Every medical billing company makes the same promises: Increased collections. Better revenue. Faster payments. And yet, 1 out of 3 healthcare practices still end up frustrated with their billing company.
Perhaps you’re frustrated too. Maybe you’re dealing with too many denials. Or your revenue cycle management (RCM) company is not as responsive as you’d like.
It’s understandable why so many independent practices end up with vendors they’re unhappy with. Modern billing complexity makes the U.S. tax code feel simple sometimes. You went into medicine to help patients, not to master claims processing, denial appeals, or payer negotiations.
As a result, many practices are left relying on easily measurable factors that don’t predict quality, such as impressive-sounding tech, scale, or low prices.
So how do you tell which RCM vendors are legitimate? How do you know they’ll be better than what you currently have?
This guide will show you exactly what to look for. You’ll discover:
- The leading indicator of quality for any firm you evaluate.
- A five-part quality checklist to separate top performers from the rest. Plus, two commonly used selection criteria that often backfire.
- How to “test-drive” a biller using their free audit, and what specifically you should walk away knowing.
You can find quality billers that will make your practice run more smoothly, not create more headaches. They’ll fight for every dollar you’re owed and can potentially boost your revenue by 20% or more in a matter of months.
We know because we’ve evaluated over 3,000 RCM providers. And we’re practice owners who founded a mental health facility (IOP), giving us firsthand experience on how billing impacts a practice.
And while we now provide RCM services ourselves, our goal with this guide is to be as objective as possible and help you make an informed decision.
Table of Contents
- Choosing an Ideal Billing Partner Comes Down to One Word: Attention
- Two Popular (But Flawed) Ways to Choose Your RCM Partner
- The #1 Indicator of Excellence: Frequent Communication & Transparency
- The RCM Quality Checklist: Five Requirements for High Performing Companies
- The Free Billing Audit: How to “Test Drive” an RCM Company at Low Risk
- Your Practice Deserves Better
Choosing an Ideal Billing Partner Comes Down to One Word: Attention
Brand-name RCM firms promise stability and resources. They tout established payer relationships, comprehensive service offerings, advanced AI tools, robust compliance infrastructure, and large support teams. Their marketing brags about the number of claims they handle every day, as if volume automatically equals quality.
Sometimes this is true. Sometimes it’s not. But regardless, there are two common problems with scale:
First, most RCM vendors prioritize high volume accounts. When an insurance payer changes their policies, whose issues get addressed first? The hospital system that’s worth tens of millions of dollars, or a private practice billing a few thousand claims a month? You can guess the answer.
Second, many billing companies prefer “easy” claims. Their goal is to minimize time spent on each claim and get as much volume as possible. That complex sleep study denial requiring three appeals and a peer-to-peer review? They’ll pass. Why fight for your one “difficult” claim when they can process a dozen simple claims and make more money?
These issues may not be as big a deal for large hospital systems.
But independent practices aren’t just smaller hospitals. Your challenges are unique. You have less bandwidth for admin. Cash flow matters more. Every denied claim hits harder.
You can’t afford to have a biller who tries to fit you into their one-size-fits-all approach. You need a true partner who becomes an extension of your practice:
- Strategic optimization. They trace issues to upstream causes and fine‑tune your whole billing process so you get paid faster.
- Customized support. They adapt to your specialty, payer mix, and clinic rhythm, fixing the bottlenecks that trip up your practice.
- Relentless determination. They follow up when insurance downcodes a claim for no reason, and they don’t stop until you get paid correctly.
- Staff development. They eliminate preventable denials by educating your staff on documentation rules for each insurance.
- Proactive expertise. They brief you about new payer requirements and update templates before the rule takes effect.
- Patient-focused processes. They send your patients clear cost estimates before treatment and plain-language statements after care. No surprises.
The best partnerships feel like having an expert consultant, colleague, and advocate combined. Your needs and goals are their priority.
Section Summary
Independent practices have different needs than hospitals. They need partners who provide customized support and attention. However, most medical billing companies (1) prioritize their biggest accounts when issues arise, and (2) focus on easy claims vs. complex denials that require extra work.
Before we dive into the best ways to find a true RCM partner, let’s quickly cover two common approaches that cause many practices to end up with disappointing results.
Two Popular (But Flawed) Ways to Choose Your RCM Partner
When looking for billers, many practices naturally gravitate toward two simple criteria: price and location. They want the cheapest option available, and they prefer working with a U.S. based company.
These selection criteria seem logical on the surface. And they’re not necessarily wrong in every situation. But they can steer you toward the wrong partner if you’re not careful.
Why Choosing the Cheapest Biller Usually Backfires
When picking a vendor, one of the first things people usually look at is price. This makes sense. Healthcare margins are tight. Every dollar matters. So if you can get the job done for less money, why not do it?
Yet choosing the cheapest RCM vendor often costs more in the long run. Low fees usually mean less qualified staff, minimal denial follow-up, slower payments, and cookie-cutter processes that miss revenue. Reduced collections alone can dwarf any savings you may get from a lower price. Not to mention all the administrative hassle that ineffective billing places on you and your staff.
At the same time, a higher price may not always correspond to better billing. One of our clients was previously paying an RCM company 10% of collections, which is the upper range of what most billers charge. Yet this company was a disaster. (At one point, 80% of all claims were failing to make it to insurance due to submission errors.)
Instead, make sure you have fair and aligned pricing:
- The pricing is clear and transparent. Typically this looks like one of (or a combination of) the following pricing models:
- Percentage: They charge a small portion of what they successfully collect. 5% to 9% is common depending on what services they’re providing.
- Full Time Equivalent: A fixed monthly rate for each billing staff dedicated to your practice.
- The scope is clear. You know exactly what services you’re getting.
- The terms are reasonable (no hidden pass‑through fees, reasonable notice period, data export included, etc.).
The pricing and terms should make sense for your practice, but it’s more important that you find a quality biller in the first place.
Now, you might think that this means working with a small, U.S. based billing company. But it might not. Your ideal RCM partner may not look like what you expect.
Why You May Want to Consider Offshore Billers
This might sound a bit controversial, but we advise practices not to pick their biller just based on location. Many practices dismiss offshore billing companies, assuming they’re just a cost-cutting shortcut that sacrifices quality. After all, shouldn’t your billing stay close to home?
The reality is more nuanced.
Over the past couple decades, world leadership in RCM expertise and quality has been shifting overseas. India, for example, has built upon their reputation for a strong technical workforce. And they now host over 60% of the global RCM workforce. These aren’t call center workers reading scripts. They’re certified, specialized billing professionals that offer:
- AI-led workflows that improve accuracy, speed, and compliance.
- Deep benches of certified specialists for your exact specialty.
- Team redundancy; no downtime if someone’s out or leaves.
- Strict HIPAA compliance and industry-leading security standards.
- Proficiency with English and the U.S. healthcare market.
Leading U.S. health institutions like Johns Hopkins are already turning to offshore billing expertise. And a growing number of private practices are taking advantage of international vendors too.
Now don’t get us wrong. We’re not saying all offshore companies are great. In fact, most of them are not. Quality varies from company to company, just like with domestic billers. You need to evaluate them using a rigorous process.
But only looking in the U.S. can limit your options unnecessarily. Geography shouldn’t be the deciding factor. Performance should.
Section Summary
When picking an RCM company:
Cheapest price ≠ best value. Low fees often mean reduced collections that dwarf any savings.
Quality matters more than geography. Many great RCM companies are located offshore.
So if you’re not using price or location, how should you instead identify a high performing company?
A quick review of their online presence can at least help narrow your options and give you an initial indication of track record, services, and more. But you also can’t tell everything about an RCM provider from their website. Nice looking websites can hide terrible companies. Basic sites might represent excellent providers.
So after a scan of a biller’s website, set up a call with their team so you can assess…
The #1 Indicator of Excellence: Frequent Communication & Transparency
Forget the promises. Forget the technology. Forget the huge list of services. While those are important, they can be hard to assess from the outside. That’s why the first thing you should look for is how the RCM company speaks and interacts with your team.
Most billers work in their own silo. You get an invoice each month and nothing else. No metrics, no transparency, no accountability. Even if you have a “hunch” that something is wrong with your revenue, you’re not getting clear data to know exactly what’s going on.
This is why the initial conversations with a billing company are so useful. How they treat you on the phone is a tangible indicator of how they’ll treat you as a client.
When you’re talking with them, ask yourself…
- Are they helpful?
- Do they answer your questions?
- Do they give you simple, plain English explanations?
- Are they competent and professional?
- Do they seem interested in your situation and problems?
- Do they show they care about your patients too?
- How do you feel about them overall?
These questions may seem a touch subjective. That’s OK. As someone who works with patients daily, you’ve developed strong instincts about people. Your intuition offers a quick gut check when selecting the right RCM partner. If a vendor fails that initial check, move on.
Still, some may argue:
Can you really go by what the sales person or RCM company rep is telling on the phone? Isn’t their job to look good and convince you their services are the best?
Yes and no. While sales calls involve positioning, genuine interest is hard to fake. You can tell when someone’s just trying to make themselves look smart and hide behind a bunch of jargon/buzzwords.
And you don’t just need to go by intuition.
Ask for Specifics About Their Communication Plan
Plenty of companies claim to offer “great customer service” but can’t explain what that looks like in practice. So you need to ask:
- How will they keep you informed? What meetings will you have? How often?
- What reports will they give you regularly? Will they give regular reporting on key performance indicators (KPIs) like:
- Clean claim rate (how many claims go through the first time)
- Denial rate by cause (how many claims get denied and why)
- Accounts receivable over 90 days (how much of your revenue is stuck)
- Days to payment (how fast you get paid)
- Will they hold themselves accountable by giving clear metrics and projected targets?
- How will they be transparent about what they’re working on, what issues are outstanding, and what action steps their team will be taking to resolve them?
- What happens if there’s an urgent matter and you need to talk to their team? How quickly will they respond?
With Plural Consulting, we hold a weekly status call (with detailed meeting minutes) and a monthly strategy call for each client we work with. And our team is available to respond immediately during office hours. Whatever company you work with should offer a similar standard of customer support.
That way you can stay updated on where things are at with your revenue, be aware of current issues, and hold your billing partner accountable for taking action and getting results.
Section Summary
The best partners keep you up to date on your billing with frequent reports and meetings. And they’re available right away whenever you need support.
- During initial calls: Trust your instincts. Does the company’s rep seem helpful, clear, competent, and genuinely interested in your needs?
- Ask about specifics: Do they detail meeting frequency, KPI reporting, accountability metrics, and response times?
- Look for transparency: Will they provide regular updates on revenue, collections, denial causes, and any current issues?
Communication is your first filter. If a company passes that bar, go through…
The RCM Quality Checklist: Five Requirements for High Performing Companies
When you’re assessing a billing company, there are plenty of straightforward items to look for:
- EMR Compatibility: Do they integrate with your current EMR (electronic medical records) system and other technology platforms?
- Specialty Coverage: Can they handle billing for your specific practice specialty (cardiology, mental health, etc.)?
- Service Menu: Do they offer the needed billing services you’re looking for?
However, lots of billers can meet these basic requirements. So be sure to use the following five quality indicators to judge who’s worth your time. These criteria are designed to help you separate top performers from the rest.
Quality Requirement 1: Proven Track Record
“We’ll transform your revenue cycle!” Every RCM company makes promises like these. Yet top performers prove it with hard data and detailed explanations of how they deliver results.
Ask for real results and case studies from clients, including:
- Detailed examples from practices similar to yours, not vague success stories.
- Specific metrics showing improvement (e.g. “We helped a 4-physician family medicine office boost their collections by 28% within two months”).
- Clear explanation of how they achieved those results. What specific changes did they implement?
- References willing to discuss their experience with the RCM company.
Remember, quality billers are happy to show their work because they know their process delivers results. And they’ll walk you through exactly how they plan to improve your revenue cycle, not just promise that they will.
Quality Requirement 2: Security and Compliance Infrastructure
HIPAA compliance isn’t optional. The company should be able to clearly explain their full security and compliance policies when asked.
Look for companies that do regular risk assessments and audits, require BAAs for all their partners, and have current SOC 2 Type II certification. This shows they take data security seriously.
If you’re considering an offshore biller, they should also meet the minimum criteria for RCM companies:
- Maintains a legitimate U.S. business presence
- Stores all patient data in U.S. data centers with HIPAA compliance
- Demonstrates English proficiency and U.S. healthcare knowledge
Dr. Pariksith Singh at MGMA sums up the importance of compliance well…
Only compliance can ensure true quality and proper evidence-based medicine, safety of patients, staff and providers, positive outcomes and a long term growth and success of the organization. Without compliance, it remains a house of cards that will be only more likely to collapse upon itself the higher and bigger it grows due to its own weight.
Quality Requirement 3: Solid Internal Processes
Companies with documented workflows and modern tech tools make fewer mistakes. Their regular internal audits spot issues early. And when problems do arise, top performers have clear escalation protocols to fix not just the immediate issue, but its root cause.
These “boring” foundations directly dictate how many of your claims get paid:
- Look for Six Sigma certification or similar quality methodologies. Not because the exact certification itself matters, but because it indicates your partner has a process to ensure quality.
- Ensure your biller is using modern technology to improve efficiency. This includes advanced billing & coding software, automated verification systems and workflows, and other tech/AI.
For example, many billers will resubmit denials once and move on. This means the same mistakes recur and your cash gets stuck. A good biller will have systems and analytics to catch these issues. And they’re proactive about stopping problems at the source.
This is a matter of necessity these days. Every year, insurance companies add more and more hurdles to jump over. They use automated systems to deny for “medical necessity,” make bulk demands for extra documentation, or downcode claims to reduce reimbursements.
You need a biller with a repeatable, proven approach to fight back effectively.
Quality Requirement 4: Patient-Centered Billing
Your billing company interacts with patients at some of their most vulnerable moments, when they’re dealing with scary health concerns and financial stress. Even though your care is exceptional, billing issues will still erode patient relationships:
- Over 36% of patients say they’d consider switching providers due to negative billing experiences.
- Billing frustrations are the 2nd biggest reason why people leave poor online reviews for healthcare practices.
No one wants to discover post-treatment that their coverage wasn’t properly verified and they’re now stuck fighting the insurance company to get the bill paid. These errors get blamed on the practice, no matter who is ultimately responsible.
This isn’t just about relationship management though. Caring about patient experience also translates into increased collections and revenue.
When we ran our intensive outpatient program, we provided a detailed cost estimate to each person before they started treatment (based on things like their insurance plan, deductible, and max out-of-pocket). Our patients appreciated knowing what to expect up-front and were more likely to pay their portion when we billed them.
Your RCM vendor can help you with:
- Clear, upfront cost estimates and authorizations before treatment
- Transparent statements that can be easily understood
- Responsive staff who can resolve billing questions on the first call
- Streamlined paperwork and convenient online payment options
- Proactive communication about insurance verification and coverage issues
Details like this can have an outsized impact. For example, trust in your billing process makes patients more likely to recommend your practice to others. A smooth prior auth process helps ensure you get reimbursed promptly and claims aren’t denied for preventable reasons. Patient-centered billing is better billing.
Quality Requirement 5: Complete Practice Support
Every administrative task steals time. Prior authorizations. Insurance verifications. Credentialing updates. Provider enrollments. Even “simple” paperwork requirements can compound into hours of lost time and revenue each week. These administrative burdens consume hours that could be spent enhancing care, growing your practice, or serving more patients.
Many RCM companies offer services to help reduce this burden, such as prior authorization management, real-time insurance verification, credentialing, or compliance monitoring. However, the best partners go beyond billing, providing solutions that multiply your team’s effectiveness:
- Medical scribes who understand billing requirements, reducing documentation burden
- Virtual assistants who handle routine tasks, freeing your staff for patient care
- IT support to ensure all your systems work together smoothly and securely
- Practice management consulting to improve operations and revenue.
You won’t necessarily need every service. But having access to them all through one trusted partner makes growth easier and problem-solving simpler. When challenges arise, you don’t have to scramble to find help. Either your RCM partner can offer the support you need themselves, or they’ll recommend another specialized vendor they know and trust.
Section Summary
Five must-have qualities for RCM excellence:
1. Proven Track Record: Real case studies with specific metrics, not vague promises
2. Security & Compliance: HIPAA compliance, up-to-date certification, regular audits
3. Solid Internal Processes: Six Sigma or similar methodologies and modern tech/AI
4. Patient-Centered Billing: Clear estimates, responsive staff, convenient payments
5. Complete Practice Support: Prior auth support, credentialing, medical scribes, VAAs, IT support, consulting
Now, websites and sales calls only tell you so much about a company. To truly evaluate an RCM company’s capabilities, you need to see them in action with your actual billing data.
The Free Billing Audit: How to “Test Drive” an RCM Company at Low Risk
Even after you’ve screened an RCM company for quality using the above criteria, you may still be uncertain. A biller may seem great overall, but will they work with your practice specifically? How can you find out before you hire them to do your billing?
It’s worth being cautious. Your choice of billing company will have a dramatic impact on your practice. Pick the wrong one, and it could cost you hundreds of thousands of dollars (or more) in lost revenue. Not to mention all the frustration and wasted time dealing with denials.
A good RCM company understands the stakes involved in your decision. And they’ll usually start with a free (or low cost) billing assessment. This lets you:
- Gain understanding of your entire billing operations. With this audit, you’ll be able to see where revenue is being lost and what quick wins could boost your cash flow immediately. These insights are useful regardless of whether or not you move forward with an RCM vendor.
- Test drive the company’s services at no risk. This is your chance to see firsthand how their billing team works with your practice. Thorough audits indicate thorough billing. Clear communication here predicts clear communication later.
Each company will have their own way of doing assessments. But generally it will look something like this:
3-Part Billing Assessment
The assessment should only take about an hour or two of your time. And you’ll get the full results from the billing team in one week.
Part 1: Compliance Framework
You want someone obsessive about protecting your sensitive data and staying HIPAA compliant. So the first step is always to setting up a Business Associate Agreement (BAA), Non-Disclosure Agreement (NDA), and other necessary legal paperwork.
For the analysis, the biller will need some reports from your EMR. You can send them these reports if you have them, or the billing team should be able to work with your EMR platform and generate those reports for you. Either way, have them detail exactly how they’ll keep your data safe and secure.
Part 2: Deep Dive Assessment
Next, the RCM company will evaluate your billing from start to finish. They’ll dig into your claims history, denial patterns, and accounts receivable (i.e. the outstanding money owed to you by insurance payers). They’ll evaluate processes for documentation and prior authorizations. And they’ll look at how everything impacts the day-to-day experience for your patients (and staff).
This analysis will determine exactly where money is being left on the table and what next steps are required to boost your collections.
Part 3: Tailored Action Plan
Finally, you and the billing company will jump on a call to:
- Explain the findings in simple English. You’ll gain a clear understanding of what’s going on with your billing and what the issues are.
- Establish benchmarks. You’ll find out how your metrics compare to similar practices and how much extra cash-flow you could be getting right now.
- Walk through your action roadmap. This custom plan will include opportunities for fast results as well as strategic initiatives to create sustainable, long-term success.
After that, you choose what’s best for your practice. The billing company should be happy to partner with you and help implement this plan in your practice. But, if you feel your current team has it covered already, that’s fine too. There should be no obligation either way.
Again, different RCM companies may do things slightly differently. What matters is you get a look at how the biller operates and communicates, and that you can see what actions/results you may expect working with them.
What You Should Know by the End of the Audit
A quality billing audit should give you three primary pieces of information. Without these, you’re not getting the full picture of the RCM company or your revenue cycle specifically.
1. Your Performance vs. Industry Benchmarks (With Dollar Impact)
The audit should show exactly where you stand compared to similar practices. Generic industry averages won’t help. You need specialty-specific data. A family medicine practice has different metrics than an orthopedic surgery center. And a mental health center will have their own specific benchmarks too.
Look for concrete comparisons on items like:
- Your collection rate vs. what similar practices achieve, with the dollar value of closing that gap.
- How long it takes you to get paid compared to peers, and what faster payments would mean for your cash flow.
- Your current denial rates against what you should expect to see for your speciality, plus the primary reasons for high denials.
- How your front-end processes (eligibility verification, prior auth) stack up against best-practice workflows.
- Your coding accuracy rates versus specialty-specific benchmarks and compliance standards.
- A quick underpayment scan against your payer contracts, with examples of recoverable dollars.
Vague observations like “your denials are high” don’t help you make decisions. The audit should (1) quantify what each issue costs your practice and (2) identify how to solve the problem. For example: “Fixing your claim submission errors could recover $23,000 in currently denied claims.”
2. A Clear 90-Day Action Plan
The audit should end with specific, actionable steps rather than generic recommendations. You should know:
- Which issues can be fixed immediately for quick wins.
- What changes will take longer but deliver big results.
- Exactly who will handle each task and by when.
- Realistic timeline for seeing measurable improvement.
You should also get a sense of what the transition period will look like. A quality RCM firm should be able to onboard your practice within as little as 3 weeks.
3. Evidence for Whether the Company Fits Your Practice
The audit process reveals how the company actually operates. Pay attention to these warning signals to avoid billers that are a bad fit:
- They can’t explain their findings in simple terms or dodge your questions
- They hide behind jargon instead of speaking plainly about your issues
- They don’t give concrete metrics and benchmarks
- They focus more on impressing you than understanding your specific challenges
- They only identify problems without explaining root causes or solutions
- They provide generic recommendations that could apply to any practice
- They don’t ask about patient experience issues or how billing affects your reputation
In contrast, companies that deliver thorough, transparent audits are more likely to provide thorough, transparent billing services.
Section Summary
Take advantage of a biller’s audit process to see firsthand how they’ll work with you as a client. By the end, you should know:
- Your performance vs. specialty-specific benchmarks with dollar impact
- A clear 90-day action plan with quick wins and long-term fixes
- Whether this company truly fits your practice.
Your Practice Deserves Better
As founders of a mental health facility, we have all too much experience with how insurance companies can push practices around. Payments delayed for no obvious reason. Countless meetings with payers where they tell you the money will go through “soon”. Waking up at 4am, wondering how on earth you’ll be able hit the next payroll.
When we share our story with other practice owners, many bring up their own experiences dealing with denials, paperwork, and all the stress that goes with it.
We don’t want other practices to go through what we did. Our mission is to help practices get paid fairly for the great work they do every day.
This is why we put this guide together. And it’s why we spent months vetting 3,000+ RCM companies to find a partner we could trust, a team in India with a proven track record. (If you want to learn more, let us know and we can set up a time to chat.)
Our goal here is to help you better understand what good billing looks like, help you make an informed decision, and help you find the ideal partner for your practice.
You don’t have to accept companies that leave you in the dark, make excuses, or treat your practice like an afterthought. Your practice deserves better than mediocre billing support. Your patients deserve better than confusing statements and poor service. You deserve better than spending weekends worrying about cash flow.
Good RCM companies are out there.
So if you’re not happy with your current billing, reach out to 1-2 vendors and schedule a free audit. See what improvements are possible by switching. Find a partner who will give your practice the attention it deserves.