Switching billing companies
The money doesn't disappear because the new billing company is worse than the old one. It disappears in the gaps no one owns — the old AR that neither side wants to chase, the claims already in the pipeline when the switch happened, and the filing deadlines that quietly expire while the two companies argue about who is responsible. Those three things get decided long before you send the notice letter.
A recent public example is MultiCare Health System's lawsuit against Optum and Change Healthcare. MultiCare said Change failed to timely submit or process about $1.6 million in claims. Roughly half had already passed their filing windows by early 2024. After formal breach notice and the 90-day wind-down, at least $1.2 million was still outstanding and unrecoverable. That is exactly the pattern this page is written to stop.
Section 2
Do these six things while the relationship is still civil and you still have access. None cost anything. All get harder or impossible the moment you give notice. This is the section that actually changes the outcome.
1.Export your data yourself. Full claim history, payment history, patient demographics, AR detail — in the most usable format you can get. Do it before anyone knows you're leaving.
2.Take a proper baseline of your AR. By payer, by aging bucket, days in AR, net collection rate, denial rate. Without a baseline you will never prove whether things improved or whether the wind-down was worked properly.
3.Confirm you are the administrator of record. On every payer portal, not your billing company. If they are, you cannot give the next company access without going through them.
4.Check your credentialing records. Make sure CAQH attestation is current and the reminder email is yours, not theirs. If it lapses after they leave, nothing breaks loudly.
5.Actually read your contract. Notice period, auto-renewal date, termination fees, data return, wind-down. The auto-renewal window may force your timing.
6.Pay everything that is undisputed. It removes the easiest pretext for suspending work or holding data hostage. Money disputes are how data hostage situations start.
Section 3
The biggest financial issue in any switch, and the one most practices leave unresolved. Claims already submitted do not travel with you. Someone has to keep working them, and neither company has much incentive to do it well.
The MultiCare case above is what happens when that decision is left open: $1.2 million permanently unrecoverable after a standard 90-day wind-down.
Outgoing company keeps working it. During a wind-down (usually 60–120 days, often 90) at their normal rate on what they collect. The most common arrangement.
Incoming company takes it. Usually priced separately and often higher, because aged claims cost more to work. Get the rate in writing before you sign.
You work it yourself. Only practical if you still have access to the old system and the staff capacity. Access is usually the first thing that disappears.
You write it off. Only rational for truly uncollectible or trivial balances. Otherwise this is just the expensive default that happens when nobody decides.
Both companies are structurally motivated to let aged claims die. The outgoing company gets paid a percentage of what it collects — once it knows the relationship is ending, a denial that takes four phone calls is no longer worth the effort. The incoming company priced your day-forward work; legacy AR is extra work it did not quote for, and its attention is on getting your new claims flowing. Neither side is being evil. The structure produces the outcome. That is why the answer is not a promise from either of them. The answer is reconciliation.
On the day you give notice, get a full AR aging report by payer and by bucket. That is your baseline. Then require weekly reconciliation for the entire wind-down: claims worked, collected, adjusted, with a reason code on every write-off. A write-off with no reason code is usually where a recoverable claim disappears.
Section 4 · Tool
Enter your aging buckets and payer mix and see how much of your open AR is at risk of expiring during a wind-down of a given length. Runs entirely in your browser. Nothing is sent anywhere.
Aging buckets (% of total)
Payer mix (%)
Educational only. Not financial or legal advice. Filing windows vary by payer and plan; your contract controls. Aggregate numbers only — do not enter patient information. Medicare timely filing per 42 CFR 424.44 (365 days from date of service). Runs in your browser; nothing is sent anywhere.
Each aging bucket is assigned a midpoint age. Remaining filing days are calculated as the payer's filing window minus that midpoint. Any bucket whose remaining days are shorter than the wind-down is flagged at risk, weighted by your payer mix. Medicare uses 365 days from date of service under 42 CFR 424.44. Commercial defaults to 90 days (overridable). Medicaid is user-set by state.
| Payer | Filing window | Source |
|---|---|---|
| Medicare | 365 days from date of service | 42 CFR 424.44 |
| Commercial | ~90 days (varies by plan) | Payer contract |
| Medicaid | Varies by state | State plan / contract |
| Corrected claims | Generally half the original window | Payer policy |
Worked example
A practice with $500,000 open AR, 20% in the 120+ bucket, a 60/10/30 Medicare/Medicaid/commercial mix, and a 90-day wind-down. The 120+ commercial share (roughly $30,000) sits inside a 90-day commercial window already exhausted at the midpoint — flagged at risk. The Medicare share of the same bucket still has ~215 days and is not near-term expiry. The tool separates the two rather than labelling the whole bucket lost.
Illustrative arithmetic only. Not a recovery estimate.
Honesty note: Recovery likelihood is directional only. The 60–80% recovery figure that floats around the industry comes from companies that sell legacy AR recovery services. It has no independent source. The tool says so instead of pretending the number is real.
Section 5
Your data is yours, but that sentence does less work than most people think. HIPAA requires a business associate to return or destroy PHI when the agreement ends. That is a privacy obligation, not a portability right.
Under 45 CFR 164.504(e), the business associate agreement must require the vendor, on termination, to return or destroy all PHI it still holds, keep no copies, and continue the protections if return or destruction is not feasible. It does not force them to give you a clean, usable file, and it does not stop them charging you for the work of producing one. Portability is a contract question, decided when you sign, not when you leave.
First, "return or destroy" is your choice. Always choose return. You will need the claim and payment history for appeals and payer audits, sometimes years later. Get in writing what they are keeping under their own retention policy.
Second, the rule says nothing about format. A vendor can satisfy HIPAA by giving you something that is technically complete and practically useless. If your contract is silent on format, timeframe and cost, you have no leverage when a fee appears.
Whether they can lawfully withhold work or data over an unpaid invoice depends on your contract and your state. Some agreements explicitly allow suspension for non-payment. We are not going to give a confident answer to a question that turns on your specific agreement and jurisdiction.
Pay anything undisputed right away so there is no pretext. Get your data out before a fight starts rather than during one. If it has already started, a healthcare attorney will usually cost less than the claims you lose while arguing.
Note: this section needs legal review before publication.
Section 6
Six clauses largely determine whether the transition is orderly or expensive. Most practices only read them when they want to leave, which is the worst possible time. Read them before notice, negotiate them before you sign.
Notice period. Usually 30–90 days. Anything longer than 90 is worth pushing back on.
Auto-renewal. The one that catches people. A one-year term that auto-renews unless you give notice 90 days before the end means missing the date by a week can lock you in for another full year. Find your renewal date before you plan anything else.
Early termination fees. Look for liquidated damages calculated against the remaining months of the term, including a renewal term you did not realise had already started. This is how a switch becomes expensive even if everything operational goes smoothly.
Data return. Should say your billing data and patient accounts come back in an electronic, readable format within a defined period (ideally ≤30 days) without excessive exit fees. Silence is the problem.
Wind-down and transition assistance. A surprising number of contracts say nothing about what happens after termination. It should require the outgoing company to keep working claims with dates of service before the effective date for a defined period, with reporting.
Assignment and change of control. RCM is consolidating fast. Large vendors get acquired by payers or private equity. The contract you signed can end up owned by a company you never chose. Negotiate the right to terminate on change of control without penalty.
Who owns the practice management system. If the billing company supplied the software, leaving usually means losing the system and everything in it. That is the classic data-hostage structure. Prefer companies that work inside your own system so the licences stay in your name.
Note: this section needs legal review before publication.
Section 7 · Tool
Answer a few questions about your current agreement and see how each clause stacks up against published norms. Educational only. Not a substitute for a lawyer reading the actual document.
Compares a contract structure against published norms. It does not interpret anyone's specific agreement. Not a substitute for a lawyer reading the actual document.
Notice period — Strong
30–90 days is the published norm; longer than 90 is worth pushing back on.
Auto-renewal — Review
Auto-renewal with a short notice window is the clause that catches practices. Find the renewal date first.
Early termination fees — Weak
Liquidated damages on the remaining term — including an unnoticed renewal term — is how a switch becomes expensive.
Data return — Strong
Should specify electronic, readable format, defined period (ideally ≤30 days), no excessive exit fee. Silence is the problem.
Wind-down terms — Strong
Should require the outgoing company to keep working pre-cutover claims for a defined period, with reporting.
Assignment / change of control — Review
RCM is consolidating. Negotiate the right to terminate on change of control without penalty.
Who owns the PMS — Strong
If the vendor supplied the software, leaving usually means losing the system. Prefer working inside your own system.
Questions to ask before signing the next contract
Educational only. Compares a contract structure against published norms. Does not interpret your specific agreement and must not be treated as legal advice. Have a healthcare attorney read the actual document before acting.
This tool compares a contract structure against published norms. It does not interpret anyone's specific agreement and must not present itself as doing so. Have a healthcare attorney read the actual document before acting.
Section 8
Run both operations in parallel with a clean date boundary. The old company owns every claim with a date of service before the cutover. The new company owns everything after. A hard cutover on a single Monday is how claims fall between the two.
Claims submitted just before the boundary belong to no one. Remittances keep arriving at the old company's setup while the new one is not yet enrolled, so payments sit unposted. And nobody has agreed who works the claim that was denied on the Friday. Parallel running is the only structure where every claim has an owner.
Not the new company's enthusiasm. Four enrolment processes that all run on payer time:
ERA and EFT re-enrolment. Usually 2–4 weeks per payer, sometimes longer. Most payers allow only one ERA receiver at a time, so the handover has to be deliberate. The main reason collections dip in the first cycle.
Clearinghouse and submitter ID. Needs payer-side EDI setup and testing before live claims flow.
Payer portal access. Days to weeks, longer when an administrator has to be replaced rather than a user added.
Credentialing verification. Confirm every provider is current before cutover instead of discovering a gap afterwards.
1.2–4 weeks before notice. Everything in Section 2.
2.At notice. Send written notice per the contract. In the same message ask for the AR aging report, the full data export, and written confirmation of the wind-down terms.
3.Parallel running (30–60 days). Old company works legacy claims and keeps collecting. New company configures payer accounts, verifies enrolment, loads fee schedules, runs a test batch, then starts day-forward billing.
4.Cutover. The date boundary takes effect. Everything before it stays with the old company.
5.First 90 days after. Weekly reconciliation against your baseline. Watch remittance posting and the denial trend. Make sure every legacy claim is resolved or explicitly transferred rather than quietly dropped.
Section 9
Collections almost always dip in the first cycle. That is normal — caused by remittance re-enrolment lag, not by the new company's performance, and it recovers as the pipeline fills.
Thirty to sixty days to fully operational is the common industry expectation, though every published number in this area comes from companies that sell the service. There is no independent benchmark for transition timelines, and we are not going to present a vendor's marketing figure as if MGMA published it.
The claim that practices lose 6 to 14 percent of revenue during a transition leads search results. It originates in billing company marketing and has no traceable independent source. Treat it as a sales argument, not a benchmark.
The claim that 60 to 80 percent of legacy AR is recoverable comes from companies that sell legacy AR recovery. Same caution.
What is independently grounded: collectability falls as claims age and filing windows close, and MGMA data shows that more than 20% of AR past 90 days is a structural problem rather than a seasonal one.
Section 10
Different transition, different risk. There is no outgoing vendor and no data-hostage exposure. What replaces those problems is knowledge loss, and it is easy to underestimate because the person carrying that knowledge is still in your office.
Your biller knows which payers stall on authorisations, which codes trigger scrutiny, which patients are mid-payment-plan, and which denials are worth appealing. Almost none of that lives in the system. It walks out with them.
Before anything changes
1.Document the payer quirks and workarounds while they are doing the work — a list written alone is always thinner than one written while someone asks questions.
2.Record the status of every open claim over 60 days.
3.Capture every login and confirm which portals they are the named administrator on.
4.List active patient payment plans and prior authorisations still in flight.
If outsourcing means redundancy, the person you need most during the handover is the person whose job is ending. In most of the better engagements the practice keeps them — patient balance calls, front-desk eligibility, chasing documentation. What moves out is submission, coding review, denial work, AR follow-up, prior auth and credentialing. Say so early. A biller who thinks they are training their replacement behaves differently from one who knows they are keeping their job.
Section 11
If the only problem is aged AR or a credentialing backlog, that is a scoped project, not a vendor change. Switching adds transition risk to a problem that does not need it.
Do not switch when:
Aged AR is the whole problem. Buy a focused AR recovery project and keep the current vendor on day-forward work. You get the money back without the transition risk.
A single credentialing gap is causing the denials. Fix the credentialing.
You are inside 90 days of a filing cliff. Recover it first, then switch. A wind-down during a filing crunch is the exact scenario that produces permanent losses.
Your numbers are fine and the frustration is communication. Ask for the reporting first. A vendor that produces it when asked is usually worth keeping.
Switching is the right move when the underlying performance is wrong and has not moved even after you raised it. It is not a fix for a specific, solvable problem.
Section 12
Everything in Section 6 applies to Quilven. You should hold us to the same list. Here is where we stand so you can check us against it rather than take our word for it.
Ask every company you are considering for the same six answers in writing. The ones that hesitate are already telling you how the exit will go.
Section 13
Before you switch anything, know what is actually sitting in your AR and what is at risk. We look at your claim data and tell you what is recoverable, what is close to a filing deadline, and what has already gone. No obligation. If the audit shows your current arrangement is working, we will say so.
Step 1 of 4
Your details stay private. No requirement to change vendors.
Section 14
Only if the contract allows it or the other side agrees. Check the auto-renewal first — the renewal date often matters more than the notice period. Missing the window by a week can cost you a full extra year.
Usually yes, on the legacy claims they actually work during the wind-down, at their normal rate. That is normal. What is not reasonable is being charged on collections they did not work. Require reporting that shows which claims they touched and reconcile it against your baseline.
Two to four weeks per payer, sometimes longer. Most payers allow only one ERA receiver at a time. This is the main reason collections dip in the first cycle, and it is not fully in the new company's control. Start the enrolment during parallel running rather than at cutover.
They should not, if statements and payment plans are handed over deliberately. They will if no one owns the statement cycle during the transition and it simply stops. Confirm in advance who is generating statements in the cutover month and that active payment plans have moved across.
Pay anything undisputed first — it removes the easiest pretext. Whether they can lawfully withhold over a genuine dispute depends on your contract and your state. That is not a question to answer from a web page. Involve a healthcare attorney early. The claims you lose while arguing usually cost more than the advice.
No one can tell you honestly without seeing it. Recovery depends almost entirely on how much still sits inside a live filing window, not on how old the claim is. The recovery percentages quoted around the industry come from companies selling recovery services and have no independent basis. Get the aging report and count what is still live.
Yes, for 30 to 60 days. It is the only structure where every claim has an owner. A single-date cutover leaves the claims submitted immediately before it belonging to no one, and those are the ones that expire.
It happens, which is why you take a baseline before you leave. Without one you are comparing a memory against a first quarter that was always going to look soft because of enrolment lag. With a baseline you know within two cycles whether the trend is real.
Section 15