01Start with your own baseline
The best partner for a practice with a coding backlog isn’t necessarily the best partner for a hospital with aging A/R. Be clear about the problem before you compare solutions.
Before you speak to anyone, write down where you are today. It makes proposals comparable and gives you a starting point to measure any partner against.
- Volume: monthly claims, encounters or charts by specialty and payer mix.
- Current performance: days in A/R, clean claim rate, denial rate, and A/R over 90 days.
- Where it hurts: which steps of the cycle are backlogged, under-resourced or error-prone.
- Scope: full revenue cycle, or a specific function such as coding, denials or payment posting.
- Systems: your EHR, practice management and clearinghouse, and how you’d grant access.
Tip: share the baseline
Partners who receive the same baseline data give you proposals you can actually compare, rather than three different sets of assumptions.
0210 things to evaluate
Open each one for what to look for and the questions to ask. The same ten criteria appear in the scorecard below.
01Relevant experienceYour specialty, setting and payer mix.
Revenue cycle work varies widely between specialties and between providers and health plans. Look for experience that matches your actual claims, not just general healthcare.
02Clear scope of workExactly what they do, and what they don’t.
A good proposal names each task, the handoffs between your team and theirs, and what happens with exceptions.
03Coding credentials & qualityCertified coders and a defined QA process.
Ask how coders are certified, how work is audited, and what happens when an error is found.
04Data security & complianceHIPAA, a BAA, and access controls.
Your partner will handle protected health information. They should be able to explain their safeguards plainly.
05Systems fitWorks inside your EHR and PM system.
Partners who can work directly in your systems avoid duplicate data entry and keep your data where it belongs.
06Reporting & transparencyMetrics you can verify.
Agree the reports, their frequency and definitions upfront. Numbers should tie back to your own system.
07Denial management approachFixing root causes, not just reworking claims.
Strong partners categorise denials, find patterns and feed fixes upstream to front-desk, coding or charge capture.
08Communication & teamA named contact and a regular cadence.
You should know who works on your account, how to reach them, and how issues get escalated.
09ScalabilityHandles volume spikes and backlogs.
Ask how quickly the team can add capacity for a backlog, a new location or a payer change.
10Pricing & contract termsSimple, predictable, fair exits.
Compare the full cost, not just the headline rate, and understand how you leave if it isn’t working.
03Red flags
Specific promises about collections or denial rates before anyone has looked at your data.
Can’t clearly explain access controls, a BAA, or how they handle a security incident.
You can’t find out who will actually work on your account or who your day-to-day contact is.
Metrics that can’t be traced back to your own system data.
Long terms with no performance-based exit and unclear data return on termination.
Setup, technology, or “out of scope” fees that only appear late in the conversation.
04Compare partners side by side
Rename the columns, set how much each criterion matters to you (1–5), and score each partner (1–5). The weighted total updates as you go and is saved in your browser.
RCM partner scorecard
Weighted score out of 100
05Run a short pilot
The best test is real work. Agree a 60–90 day pilot on one defined workflow, with baseline numbers, weekly reporting and a review at the end. If quality, turnaround and communication hold up, expand the scope from there.
06Plan the transition
The first 90 days set the tone for the relationship. Agree on these before signing:
- Discovery and access (weeks 1–2): systems access, workflow walkthroughs, payer rules and existing backlogs.
- Parallel run (weeks 3–6): the partner works a defined slice of volume while QA is high and feedback is fast.
- Ramp-up (weeks 6–12): volumes increase in agreed steps, with weekly check-ins and a shared issue log.
- Steady state: monthly reporting against the baseline you set at the start, and a quarterly review.
Don’t leave the old work behind
Decide upfront who works the existing A/R and open denials during the switchover, so nothing falls through the gap between teams.
This guide is general information to help with evaluating service partners. It isn’t legal, financial or compliance advice. Review contracts and security arrangements with your own advisors.