Addressing 5 Key Concerns You May Have While Changing Your RCM Provider

5 Concerns You May Have When Changing Your RCM Provider + How to Address Them

1. Downtime and Disruption

When you leave your current medical billing vendor and switch to a new one, you’re likely to deal with some leftover baggage. There could be potential disruption to your billing and claims processing activities, along with a direct impact of pending claims in your accounts receivables.

Ideally, you need a proper action plan to deal with that residual AR and avoid operational disruptions. Coordinate with the new billing partner and define clear timelines with a set date of service commencement. Before this date, your existing billing partner can complete and wrap up their processes for a smooth transition. 

At Lister, we further streamline your transition by taking care of collections and follow-ups for the pending claims in your accounts receivables. With this added support to resolve your residual AR, we help you avoid the expected operational downtime and disruption during the transition period.

2. Service Quality and Performance

A prevalent concern when switching your medical billing vendor would be the service quality, credibility, and performance of the new provider. Will their claims processing abilities hold up? How about denial management? You don’t want to come out of one trouble just to land on the next. You want a vendor that can fix/ override the mistakes made earlier.

Proper due diligence is the way to go here. Identify what went wrong in your current RCM, and look for a vendor that could help resolve those issues. The right provider will be transparent and upfront in analyzing your flawed processes and offering a roadmap to enhance operations.

For instance, at Lister, we offer a free ‘mini-audit’ to assess your billing process, identify inconsistencies, and recommend corrective actions. We also provide monthly report templates that help practices track every operational detail and trend, from claim submission rates to denials and collections.

3. Compliance and Security

Handling patient data is a big responsibility, and with HIPAA regulations and constantly changing coding standards, compliance is a major concern. You want assurance that your new provider not only prioritizes compliance with regulatory standards but also stays up-to-date with coding protocols like ICD-10 and CPT.

Look for providers that have set measures for ensuring data security and regulatory compliance in their billing operations. Do they have proper security protocols? Do they have skilled, informed billing staff?

At Lister, our billing experts emphasize security with encrypted communications, advanced firewalls, and a strict commitment to transparency in our processes. Using encrypted emails, password-protected files, and secure SharePoint file transfer throughout our operations—we ensure that every sensitive patient information is protected, at all times.

4. Scalability and Adaptability

While the new vendor might be ready to handle your existing billing operations, are they prepared to accommodate periods of growth and high volume? This often becomes a key concern for growing practices and especially for specialities like dermatology and immunology, which are prone to seasonal fluctuations in patients.

Ideally, you want your new billing partner to have set systems to manage such fluctuating volumes and growth in billing activity. A plan to re-adjust resources and handle an uptick in operations can go a long way in dealing with surges.

At Lister, we set aside an operational buffer that lets us quickly adjust resources and staffing when such volume spikes occur. Past this buffer, we also recommend clinics communicate their scale-up plans, potential joint ventures, or merger deals, creating an appropriate time to prepare for volume changes. Having a single point of contact helps facilitate such communications and streamline the entire billing vendor transition process.

5. Short-Term Revenue Impact

Many clinics worry about a potential drop in revenue during the transition period. A delay in claims processing can impact cash flow in the short term, especially if collections are delayed or if unresolved issues from the previous provider persist.

Upfront communication and comprehensive documentation can help you avoid such situations, allowing your new billing provider to gain immediate visibility into your billing ecosystem. The proper visibility and information help minimize misunderstandings, delays, and revenue interruptions.

At Lister, we prepare a tailored ‘transition checklist’ that streamlines the process. We hand you a list of prerequisites, information, and updates our billing specialists might require to take over your billing activities with minimal disruptions. This also helps mitigate any general billing and carrier-specific issues affecting your operating efficiency.

The Importance of a Solid Contract

The contract with your billing vendor defines every detail of your relationship — from day-to-day billing operations to broader financial and support commitments. A robust contract ensures both parties are aligned on expectations, accountability, and performance standards, protecting your clinic’s interests throughout the engagement.

Ensure that the contract is transparent, clear, and covers all the support you need. Here’s a quick guide on what a comprehensive contract should include:

1. Scope of Work (SOW): Clearly covering all services the provider will handle, while specifying if any services are outside the standard agreement to prevent unexpected fees.
2. Performance Metrics and Service Level Agreements (SLAs): Specific performance metrics, such as claim submission timelines, denial response times, and error rates.
3. Fee Transparency: Section to itemize all costs, from initial setup fees to ongoing charges, technology fees, and any other additional costs.
4. Customer Support and Availability: Specifications for communication expectations, including response times and availability for regular check-ins or on-demand support.
5. Data Security and Compliance Protocols: Details about the provider’s compliance and data security practices to safeguard patient information. 
6. Flexibility and Adaptability Clauses: Clauses that allow for scalability or adjustments in response to your clinic’s growth or seasonal needs.

At Lister, we draft clear, transparent contracts that cover every detail and service aspect, with no scope for hidden charges. Our experts also maintain a proactive customer support channel, with a short responsiveness window of 1-2 days that ensures seamless communication.

Key Takeaway

Switching RCM providers is a daunting step, with your cash flows, revenue, and billing activities—all seemingly on the line. But with the right approach and a proper transition plan, the switch will help you overcome your existing billing issues and inconsistencies, without disrupting your operational or financial stability.

Set clear goals, ask the right questions, and partner with a provider who offers transparent communication, robust security measures, and a clear, detailed service contract. These strategies will help you mitigate downtime, maintain cash flow, and adapt to growth—while allowing your clinic to stay focused on delivering excellent patient care.

If you’re looking for a new medical billing service vendor with a smooth transition process, feel free to drop your request at contact@listerventures.com. Our medical billing specialists will set up a quick consultation to walk you through each step of the process.