remittance files.
The safest formats for each domain are: EHR data in CSV or HL7/FHIR; PM billing history in CSV or structured Excel-compatible reports; ERA and remittance files in ANSI 835; and patient statements in PDF plus a CSV balance summary. Confirm format compatibility with the new vendor before initiating the export, not after. Mismatched formats are one of the most common causes of migration delays, and they’re entirely preventable with a ten-minute conversation in week two.
Any transfer of patient billing records between vendors is a HIPAA-regulated activity. Confirm that the new vendor signs a Business Associate Agreement before any data is shared, that all data is transmitted over an encrypted channel, and that both vendors have documented breach notification policies. Don’t treat this as a formality. If the transition is moving quickly, the temptation is to share files over email and sort out the paperwork later. That approach creates compliance exposure that outlasts the transition itself.
Step 5: Assign Claim Ownership Before the Cutover Date
There are two models for handling legacy AR, and you need to choose one explicitly before the cutover date. In the first model, the outgoing vendor retains all claims submitted before the cutoff and continues working them through resolution. In the second, the new vendor takes over all open AR as of the cutoff date and assumes responsibility for follow-up, appeals, and collections. The first model requires your old vendor to remain cooperative after termination. The second requires your new vendor to have clear status notes on claims they didn’t originally submit. Neither model works without a written agreement defining the boundary.
Put the ownership decision in writing with both vendors. The agreement should specify the cutoff date, which claims fall under each vendor’s responsibility, who handles denied claims and appeals filed before the cutoff, and the timeline for the outgoing vendor to return all data. A verbal understanding is not enough. Practices that skip this step routinely discover months later that a bucket of denied claims was never appealed because each vendor assumed the other was handling it. That kind of gap is invisible until the write-offs show up.
Timely-filing deadlines don’t pause for a billing transition. Map the filing deadlines for your top five payers: Medicare allows 12 months from date of service, while many commercial plans run 90 to 180 days. Flag any open claims within 60 days of their filing deadline and mark them as high-priority on your handoff inventory. These claims need to be actively worked during the transition window, not parked in a queue waiting for cutover to complete.
The Ownership Matrix
Create a table like this:
| Claim Type | Cutoff Rule | Owner | Required Action |
| New claims after go-live | New vendor | New vendor | Submit + follow up |
| Open claims before cutoff | Written agreement | Named vendor | Continue follow-up |
| Denials received before cutoff | Written agreement | Named vendor | Appeal/resubmit |
| Patient balances | Written agreement | Named team | Statements/follow-up |
| Unposted ERAs | Transition responsibility | Named team | Post + reconcile |
| Unidentified payments | Transition responsibility | Named team | Research + reconcile |
This prevents one of the most dangerous transition problems: “I thought they were handling it.”
Timely Filing: Do Not Let a Vendor Change Put Old Claims at Risk
Payer filing deadlines vary. For Medicare fee-for-service claims, CMS generally requires claims to be filed within 12 months, or one calendar year, from the date of service, subject to specific exceptions. Commercial payer deadlines can be different. That means you should not create one generic “timely filing” number for every payer.
Instead, build a deadline tracker:
| Payer | Filing Rule | Oldest Open Claim | Days Remaining | Owner |
| Medicare | Verify CMS rule | From A/R report | Calculate | Assign owner |
| Commercial A | Contract/payer rule | From A/R report | Calculate | Assign owner |
| Commercial B | Contract/payer rule | From A/R report | Calculate | Assign owner |
Prioritize claims that are closest to the relevant deadline.
Step 6: Run Parallel Billing to Protect Cash Flow
Parallel billing means the new vendor processes all new claims from the go-live date while the outgoing vendor continues working claims submitted before cutover. The two streams run simultaneously for a defined overlap period. This is the single most effective tool for protecting revenue when to switch medical billing companies because it eliminates the claim submission gap that causes the 10% to 20% temporary revenue dip most practices experience when they switch vendors without an overlap window.
For a typical practice, plan for a four-week parallel billing window. If your billing is complex, multiple specialties, high-volume payers, or a significant legacy AR file, extend it to six to eight weeks. During the parallel period, track each vendor’s submission volume weekly. If new claims from the incoming vendor drop below expected volume in week two or three, that’s a signal that warrants an immediate call to your transition coordinator. Don’t wait for the month-end report to surface it.
A Simple Two-Lane Transition Map
Use this with your billing team:
| Area | Old Vendor | New Vendor | Practice |
| Historical claims | Assigned role | Assigned role | Oversight |
| New claims | No/limited role | Primary owner | Monitor |
| Legacy A/R | Assigned role | Assigned role | Escalation |
| Denials | Defined responsibility | Defined responsibility | Review trends |
| Payment posting | Defined responsibility | Defined responsibility | Reconcile |
| ERA/EFT | Verify transition | Verify transition | Confirm |
| Data migration | Export | Import/validate | Approve |
| KPI reporting | Final baseline | Ongoing reporting | Review |
Put this in writing before the cutover.
Step 7: Navigate Payer Credentialing and ERA/EFT Re-Enrollment
The Most Expensive Mistake in Any RCM Vendor Migration
The most common credentialing problem after an RCM vendor migration isn’t a new enrollment issue, it’s a transfer problem. If your prior billing company controlled your enrollment file or set up payers under their own group entity, you may need to rebuild those payer relationships under your practice’s Tax ID from scratch. That process takes 60 to 120 days for most payers and up to 180 days for commercial plans with closed panels or processing backlogs. Starting this process late is the most expensive mistake practices make when ready to switch medical billing companies.
Submit payer applications in parallel, not sequentially, and start at least 120 days before your intended cutover date. Prioritize Medicare and Medicaid first since they carry the longest processing timelines. Verify that your CAQH profile is current and attested before submitting anything, outdated information is the most common reason an application gets returned and the processing clock restarts. If you need to expedite a stalled application, call the payer around day 45, ask for the specific hold reason rather than a generic status update, and escalate to provider relations if the assigned analyst isn’t responsive.
ERA and EFT enrollment are separate from credentialing, and practices routinely overlook them until remittances stop arriving. Your new billing vendor needs to be enrolled to receive electronic remittance advice, and your practice’s banking information needs to be updated for electronic funds transfer with every payer. This process takes two to four weeks per payer. If you have six to eight major commercial payers plus Medicare and Medicaid, getting all primary payers fully re-enrolled takes two to three months. Submit ERA and EFT applications on the same day your new vendor agreement is signed, not when you’re ready to go live.
ERA and EFT Should Have Their Own Checklist
CMS notes that providers need practice Tax Identification Number and clinician NPI information when enrolling for EFT and ERA, and describes standardized EFT/ERA operating rules.
Create a payer-by-payer checklist:
| Payer | ERA | EFT | Confirmation | Date |
| Medicare | ✅ | ✅ | Confirmed | Enter date |
| Medicaid | ✅ | ⏳ | Pending | Enter date |
| Commercial A | ✅ | ✅ | Confirmed | Enter date |
| Commercial B | ⏳ | ⏳ | Pending | Enter date |
Do not mark the task complete simply because an application was submitted. Use:
Submitted → Pending → Approved → Tested → Confirmed
Step 8: Set KPI Checkpoints and Monitor Results Post-Transition
What to Review at 30, 60, and 90 Days
At the four-week mark post-cutover, review your five baseline KPIs against the benchmarks you established in Step 2. You’re looking for a clean claim rate within two percentage points of baseline, weekly collections at 95% or better of your 90-day average, and no material change in denial rate. A clean claim rate below 95% or a denial rate above 5% at week four warrants an immediate escalation, not a note in the next monthly review. Early intervention fixes these problems in days. Delayed action turns them into months of AR recovery work.
At the eight-week mark, add a payer-level AR aging review to your checkpoint. Any payer showing a spike in 60-plus day claims needs a dedicated appeal sprint, not just monitoring. This is also the point where ERA and EFT enrollment should be fully confirmed across all major payers. If any payer is still routing remittances to your outgoing vendor at week eight, that’s an urgent issue requiring direct follow-up with the payer’s provider relations team.
At the 90-day mark, conduct a full reconciliation. Compare the outgoing vendor’s final AR aging report against what the new vendor has collected or resolved. Any remaining open balance from the legacy file needs a disposition decision: appeal, write-off, or patient collection. This is also when you formally assess whether the transition met its KPI targets.
Three signals warrant immediate escalation at any point during the monitoring period. Weekly collections dropping more than 10% for two consecutive weeks points to a systemic submission or posting problem. The new vendor’s clean claim submission rate falling below 95% in month one signals a coding or eligibility verification gap. ERA and remittance files going dark from a major payer usually indicates a re-enrollment failure. Each has a root cause that resolves quickly when caught early. Left unaddressed for 30 days, they compound into a significant revenue hole.
Your 90-Day Medical Billing Transition Scorecard
| Metric | Pre-Switch | 30 Days | 60 Days | 90 Days |
| Monthly collections | Enter actual | Enter actual | Enter actual | Enter actual |
| Clean claim rate | Enter actual | Enter actual | Enter actual | Enter actual |
| Denial rate | Enter actual | Enter actual | Enter actual | Enter actual |
| Days in A/R | Enter actual | Enter actual | Enter actual | Enter actual |
| 90+ day A/R | Enter actual | Enter actual | Enter actual | Enter actual |
| 120+ day A/R | Enter actual | Enter actual | Enter actual | Enter actual |
| Open claims | Enter actual | Enter actual | Enter actual | Enter actual |
| Rejections | Enter actual | Enter actual | Enter actual | Enter actual |
| Payment-posting lag | Enter actual | Enter actual | Enter actual | Enter actual |
This table turns the vendor change into a measurable project.
Protecting Your Revenue Starts Before the Transition Does
To switch medical billing companies is one of the highest-risk operational decisions a practice can make, but the risk is manageable with the right structure. The practices that come through a vendor change without a revenue gap don’t just pick a better billing partner; they run a documented transition. They audit before giving notice, assign ownership to every open claim, run parallel billing during cutover, and monitor KPIs at defined checkpoints. This eight-step playbook on how to switch medical billing companies without losing revenue gives you exactly that structure.
The billing partner you choose matters, but the process matters more. A capable vendor can still create a revenue disruption if your practice doesn’t have a migration plan in place before day one. At Revex Square, we’ve helped practices across 25-plus specialties transition to structured, high-performing RCM operations, many of them coming from situations with high denial rates, aging AR, and years of billing data that needed careful migration and reconciliation. The eight-step process above is how those transitions happen without the 30-day cash flow lag that catches most practices off guard.
If you’re considering to switch medical billing companies or already planning one, get in touch with our team before you give notice. We’ll walk through your current vendor’s performance data, identify any credentialing or enrollment risks, and build a written transition plan tailored to your practice’s payer mix and specialty. Starting at just 2.75% of collections, Revex Square gives you the expertise and the structure to make the switch without sacrificing a dollar of revenue you’ve already earned.
Revex Square Published Performance Snapshot
The following figures are published on Revex Square’s own website and are included here as vendor reference data not as universal industry benchmarks or guaranteed outcomes.
| Metric / Capability | Published Revex Square Data | Website Source |
| Clean claim submission rate | 99%+ | Medical Billing Services |
| Claim rejection rate | Less than 1% | Medical Billing Services |
| Average days in A/R | Less than 30 days | About Us |
| Reporting | Real-time performance dashboards and detailed monthly RCM reports | About Us |
| Service coverage | Billing, coding, credentialing/enrollment, eligibility, denial management, A/R, and patient billing | Medical Billing / About Us |
Conclusion: A Billing Vendor Change Should Be Managed Like a Project
A medical billing company transition should never be as simple as, “We fired the old vendor on Friday and the new company starts Monday.” Instead, it should follow a structured process that includes auditing, establishing a baseline, organizing data, assigning ownership, reviewing payer information, completing the cutover, and monitoring results. The most important protection is not a promise that nothing will ever go wrong, but having enough documentation and visibility to identify problems while they are still manageable. Before the transition, practices should know what they have. During the transition, they should know who owns the next action. After the transition, they should know what changed. This practical approach provides a strong foundation towards switch medical billing companies while minimizing unnecessary disruption to the revenue cycle.
Need Help Reviewing Your Billing Transition?
Before you give notice to your current billing company, review your:
- A/R aging
- Denial patterns
- Claim inventory
- Payer enrollment
- Data-access requirements
- ERA/EFT setup
- Reporting
- Transition responsibilities
Revex Square works with healthcare practices on medical billing, coding, credentialing, eligibility verification, denial management, A/R, and patient billing workflows.
Learn more about Medical Billing Services or contact Revex Square to discuss your current billing operation and transition requirements. A well-planned billing transition starts before the old vendor leaves.
Frequently Asked Questions
How do I switch medical billing companies without losing revenue?
Start before the contract termination date. Establish your billing baseline, secure your data, inventory every open claim, define A/R ownership, verify payer and electronic payment processes, and use a controlled transition plan.
How long does it take to switch medical billing companies?
There is no universal timeline. Contract notice requirements, practice size, payer mix, system integrations, data migration, provider count, and A/R volume all affect the schedule.
Will switching billing companies affect my claims?
It can if the transition is poorly coordinated. The main operational risks are delayed submission, unclear claim ownership, missing data, payer-setup issues, and payment-posting problems.
What happens to old medical claims after switching billing companies?
They should be assigned to a specific owner based on your written transition agreement. The outgoing vendor may retain responsibility, or the new vendor may take over legacy A/R.
Do I need to re-credential with every payer when changing billing companies?
Not automatically. Credentialing and enrollment requirements vary by payer and by your existing arrangement. Review each payer relationship to determine whether an update, transfer, re-enrollment, or no change is required.
Should the old billing company keep working my A/R?
That depends on your contract and transition agreement. If the outgoing company retains legacy A/R, define the exact cutoff date, responsibilities, reporting, and final handoff requirements.
How do I transfer billing data to a new company?
Request the relevant EHR, practice-management, clearinghouse, claim, payment, adjustment, A/R, and denial information available to your practice. Confirm file formats and validate imported records before cutover.
What should I export from my old medical billing company?
At minimum, request claim history, open claims, A/R aging, payment and adjustment records, denial information, payer information, and other billing data needed for continuity.
Should I run parallel billing when switching vendors?
A controlled overlap can be useful, especially when the practice has a large A/R file, complex payer mix, multiple providers, or complicated system integrations. The exact overlap period should depend on operational readiness.
What KPIs should be monitored after I switch medical billing companies?
Track collections, clean claim rate, denial rate, rejection rate, days in A/R, aging A/R, claim volume, payment posting, and unresolved legacy claims.
What is a claim ownership map?
A claim ownership map assigns responsibility for every open claim. It shows who is responsible, what the current status is, and what action needs to happen next.
What is the Medicare timely-filing deadline?
CMS generally requires Medicare fee-for-service claims to be submitted within 12 months, or one calendar year, from the date services were furnished, subject to specific exceptions. Other payers can use different filing rules.
What is the difference between ERA and EFT?
ERA provides electronic remittance information explaining payment and claim adjudication details. EFT is the electronic transfer of funds. CMS describes both as standardized administrative transactions and encourages providers to enroll for both with participating health plans.
Does HIPAA apply when sending billing information to a new billing company?
Medical billing can involve PHI, and HHS identifies billing and claims-processing companies as examples of business associates when they perform covered functions involving PHI. Covered entities generally need an appropriate written business associate arrangement with a business associate handling PHI.
What should I ask a new medical billing company?
Ask about transition management, legacy A/R ownership, data migration, payer setup, EDI/ERA/EFT, HIPAA safeguards, reporting, KPIs, escalation procedures, and post-go-live support.
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