What to Expect When Transitioning to an Outsourced Biller

Medical practices are evolving, and in this transition process, running medical practices is becoming more and more complex and revenue. Amidst this, keeping the revenue cycle running smoothly is adding more to the complications.

For instance, according to MGMA, 90% of medical groups reported higher year-to-date operating costs in 2025 compared to previous years.

With these financial pressures growing, practices are looking for various options to manage their billing. And outsourcing medical billing services is the top priority for many practices.

In the November 2024 MGMA report, 36% of surveyed medical practice leaders said that their organization is planning to outsource or automate certain to complete aspects of their revenue cycle management. And some trends even point towards an outsourced billing transition for practices. Another report by MGMA found that medical group leaders identified revenue cycle as the biggest new investment area in their coming year’s budget.

Having said that, deciding to outsource medical billing is one thing, and making a switch without disrupting claims, delaying payments, or leaving outstanding accounts unattended is another.

So, if you’re preparing for medical billing outsourcing onboarding, then there are certain questions that you might be having, like what happens to your pending claims, how your existing team will work in this new setting, and how long it will take to make this new medical billing transition process the norm.

Well, this is exactly what we’re going to discuss in this blog.

On that note, let’s walk through what to expect when switching to an outsourced medical biller, right from initial handover and medical billing outsourcing onboarding to go-live, and everything you need to know that will help you keep your practice’s revenue cycle on track.

So, without further ado, let’s get started!

Pre-Onboarding: What Should You Prepare Before Switching Billing Companies?

If you’ve decided to outsource your practice’s revenue cycle to medical billers, then you can’t directly choose one medical billing company and get started, right? There are some medical billing outsourcing transition checklists that you need to do to lay the groundwork before actual work starts.

So, the very first thing that you need to do is take a closer look at your existing billing setup. You have to review your current workflows, contracts, payer information, open claims, and accounts receivable (A/R). You also need to check whether your claims are waiting to be submitted, or if there are any denials that need follow-up, etc.

Identifying these things is important because it gives you a clear picture of where you stand and what needs immediate attention in your revenue cycle.

Next, decide who will handle claims and A/R generated before the new medical biller starts working on your revenue cycle. This depends on your practice, some practices transfer all outstanding accounts to a new biller, while some retain legacy A/R or agree on a phased handover. The most important thing is to establish clear ownership, roles and responsibilities so that claims don’t fall through the cracks.

Other than that, before finalizing the transition, check who will work on pre-go-live claims and for how long. This is to prevent unresolved claims, missed follow-ups and confusion over payment responsibilities.

Last but not least, establish communication channels, define responsibilities, agree on key milestones, and confirm the go-live dates. Getting these details before medical billing outsourcing onboarding begins helps both teams stay aligned and make the transition easier to manage.

What Happens During the Medical Billing Onboarding Process?

After you’ve laid the groundwork, it’s time to get your new billing partner up and running to work on your revenue cycle. The medical billing onboarding process typically happens in phases.

Here are the phases in detail and what you can expect at each stage:

Phase 1: Assessment and Setup (Weeks 1-2)

Before handling your claims, the outsourced billing team needs to understand how your practice operates and where your practice stands financially. This is important for you to understand because it will help you understand what sections of your revenue cycle need immediate attention.

Here are the things that you need to do in this phase:

• Define the scope of work: Agree on responsibilities, workflows, deliverables, and the transition timeline so both teams know what to expect.

• Review existing billing operations: Audit open A/R, pending claims, payer information, and current processes to identify backlogs and potential issues before go-live.

Phase 2: Integration and Testing (Weeks 2-4)

With the completion of your initial assessment, the focus shifts to preparing the systems and making sure information flows correctly between your practice and the chosen billing partner.

Here are some of the activities in this phase:

• Set up system access: Provide secure access to the required EHR, practice management software, and other billing systems.

• Configure payer and clearinghouse connections: Ensure the necessary connections are in place for claim submission, eligibility checks, and payment processing as applicable.

• Test workflows: Verify claim processing, data exchange, system permissions, and reporting before moving into live operations.

Phase 3: Go-Live and parallel Processing (Weeks 4-8)

It is at this phase that the outsourced billing transition starts becoming a part of your day-to-day operations. The new team begins handling its assigned responsibilities, but existing claims and outstanding balances still need attention.

• Start processing new claims: The outsourced team begins submitting claims and managing the billing tasks covered by your agreement.

• Continue working on legacy A/R: Ensure previously submitted claims, denials, and pending payments have clear ownership and receive timely follow-ups.

• Compare claim activity: Monitor submissions, rejections, payments, and unresolved accounts to identify gaps during the handover.

Phase 4: Stabilization (Weeks 8-12)

Once the new workflow is set and running, the focus immediately shifts to resolving recurring issues, reviewing performance, and establishing a consistent operating routine.

• Monitor key metrics: Track claim acceptance, denials, payments, days in A/R, and outstanding accounts to understand how the transition is progressing.

• Resolve workflow issues: Address communication gaps, processing errors, access problems, and other issues identified during the initial weeks.

• Establish regular reporting: Review performance with your billing partner, agree on reporting frequency, and define how ongoing issues will be escalated.

*NOTE: These timelines are given as an average and they are subject to change depending on your practice’s size, existing systems, payer setup, and billing complexity. Remember that the medical billing transition process can move faster than anticipated and can even take longer.

Following these phases is essentially necessary because it helps you ensure that your billing operations continue running smoothly as responsibilities shift to the new team.

How Do Staff Roles Change After Switching to an Outsourced Biller?

One of the questions that you might have when switching billing companies is what happens to your existing staff, right? Certain thoughts, like do they need to change the way they work or who will handle billing questions from patients and service providers and who handles when a claim is denied, do cross your mind and create more confusion.

Well, in simple words, outsourcing changes who handles certain billing tasks, but it does not mean that your in-house team is not required. The key is to establish clear responsibilities so everyone knows what they’re expected to handle.

Here is how the roles typically work:

• Your front-office team: Continue managing patient registration, insurance information, eligibility checks, and collecting the details needed for accurate billing.

• Your outsourced billing team: Handles the agreed revenue cycle functions, which may include medical coding, claim submission, payment posting, denial management, and A/R follow-ups.

• Shared responsibilities: Some tasks, such as resolving missing clinical documentation, answering patient billing questions, and escalating complex claim issues, may require coordination between both teams.

During this outsourced billing transition, it is important for you to distinguish between temporary transition tasks and permanent responsibilities. During onboarding, your staff may need to help transfer records, explain existing workflows, and clarify outstanding claims. Once the transition settles, these activities should give way to regular divisions of work agreed upon with your billing partner.

However, before going live, documentation of who owns which tasks is important. Along with that, the document should also mention who handles escalations and how unresolved issues are communicated. Having this clarity helps your team adjust to the new arrangement without confusion or duplicated effort.

What Should Be Included in a Medical Billing Outsourcing Transition Checklist?

With so many things being moved and jumbling during the transition, it’s very easy to overlook a small but important detail. That is why having a medical billing outsourcing transition checklist helps you keep track of completed tasks, assign, responsibilities, and ensure everything is ready before your new billing partner takes over.

Here is a quick checklist for you:

Checklist Item	Owner	When
Confirm scope and responsibilities	Practice + biller	Before onboarding
Complete HIPAA/BAA requirements	Practice + biller	Before data access
Transfer required billing data	Practice + biller	During setup
Configure EHR/PM and clearinghouse access	Biller + technical team	During integration
Audit open claims and A/R	Practice + biller	Before go-live
Assign responsibility for legacy A/R	Practice + biller	Before go-live
Test billing workflows and reporting	Biller + practice	Before go-live
Confirm communication and escalation processes	Practice + biller	Before go-live
Monitor claims and A/R after launch	Practice + biller	Post-launch

Before go-live, make sure every critical item has a clear owner and is completed or explicitly accounted for to help keep the transition on track.

What Happens to Existing Claims and A/R During the Transition?

When switching billing companies, what happens to the claims that are already in progress is something that might be concerning you. Unpaid claims, pending appeals, and outstanding balances still need follow-up, and without clear ownership, these accounts can easily get overlooked during the handover process.

How Is Legacy A/R Handled?

Legacy accounts receivable (A/R) refers to unpaid claims and outstanding balances generated before the new biller takes over. So, before go-live, both teams should review these accounts and agree on who will manage them.

• Identify outstanding accounts: List unpaid claims, rejected claims, pending appeals, and balances awaiting follow-up.

• Assign ownership: Decide whether the outgoing biller, incoming biller, or in-house team will manage each account.

• Define responsibilities: Clarify who handles resubmissions, payer inquiries, appeals, and payment posting.

What Is the Orphan A/R Window?

The orphan A/R window occurs when the outgoing billing team stops working an account before the incoming team assumes responsibility. This gap can lead to missed follow-ups and delayed payments.

To prevent it, establish a clear cutoff date and document who will work pre-go-live claims. If the outgoing biller will continue managing legacy A/R, agree on the duration, scope, and payment terms beforehand.

How Can Practices Prevent A/R From Being Missed?

Keep every outstanding account visible and assigned throughout the transition.

• Use a shared tracker: Record each claim’s status, next follow-up date, and assigned owner.

• Monitor open claims: Review unresolved accounts regularly to ensure timely follow-ups and resubmissions.

• Track legacy and new A/R: Monitor both separately to spot delays and prevent missed revenue.

Every outstanding claim needs a clear owner and documented next step. This helps to protect your revenue while switching billing companies.

Frequently Asked Questions