Your billing reports identify numerous claims that have not been paid. Your account representative changes, and you still do not learn the name of the person who will provide you the information you need to resolve the claims.
A number of medical billing practices in the United States have switched from being medical billing practices to medical billing service businesses in an effort to have their bills collected in a more timely manner. Medical billing service businesses, by their very nature, should be able to provide more information and “follow up” on issues related to medical billing in a more timely and efficient manner.
It is not enough, however, for the owner of a medical billing service business to be actively involved in the business and collections. The medical billing service business should have sufficient personnel to provide the service in an efficient and effective manner. The medical billing service business should provide clients with reports that reflect the status of claims submitted for payment.
This document evaluates HMS USA, Resilient MBS, Professional Credentialing Service, OneSource RCM, and Professional Billing Service. Questions that should be addressed prior to using the service of each of these businesses are provided.
Five Companies, Five Different Starting Points
Begin with the work your practice needs done. A company suited to daily billing may not be the right choice for a standalone credentialing project. Equally, an enrollment specialist may solve your immediate problem without replacing a billing team that already performs well.
The table below gives you a starting point. Practice-fit descriptions are editorial assessments of service relevance, not measured claims that one company outperforms another.
| Company | Main service focus | Practice situation worth discussing |
|---|---|---|
|
HMS USA |
Medical billing, coding, and broader RCM support |
Several billing functions need coordinated management |
|
Resilient MBS |
Billing, audits, credentialing, and related practice support |
Billing issues overlap with administrative workflows |
|
Professional Credentialing Service |
Provider enrollment and credential maintenance |
Applications, payer participation, or provider updates need attention |
|
OneSource RCM |
Owner-operated billing and operational support |
The practice wants direct accountability and workflow troubleshooting |
|
Professional Billing Service |
Owner-led billing with a patient-service emphasis |
Patient communication and billing-team continuity are priorities |
A shortlist should make your next conversation more specific. Instead of asking each company to describe everything it does, ask how its team would handle the problem currently costing your practice the most time.
HMS USA: A Starting Point for Coordinated Billing Support
HMS USA provides billing and coding, revenue cycle services, and credentialing. Considering it provides a variety of related services, it can be beneficial when a client wants to assess multiple related services with one service provider.
Given its services, HMS USA can identify various kinds of billing issues. For example, claims can remain unpaid due to incomplete documentation, or a payer’s response can get lost and reach the wrong employee.
The key question is if the HMS USA team is able to recognize all the relationships and dependencies in a claim in order to address the claim status.
The Angle Worth Exploring
HMS USA allows practices to incorporate various services related to credentialing and billing. However, offering multiple services does not necessarily mean those services will be provided under the contract executed between the client and HMS USA.
Probe how the client team approaches handoffs. In the case that a credentialing issue occurs and a claim is blocked, who reaches out to the credentialing team? Who serves as the point person for the practice? Who verifies that the claim is ready for the next level?
The answers to these questions help understand how the client would operate with the proposed solution.
Services to Review in the Proposal
Relevant areas include:
- Medical billing and coding support
- Revenue cycle management
- Credentialing assistance
- Claims follow-up and aging reports
- Billing review and related practice support
Confirm which tasks are included, which are optional, and which remain with your staff. Coding support, in particular, should have a clear definition.
Practices Most Likely to Find the Offering Relevant
HMS USA could potentially be a better choice for practices requiring support for multiple billing functions as opposed to a one-time solution. The flexibility of this solution will depend on the specialization of your practice, the type of software you use, the volume of claims you need processed, and the staffing level provided.
This solution is offered by a 100% owned and operated company, and access to the company owners is not indicated in this comparison. Before you make a final decision, verify that the owners will be involved and define your ownership escalation path.
You should ask for and review a sample report provided by the company to give you an idea of the type of work the company will perform for you. Also request an itemized description of work to be performed. You should also request the company explain how it would address one of the more problematic issues you face. Request the company describe the information it would find useful to resolve that issue, and explain the actions that your practice would continue to perform.
Resilient MBS: Explore the Connection Between Billing and Practice Operations
A Useful Scenario to Discuss
Imagine a practice whose staff repeatedly select an outdated insurance plan during registration. The billing team can correct each affected claim, but the same work returns unless someone addresses the registration process. Ask Resilient MBS how its team would identify the pattern, explain it to your staff, and monitor whether the correction worked. This is an illustrative scenario, not a claim about a particular client result. It is a useful way to test whether a proposed partner thinks beyond individual claim corrections.Services to Consider
The company’s offering includes:- Medical billing and RCM
- Billing audits
- Provider credentialing
- Front-office assistance
- Reporting and performance-related support
Practices Most Likely to Find the Offering Relevant
Resilient MBS might be useful when a practice wants to combine billing and ancillary administrative processes. Additionally, it could be used when the leadership team wants to evaluate their billing processes in order to decide which billing-related processes to outsource. It is not clear how frequently the owner personally reviews an account. For account contacts and management-review scheduling, be sure to identify who would provide that input. You should request sample reports, not generic descriptions, of the types of reports your practice would receive. The key is to determine if the samples include Work in Process (and the next actions to take on the Work in Process) rather than if the samples merely present totals.Professional Credentialing Service: Keep Enrollment Work From Becoming an Unclear Handoff
Professional Credentialing Service focuses on provider enrollment and credential maintenance. Its services include CAQH profile management, Medicare and Medicaid enrollment, commercial payer applications, recredentialing, and provider-information updates.
It will be helpful to understand its position in the revenue cycle. Traditionally, this company has focused on claims management and payment posting and, more recently, on the appeal process.
Understanding this will help explain the position of this company in the revenue cycle when a practice grows by hiring additional clinicians and/or opening new locations while still doing its own billing.
The Angle Worth Exploring
Credentialing work is easier to manage when someone owns the application history. A practice needs to know what was submitted, what remains outstanding, and which decisions must be passed to the billing team.
A vague update such as “still pending” is not enough to manage staffing or scheduling expectations.
Ask PCS to explain how it tracks each provider-and-payer combination, how missing information reaches your practice, and how completed decisions are documented.
Services to Review
Relevant services include:
- Individual and group provider enrollment
- CAQH setup, updates, and re-attestation
- Government and commercial payer applications
- Recredentialing support
- Demographic and practice-information changes
- Application follow-up and status tracking
The agreement should identify the providers, locations, and payers covered. It should also explain who responds when a payer requests additional information.
Practices Most Likely to Find the Offering Relevant
PCs services are most applicable to practices requiring a credentialing process to accept new patients. This may include practices that want credentialing support for a limited portion of their practice.
PCS does not provide all of the services that may be associated with the practice of medicine, such as billing, claim submission, denial appeals, patient statements, and collections. These services must be requested separately.
PCS does not have a large workforce; owner-management must also be confirmed. Inquire as to who is in charge of the project and who will be intervening to address communication bottlenecks. This is important for a project of any scope, including the establishment of a single practice, or the expansion of a larger practice.
OneSource RCM: Direct Ownership With an Operational Focus
OneSource RCM explicitly operates as an owner-operated company. Its services connect medical billing with credentialing, claim follow-up, accounts receivable work, patient billing, and practice-workflow support.
That operating model is relevant to practices seeking a close relationship with someone responsible for both the work and its coordination.
Its published approach also considers upstream factors such as enrollment information, authorization capture, and EHR configuration. These are useful areas to explore when the same claim problem keeps returning.
The Angle Worth Exploring
OneSource can clarify how it determines if a recurring adjustment is due to a process issue rather than an error at the claim level.
An ongoing rejection may be due to a software default, for example, and not require a correction. It may be necessary to evaluate how the software responds to various types of inputs and who, if anyone, can modify that response.
Services to Discuss
Its service offering covers:
- Claims management and denial follow-up
- Accounts receivable recovery and cleanup
- Patient invoicing and support
- Credentialing within RCM engagements
- Workflow and practice-operations support
- Reporting based on available practice-system data
Confirm which activities belong to the ongoing service and which require a separate project. Historical cleanup, implementation work, and routine billing may involve different workloads.
Practices Most Likely to Find the Offering Relevant
OneSource may be a suitable choice for outpatient practices that want more direct control and assistance with identifying the root cause of operational issues.
Analyze your limits as carefully as the alternatives. Look into the experience of the specialists in your chosen specialty, the average number of claims processed per month, how absences are covered, and the various systems and software your practice uses.
The relationship should be direct. However, there should be documented procedures to ensure that work continues in the absence of the representative or when the current workload requires it.
Professional Billing Service: Evaluate the Patient Experience Alongside Collections
Professional Billing Service gives its founder the title of owner and CEO. It describes those in management positions who oversee the billing staff. Professional Billing Service differentiates itself from the competition by focusing on its staff’s interaction with patients during the billing process.
It’s important to consider the patient experience during vendor selection process. Patients often develop a poor perception of your practice based on outsourced billing company staff’s behavior during a collection call.
This aspect of Professional Billing Service would attract an aesthetic medicine practice concerned about its patients’ complaints and feedback about its billing practices.
Look Closely at Account Investigation
The team members have been asked to provide an example of how they handle patients who believe they have already made a payment and want to know the status of their account.
The answer should include discussing payment history, checking for posting errors, working with the practice, and reporting the results of the interaction. The answer should include that reviewing these cases requires management’s input.
This type of case assist in validating customer service statements.
Service Areas to Confirm
Discuss the proposed scope for:
- Medical billing and insurance follow-up
- Patient billing questions
- Account review and unresolved balances
- Practice communication
- Reporting and account oversight
Clarify what the team can decide independently and what requires your approval. Your practice may have specific policies governing payment arrangements, adjustments, or disputed balances.
Practices Most Likely to Find the Offering Relevant
Professional Billing Service is a great option if your practice values interpersonal interactions with patients and has a recognizable management team.
Consider your specific needs. Explore the company’s experience with the types of services and payers used by your practice. Ask for a reference if they have previously performed collections for your type of practice.
Their on-site management team and ownership takes a relationship-focused approach to their business, but to be truly comfortable, you need to verify that the team has a defined range of services and meets agreed upon objectives.
Discuss Recurring Financial Needs with Billing Specialist
Are the same claims appearing on your “To Do” list? With a billing specialist, review your denied claims and accounts receivable balances and discuss the financial needs of your practice. Ask the specialist to create a billing service scope based on your practice’s actual requirements.
Owner-Operated Medical Billing Services in the US: Look Past the Label
Generally, an owner-operator is hands-on in the operation of the business. The term doesn’t describe a limited partner, or describe the extent of an owner’s participation in the day-to-day business.
“Owner-operated” is distinct from “privately held.” In a closely held corporation, an owner may not be actively involved in the operation of the business.
You need to determine the answers to the following questions to gain a full appreciation of the organization:
Who owns the business?
Who manages the business?
Who is your point of contact and is accountable?
The various combinations of the answers to the above questions may work effectively in a business.
Billing companies that provide services to the health care industry often provide a single point of contact for a health care practice. That person is often able to process requests to change the manner in which the practice operates.
Match the Service to Your Specialty’s Actual Work
A potential partner company listing your specialty on their website is a good first step in evaluating partner candidates. The stronger check is determining if the partner company team understands your most frequent sources of work.
You should describe a few sample cases for each of the areas you wish to have the partner company team evaluate. In each case description, you should capture the type of work performed and any administrative challenges. You should not, however, include information which would identify a patient.
The administrative challenges may include the need to track authorizations, enroll providers, or respond to requests for documentation. Challenges may also include requirement to coordinate or integrate the work of two or more billing units.
The challenges may also include the need to establish new offices or other practice locations and the accompanying challenges of working with new payors to set up and activate new provider records and assign new billing units.
You are evaluating the team’s method, not testing whether a salesperson can recite billing terminology.
Listen for the information they would request before reaching a conclusion. A careful answer usually identifies dependencies: documentation, payer requirements, system access, or the service agreement.
Also clarify coding responsibility. Does the company assign codes, review codes supplied by your practice, or submit claims without coding review? Who contacts the clinician when documentation needs clarification?
These boundaries affect daily work and should appear in the written scope.
Make the Fee Calculation Easy to Reproduce
Percentage-based pricing can get complicated. One company may use total patient payment collections as their basis. Another company may use gross collections as their basis.
With the first example, your practice may be responsible for collecting copays and coinsurance. With the second example, your responsibility may be even greater, since your practice may also be responsible for collecting all patient balances and institutional balances.
Some companies may charge a separate fee to recover aging accounts receivable.
Ask the company to define the collection base. Your practice should be able to reproduce this definition from its own records.
Consider this hypothetical comparison:
| Monthly cost item | Proposal A | Proposal B |
|---|---|---|
|
Eligible collections |
$100,000 |
$100,000 |
|
Percentage fee |
4% |
5% |
|
Base billing charge |
$4,000 |
$5,000 |
|
Additional monthly charges |
$1,300 |
$200 |
|
Total monthly cost |
$5,300 |
$5,200 |
The figures are illustrative. They demonstrate why the lower advertised percentage may not produce the lower total cost.
The next question is whether the proposals cover equivalent work. A slightly lower fee is not useful if your staff must continue performing tasks you expected to outsource.
Review onboarding charges, minimum fees, software, statements, coding, credentialing, appeals, and legacy AR. Identify which items are recurring and which are one-time costs.
Then examine the exit terms. Confirm notice requirements, data-export arrangements, final invoices, and responsibility for claims still outstanding when the relationship ends.
Separate Claim Activity From Financial Progress
Your billing teams may be really busy without resolving the balances most important to you.
Having your billing staff spend a lot of time on collections activities does not mean your receivables are being collected. You need to see details of collections activities to determine if claims are being pursued. Often, you will see only a high-level description of collections activities and will not be able to tell if the staff is following up on the same claims over and over again.
Some of the more important metrics need to be tracked and reported on separately.
Claim Acceptance
Acceptance means a claim has passed a particular submission or processing stage. It should not be treated as proof of payment.
Ask where the measurement occurs and what counts as an accepted claim.
Denials and Rejections
Keep these categories distinct. Understand whether a reported rate counts claims, service lines, or dollars, and which period it covers.
Otherwise, two percentages with the same label may describe different things.
Aging Receivables
Review balances by different factors including the age of the balance, the payer, and your responsibility. For each of the older balances, determine whether the patient still owes the balance, if there is an appeal pending, or if you do not have the information needed to process the claim.
A balance alone does not warrant collection action. Collection action may be taken once it is determined that a patient still owes the balance, an appeal has been denied, or other claims remain pending.
Collections and Adjustments
Understand the methodology the company uses to measure collections performance. Is there an adjustment process? What impact do changes in payer mix, patient volume, and recovered bad debts have on the figures presented?
As you evaluate your company’s performance relative to others, the choice is yours as to the significance you may give to any benchmarks. Depending on the rationale that supports the calculation of the benchmarks, some may be relevant to you.
Make specific action plans and time frames to changes suggested in your reports. Reports should assist you in making decisions.
Put Denial Prevention Into the Working Agreement
Most companies advertise denial management. The practical difference is whether their work helps prevent the same problem from returning.
Consider a hypothetical group where claims associated with one provider repeatedly require additional review. A useful investigation would determine whether the issue concerns documentation, enrollment information, claim setup, or a payer-specific requirement.
The team should not choose a correction merely because it seems likely to obtain payment. The action needs to match the underlying facts and supporting records.
Ask the proposed company to describe its process:
- How are recurring problems identified?
- Who reviews the cause?
- How are findings communicated to the practice?
- Who approves a workflow change?
- How is the effect checked on subsequent claims?
This approach also clarifies shared responsibility. Some problems require action from your front desk or clinicians. A billing company should identify that dependency early and document what it needs.
The strongest working relationship makes those requests specific enough to act on.
A Stable Team Needs a Backup Plan
It is important to maintain a working relationship with your account representative. However, it is equally important to understand what happens when that person is away from work.
How is account knowledge captured and retained? It is important that the next account representative understands the accounts he/she is working, without having to repeat the research and answer the same questions.
Find out how the work flow is managed and prioritized, when the normal work flow of the office is disrupted.
It is important to ask these questions of medical billing companies that you are considering for your office.
Staff should be trained to answer the same questions. It is also important that the staff understand who covers patient contact when patients make inquiries about their accounts.
Continuity should be in place for handling customer service.
When a staff member leaves, determine how access to account information is restricted and how the account information is explained to the remaining staff.
A personal relationship should be complemented with standard operating procedures.
Plan the Transition Around Specific Accounts and Dates
Switching billing companies becomes harder when responsibilities are described loosely.
“Continue working the old claims” is not enough. Identify which claims belong to the outgoing company, which move to the incoming team, and how both sides avoid duplicate activity.
Before the handoff, prepare a baseline that includes open balances, pending appeals, unresolved credits, claims awaiting documentation, and current access arrangements.
Then agree on three stages.
Before the Start Date
Review service scope, required contracts, access to systems, and the person in charge of the change. Review contractual commitments to the departing service provider.
Determine what reports and what details of the account history need to be kept.
During the Handoff
Assign responsibility for new claims and existing receivables. Clarify who posts payments, reconciles deposits, and communicates unresolved issues.
Test the practical workflow with a limited set of representative accounts where appropriate. Resolve access problems before they become a backlog.
After the Start Date
Conduct regular operation reviews. Review if work is moving appropriately. Are claims being submitted? Are exceptions assigned? Have payments been reconciled? Are your questions answered?
It takes longer to decipher financial trends, but they should be reviewed. Additionally, they should be compared to the baseline. Normal trends in cash flow should be taken into consideration. This includes the normal payment cycle, volume of patients, and changes within the practice.
A transition plan outlines the responsibilities to be performed in a specified sequence. It does not accept responsibility to perform a service and ensure an immediate or ultimate improvement.
Use the Same Consultation Questions for Every Company
A consistent evaluation makes it easier to compare proposals without being distracted by presentation style.
Bring the following questions to each discussion:
- Which services are included, and which remain with our staff?
- Who will manage the account and handle escalations?
- How does the owner participate in operations?
- What comparable specialty and software experience does the proposed team have?
- How do you investigate recurring denials?
- Which reports will we receive, and how are the metrics calculated?
- What is the complete fee calculation?
- Who owns the transition and unresolved work if we leave?
Request a sample report and a relevant reference. During the reference conversation, ask about response quality, clarity of invoices, and handling of difficult issues.
A polished proposal is useful. A clear explanation of everyday work is more useful.
Frequently Asked Questions
Are owner-operated billing companies better for small practices?
They can be a good fit for practices seeking direct leadership access and flexible communication. However, ownership alone does not establish quality. Relevant experience, staffing, reporting, and clear responsibilities are stronger grounds for a decision.
Can I outsource billing while keeping my existing EHR?
Often this is possible, but it depends on the company and your system. Confirm whether staff work directly in your platform, need an interface, or require a migration. Include implementation and ongoing software costs in the comparison.
Should credentialing and billing use the same provider?
Either arrangement can work. The key is a documented handoff. Your billing team needs timely information about enrollment decisions and unresolved requirements, whether that information comes from an internal employee or a separate specialist.
Will the owner personally review every account?
Not necessarily. Some owners supervise managers, while others participate directly in client work. Ask what owner involvement means in your proposed engagement and how routine support differs from escalation.
Can a billing company guarantee higher collections?
Treat an unconditional promise cautiously. Collections depend on factors including services provided, documentation, payer policies, patient responsibility, and the starting condition of the account. Ask for relevant evidence and a practical improvement plan rather than relying on a guaranteed percentage.
Which company should I contact first?
Start with the service that matches your immediate need. HMS USA and Resilient MBS are relevant to broader billing discussions. PCS is a credentialing-focused option. OneSource RCM and Professional Billing Service offer owner-led models worth evaluating for operational fit.
Choose Clear Responsibilities Before Choosing a Brand
It’s not hard to understand the allure of using an owner-operated medical billing service. When something goes wrong with a billing service, you need to know who to call and it helps to know exactly who’s in charge.
Look at the service from this point of view, and evaluate the team members, the services provided, and the reports generated. Review the fees charged and the plan for transitioning the client. Compare proposals for full medical billing and collection services and proposals for credentials-only services.
Before signing, make sure you can answer four questions:
- Who will do the work?
- Who will resolve problems?
- How will progress be demonstrated?
- What will the complete service cost?
Shortlist the companies that match your needs, request written proposals, and bring one real operational problem to each consultation. Choose the partner whose explanation gives your practice a clear, workable next step.
Looking for a Billing Partner You Can Actually Reach?
We can help you set clear expectations. For a more detailed assessment of how we can support you, including fees, ask for a proposal and schedule a consultation to discuss your specialization and the work you do. Also, let us know your concerns and priorities and we’ll address them.
