Medical Billing for Independent Practices: 7 Things Your Billing Company Should Be Doing (But Probably Isn’t)
Outsourcing medical billing feels like a problem solved. But for many independent practices, handing billing off to a third party just means the problems become less visible — not less costly.
After years managing billing operations across hospital and private practice settings, I’ve seen what a truly effective billing partner looks like. Here are seven things your billing company should be doing — and honest questions to ask if you’re not sure whether they are.
1. Providing Transparent Monthly Reporting
You should receive a monthly report that clearly shows claim submission volume, first-pass acceptance rate, denial rate by payer, total collections, and aging A/R by bucket. If your billing company can’t or won’t provide this data, that’s a serious red flag.
Ask your billing company: Can you send me a denial rate breakdown by payer for the last 90 days?
2. Actively Working Denied Claims
Submitting a claim is the easy part. Working denials — analyzing why a claim was denied, correcting the error, and resubmitting with a proper appeal — is where most billing companies fall short. Many simply report denials to you and move on.
Ask: What is your process when a claim is denied? How do you track appeal outcomes?
3. Verifying Eligibility Before Every Visit
Eligibility verification should happen before every appointment, for every patient — not just new patients. Insurance changes constantly. If your billing company only verifies eligibility on initial visits, you’re almost certainly generating preventable denials.
4. Monitoring Timely Filing Windows
A claim denied for timely filing is revenue that is permanently, irreversibly gone. Your billing partner should have an internal workflow that flags any claim approaching its timely filing deadline — and escalates it immediately.
5. Identifying Underpayments
Most billing companies post payments without auditing whether the payment amount matches the contracted rate. This is a significant source of revenue leakage. A good billing partner compares remittances against your fee schedules and disputes discrepancies.
6. Staying Current on Payer Policy Changes
Payers update their billing requirements, coverage policies, and fee schedules regularly. A proactive billing company monitors these changes and adjusts your claim submission process accordingly — rather than letting you discover changes through a wave of denials.
7. Giving You a Dedicated Point of Contact
You should have one person who knows your practice, knows your payers, and can answer specific questions about your account. If every call to your billing company ends up in a generic support queue, the relationship isn’t serving your practice effectively.
What to Do If Your Billing Company Isn’t Delivering
The first step is to pull your own aging report from your practice management system and look at your 60–90+ day bucket. If there’s significant money sitting there untouched, that’s a clear signal something isn’t working.
At Apex Flow, we offer a free A/R analysis that will show you exactly what’s sitting in your aging claims and what could realistically be recovered. If you’re not confident your current billing company is doing these seven things, it’s worth a conversation. Schedule your free analysis here.