Key Takeaways
- Practices rarely decide to leave a billing vendor over one incident. It’s usually the accumulation of smaller, unresolved issues that eventually forces the decision.
- The reasons span the entire relationship, claims accuracy, communication, compliance, even how patients experience billing, not just one type of failure.
- Several of the most common reasons have nothing to do with anyone doing something wrong. A setup that worked at a smaller size doesn’t always hold up as a practice grows.
- Any one of these issues on its own is often easy to rationalize. It’s when a few of them show up at the same time that practices tend to take a harder look.
- Most practices that switch don’t do it dramatically. They reach a quiet point where the current setup no longer makes sense to keep.
Practices and labs come to PGM for a lot of different reasons. Some are moving from an in-house billing team to an outsourced one. Some are new (de novo) organizations outsourcing from day one. And some already have a billing/revenue cycle management company and are thinking about leaving it. This piece is about that last group, the conversations where a practice is weighing what they have now against what they think they actually need.
As PGM’s VP of Business Development, I hear a lot of these conversations directly, and the same patterns come up across our team’s calls with practices and laboratories considering a switch. Nobody usually reaches out over one bad week. It’s typically a handful of small frustrations that added up until working around them stopped making sense.
Here’s what comes up again and again, in no particular order.
Denial Rates That Keep Climbing With No Clear Explanation
One of the recurring reasons practices give is that denial rates have been rising for months, and nobody at the current vendor can explain why.
Practices don’t expect a zero denial rate, but they do expect someone to notice when the number creeps upward quarter over quarter without an explanation. When I ask what the vendor said about it, the answer is usually some version of “they said they’d look into it,” followed by nothing changing.
Reporting That Doesn’t Address Simple Questions
Reporting that never quite answers the practice’s basic questions comes up almost as often. Practice administrators want a clear picture of what’s outstanding, how old it is, and what’s actually being done to collect it. When those answers require multiple emails and a week of waiting, practices start to wonder what else they aren’t being told. I’ve had administrators describe pulling their own numbers from their EHR because the billing company’s reports didn’t match what they were seeing on their end.
A Billing Team That’s Hard to Reach
Poor or inconsistent communication is another common complaint, usually described as calls and emails that go unanswered for days. Sometimes it’s a slow response. More often, it’s inconsistency. The practice or laboratory gets a different person every time they call, and that person doesn’t know the account’s history or current issues. There’s no one who can just pick up the thread. I’ve heard more than one office manager say some version of, “I don’t even know who our account rep is anymore.” Staff turnover happens everywhere, including at PGM. The difference should be continuity: a practice shouldn’t be the one who feels it.
Coding That Doesn’t Reflect the Practice’s Specialty
Among specialty practices and labs especially, a billing team that doesn’t understand the coding nuances of what they do is a common source of frustration.
Generalist billing companies can handle straightforward E/M coding well enough, but they often miss the modifier rules, bundling logic, or payer-specific quirks that a given specialty depends on. Practices and laboratories notice this in the form of denials that trace back to the same handful of coding mistakes, over and over, without the vendor ever closing the gap.
Deadlines and Filings That Slip
Missed deadlines, whether it’s timely filing, appeal windows, or credentialing renewals, are one of the more concrete reasons practices and labs give me for wanting to leave.
These aren’t judgment calls or gray areas. A claim either gets filed within the payer’s window or it doesn’t, and when it doesn’t, that revenue is usually gone for good. I’ve talked to practices that discovered a credentialing lapse only when a claim was rejected for a provider who was, on paper, no longer in-network. It’s one of the easiest things to let slip when it isn’t someone’s full-time responsibility.
Growth the Vendor Can’t Keep Up With
Growth is one of the most overlooked reasons organizations switch. A billing arrangement built for a three-provider practice often doesn’t hold up once that practice adds locations, providers, or specialties. Volume increases and payer complexity grows, but the vendor’s staffing and systems don’t always keep pace. Signs I hear about include:
- A practice or lab that added providers or locations faster than the vendor could onboard them
- Turnaround times that got noticeably slower as claim volume increased
- A vendor that seemed built for a smaller, simpler operation than the one it now serves
A vendor that fit the practice five years ago doesn’t automatically fit the practice today.
Collections That Drift Down Quietly
Sometimes there’s no single bad event, just a collection rate that’s been sliding for months or years without anyone flagging it.
This one is easy to miss because it doesn’t happen all at once. A percentage point here, a slower month there, and eventually a practice looks back at a year of numbers and realizes performance has been declining the whole time. When I ask what the vendor said about it, the answer is usually that nobody brought it up. A billing partner should be the one noticing that trend first, not the practice.
Denials That Get Filed, Not Fought
A subtler complaint I hear is that denials get logged and closed out, but nobody is actually working to overturn them. There’s a real difference between a vendor that reacts to denials and one that pursues them. Proactive appeals work looks like:
- Identifying denial patterns before they become chronic
- Actually filing appeals within payer deadlines, not just noting the denial
- Following up on appeal status instead of waiting for the practice to ask
When appeals become the practice’s job, that’s a good sign the billing company isn’t doing its own.
Questions About Compliance That Never Get Answered
Sometimes what pushes a practice to switch is less concrete: a sense that their claims aren’t being coded and submitted the way they should be.
There’s often no audit or formal complaint behind it. A practice just starts asking questions about documentation and coding decisions, and doesn’t get answers that build confidence.
Patients Calling the Practice Instead of the Billing Company
Patient billing complaints are easy to underestimate: patients calling the practice, confused or frustrated about a bill, when the billing company is supposed to be the one handling that.
Practices don’t outsource billing to also inherit patient billing complaints. When statements are unclear or collections calls feel aggressive, patients don’t call their billing vendor, they call their doctor’s office. That ends up landing on front-desk and billing staff who had nothing to do with the original decision, and it’s often the final straw for practices already frustrated with everything else going on.
What to Do If This Sounds Familiar
If one or more of these scenarios feel familiar, it’s worth pausing to ask why. Most practices and labs don’t switch billing companies impulsively, and most don’t regret looking into it a little earlier than they planned to either. What tends to separate a good decision from a rushed one is having an actual conversation before a pattern turns into a real revenue problem. Schedule a consultation with PGM to talk through what’s actually happening with your billing, and what a different setup could look like.
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Frequently Asked Questions About Switching Medical Billing Companies
How long does switching billing companies typically take?
Timelines depend on practice size, payer mix, and how the current vendor manages the handoff, so it’s worth asking any prospective billing partner for specifics rather than a general estimate. This is a detail we’re planning to cover in more depth in a future post.
Will switching disrupt claims that are already in progress?
A well-managed transition accounts for claims already in the pipeline, so they don’t get lost in the handoff. This is one of the first things worth asking any prospective billing partner about directly.
Is it worth switching over problems that only happen occasionally?
Occasional problems are often early signals of a pattern, not isolated incidents. It’s worth tracking whether the same issue keeps resurfacing before deciding it isn’t significant.
What should we ask a potential billing partner before switching?
Ask how they handle denial trends, how quickly you’ll get direct answers on outstanding claims, and who your actual point of contact will be day to day. The answers to those questions tend to predict a lot about the relationship ahead.
Can we switch billing companies in the middle of a contract term?
Most billing contracts include a notice period or termination clause rather than an outright lock-in, though terms vary by vendor. Reviewing the current contract’s exit terms early avoids surprises, regardless of which billing company a practice ultimately chooses.
Do payers need to be notified when we switch billing companies?
Certain payer and credentialing records, particularly claims routing and remittance details, typically need to be updated when a billing company changes. A new billing partner should walk through exactly what needs updating and when, as part of the transition.