When to Fire Your Medical Billing Company — 8 Red Flags 2026
Red Flag 1: Denial rate over 10%
Industry benchmark is 5-7% for BH. Over 10% means the billing service is not fixing systematic issues, just processing claims.
Red Flag 2: Days in AR over 45 days
Industry benchmark is 30-40 days for BH. Over 45 days means slow follow-up or bad relationship with payers.
Red Flag 3: Net collection rate under 95%
Industry benchmark is 96-98%. Under 95% means writing off collectable revenue.
Red Flag 4: No monthly reporting or opaque reporting
You should get monthly reports showing: claims submitted, denials by CPT + payer, collections, aging AR, MHPAEA parity issues. If your vendor cannot produce this, they are not doing the work.
Red Flag 5: No named account manager
You should have a named person you can call/email who owns your account. If tickets route to a generic queue, escalation is impossible.
Red Flag 6: No specialty expertise
Ask your billing vendor to explain MHPAEA parity appeals or 97155 supervision documentation. If they cannot, they are a generalist misrepresenting BH capability.
Red Flag 7: Unwilling to show real client references
If they cannot name 3 similar-size BH clients you can call to verify, they either have no BH clients or are hiding poor performance.
Red Flag 8: Long contracts required
Confident vendors offer month-to-month or 60-day pilots. Long contracts (12+ months) mean they lock in clients before proving value.
What to Do
- Run a 30-day audit against these 8 red flags
- If 3+ red flags: schedule termination review
- Give current vendor 60 days to fix (in writing)
- If not fixed: transition to new vendor with month-to-month terms
Free 30-day audit · Revenant Care
– KD, Revenant Care