Top Myths About Transitioning Medical Billing Teams

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Myth One: Will my old AR be lost if I transition?

This concern shows up in many conversations with practices that are unhappy with their current AR and are looking for a change. They wonder what happens to the bucket of money sitting in their accounts receivable. In reality, old AR typically includes unpaid claims from prior billing, which can involve insurance AR, patient AR, or claims that haven’t been adjudicated for one reason or another, as well as items in collections. There are a variety of reasons these claims aren’t paid yet, but old AR is not automatically lost. When we take on a transition, we can pursue that old AR. The exact approach depends on the software you’re using and what the implementation plan looks like. There is an important exception to keep in mind: claims past the timely filing limit should be written off or cleaned up so you can accurately measure performance. If you have a large amount of old AR from 2022 or 2023 with little to no expectation of payment, we’ll address those items, clean up the past-due entries, and then begin working on them under the new team. You have options for how to handle this. You can either continue to manage old AR within your current software or move to a new software and start fresh, with reports that identify and guide the work on those older claims. The key point is that old AR isn’t lost. It remains actionable as long as it’s within timely filing limits. Do keep in mind that the larger the old AR bucket, the longer it may take to resolve it. AR is inherently time-consuming; it often involves waiting on insurers for updates, sometimes for lengthy periods, and calls to payers can be challenging, with constraints like being limited to handling only a few claims per call. Having multiple team members dedicated to old AR is especially important for larger portfolios.

Myth Two: Will I experience payment delays when I transition billers?

“When I transition billers, I won’t get paid.” This is a very common worry, and it can deter needed transitions. In practice, transitions can be carried out with minimal disruption to cash flow. There are a couple of ways we can take over an account. We can operate within your current billing software, which means you don’t have to worry about enrollment changes through the clearinghouse, also known as EDI enrollment. EDI enrollments are how we connect your software to the clearinghouse and payers so electronic claims can be submitted. If there’s a reason to move to new software, there will be EDI enrollments to complete, but there are options: you can schedule those enrollments ahead of time and perform them as part of the transition, often with no gap in electronic claim submission. With careful planning and a clearly defined transition timeline, you can continue to receive payments during the transition. The challenge lies in managing EDI enrollments, which is precisely why we provide a transition guide to help our clients stay on track. When you partner with us, you’ll typically see no unnecessary delays in payments, provided the transition timeline is well-planned and executed.

Myth Three: Will I retain data visibility during a biller transition?
Data visibility is essential, and every practice should have access to its information regardless of the billing partner or software. Ideally, you should be able to log in, navigate the practice management system, and access reports that summarize AR, monthly charges, and receipts. We also supply customized monthly spreadsheets for each client, detailing metrics by provider or by payer, tailored to the practice’s goals. The core idea is that you should have your data at your fingertips to inform decision-making, no matter who is handling your billing.

To recap, the three myths and the realities: old AR isn’t lost during a transition and can be addressed within timely filing limits; you can continue to receive payments during a transition with proper planning around EDI enrollments and a thoughtful project timeline; and you will retain visibility into your data regardless of the software or billing partner used.

I hope this was helpful. For a free practice audit, answers to your transition questions, and our Transition Readiness Checklist, email info@dresdenmed.com to get started.

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