Before switching medical billing vendors, review the contract for more than the monthly fee. Pay particular attention to termination terms, legacy A/R ownership, services included, data access, HIPAA responsibilities, reporting, and transition obligations. A clear contract should explain who handles outstanding claims, who owns the data, what happens at termination, and how the new RCM partner takes over.
7 Contract Areas Worth Checking
1. Termination and Transition Terms
Confirm the required notice period, renewal provisions, early-termination charges, and exact notice procedure. Also check whether the agreement requires the vendor to cooperate with a transition after termination.
2. Outstanding A/R
This is one of the most important areas to clarify. Specify who follows up on unpaid claims created before the switch, who handles Claim Denials and appeals, and whether the previous vendor receives fees on collections made after termination.
A written A/R handoff should identify claim status, payer, filing deadlines, denial reason, and next action.
3. What Is Actually Included?
Do not assume that “full-service billing” covers everything. Confirm whether the fee includes Medical Coding, Eligibility Verification, Prior Authorization, Claim Scrubbing, Payment Posting, denial management, and AR Management.
4. Fees and Billing Basis
Determine whether fees are based on collections, charges, encounters, or a fixed amount. Ask about setup fees, clearinghouse costs, coding charges, software expenses, and other pass-through fees.
5. Data, Access, and Compliance
The agreement should address access to patient and financial data, data return or export procedures, security responsibilities, subcontractors, and applicable HIPAA obligations. Practices should understand what happens to their information when the relationship ends.
6. Reporting and Accountability
Define the reports you will receive and how often. Useful reporting may include A/R aging, denial trends, payment activity, claim status, and payer performance.
7. EHR and Workflow Compatibility
Confirm who is responsible for system configuration, payer setup, testing, and resolving migration problems. A vendor should understand your existing workflow before changing it.
Expert insight: The cheapest contract is not necessarily the clearest contract. Before signing, make sure every important handoff has a named owner and documented process.
The Medicator’s can help practices evaluate their current medical billing workflow and identify transition requirements before moving to a new RCM partner.
