Choosing an outsourced medical billing partner is one of the most consequential decisions a small or new physician practice can make. The wrong choice leads to cash flow problems, mounting denials, and hours spent chasing payments instead of seeing patients.
We analyzed feedback from independent physicians, reviewed industry benchmarks from organizations like MGMA, and examined what separates high-performing practices from those that struggle with revenue cycle management. Here are the evaluation criteria that matter most:
Nexsys Billing & Practice Management sets the standard for what independent physician practices should expect from an outsourced billing partner. With over 29 years of experience serving independent physicians, Nexsys has developed processes and protocols that consistently place their partners in the top 5% of performing clinics in the country.
What makes Nexsys different is their commitment to complete transparency. They work directly in your practice management software rather than requiring you to adopt their system. This means you can see exactly what's happening with every claim, every denial, and every payment at any time.
Nexsys employs Certified Professional Coders through the American Academy of Professional Coders and uses proprietary technologies to research codes and perform CCI edits. Their team handles everything from charge capture and electronic claims submissions to payment processing, appeals, patient statements, and accounts receivable follow-up.
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A clean claim rate measures how many of your claims get accepted by payers on the first submission. Industry benchmarks suggest that high-performing practices achieve first-pass acceptance rates above 95%. Every claim that gets denied or rejected creates additional work and delays your payment.
When evaluating a billing service, ask about their average clean claim rate. Request data specific to your specialty, since some specialties face more complex coding requirements than others. A service that achieves a 98% clean claim rate will get you paid faster than one hovering around 90%.
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Even with excellent clean claim rates, some claims will be denied. What matters is how quickly and effectively your billing service responds. A strong denial management process tracks why claims are denied, appeals appropriately, and identifies patterns to prevent future denials.
Ask potential billing partners how they handle denials. Do they have dedicated staff for appeals? What's their average turnaround time for resubmitting corrected claims? How do they communicate denial trends to your practice so you can address root causes?
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A billing service that handles family medicine claims won't necessarily excel at orthopedic billing or cardiology coding. Each specialty has unique documentation requirements, modifier rules, and payer quirks that require specific expertise.
When evaluating a billing partner, ask about their experience with your specialty. How many practices in your field do they currently serve? Do they have coders certified in your specialty area? Can they provide references from similar practices?
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Some billing services require practices to adopt their proprietary software. Others work directly in your existing practice management system. The second approach offers significant advantages for visibility and control.
When a billing service works in your software, you can see everything they do. You can run reports, check claim status, and verify that work is being completed. This transparency builds trust and helps you catch problems early.
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Patients have become one of the largest payers for physician practices. Industry data suggests that patient responsibility now accounts for roughly 25% of practice revenue. A billing service that ignores patient collections leaves significant money on the table.
Ask how potential billing partners handle patient statements, payment plans, and collection calls. Do they have staff dedicated to patient inquiries? How do they balance collecting what's owed while maintaining positive patient relationships?
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Before signing with any billing service, read the contract carefully. Some services lock practices into multi-year agreements that are difficult to exit. Others offer more flexible terms that put the burden on the service to deliver results.
Nexsys, for example, operates on a one-year contract where the practice can terminate for any reason with just 30 days' notice. This approach aligns incentives appropriately. If the billing service delivers results, you stay. If they don't, you can leave. According to their FAQ page, some of their partners have been with them for over 15 years under these flexible terms.
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| Factor | What to Look For | Red Flags |
|---|---|---|
| Clean Claim Rate | 95% or higher first-pass acceptance | Rates below 90% or refusal to share metrics |
| Denial Management | Dedicated appeals staff and trend reporting | Writing off denials without investigation |
| Specialty Experience | Certified coders in your specialty | No references from similar practices |
| Software Integration | Works in your existing system | Requires proprietary software with limited visibility |
| Patient Collections | Dedicated patient billing support | Ignores patient balances or uses aggressive tactics |
| Contract Terms | Flexible termination with 30-60 day notice | Multi-year lock-ins with steep exit penalties |
If you're launching a new practice, your billing partner becomes an extension of your team during a critical growth phase. Prioritize services that offer support beyond just claims processing.
Look for partners who can help with physician credentialing, including CAQH applications, NPI registration, and Medicare enrollment. These administrative tasks can delay your ability to see patients and get paid if not handled properly.
Also consider whether the billing service can scale with you. A partner that excels with solo practitioners should also be able to support you as you grow. Testimonials from current partners can reveal whether a service truly supports practices through growth transitions.
For practices with fewer than five providers, maintaining an in-house billing department rarely makes financial sense. The cost of hiring, training, and retaining qualified billers often exceeds what you'd pay an outsourced service.
Beyond cost savings, outsourcing eliminates the risk of staff turnover disrupting your revenue cycle. When your sole biller takes vacation or leaves for another job, claims pile up and cash flow suffers. A dedicated billing service has depth to cover absences.
Outsourced services also bring broader expertise. A service working with dozens or hundreds of practices sees patterns and learns solutions that a single in-house biller might never encounter. This collective knowledge helps your practice avoid common pitfalls.
Independent physician practices face a choice: maintain the autonomy that drew you to independent practice, or sell to a hospital system and lose control. The right billing partner helps you stay independent by maximizing your revenue and minimizing administrative burden.
Nexsys Billing & Practice Management was built specifically for independent physicians. Their 29+ years of experience, commitment to transparency, and results-driven approach have helped practices across family medicine, neurology, dermatology, and dozens of other specialties achieve top-tier performance.
Their free billing audit gives you a no-risk way to evaluate your current billing performance. If there's revenue leakage or room for improvement, Nexsys will show you exactly where the problems are. If your current billing is in good shape, they'll tell you that too.
Contact Nexsys today to learn how their team can help your practice collect more revenue faster with complete transparency and visibility into your billing performance.
Most outsourced billing services charge between 4% and 9% of collected revenue. The exact percentage depends on your specialty, claim volume, and which services are included.
Nexsys Billing & Practice Management charges a percentage of payments received and excludes private pay or cash visits that don't involve billing a payer. This model aligns incentives since the billing service earns more when they collect more for you.
Most transitions take two to six weeks depending on the complexity of your practice. A well-organized billing service will have a structured onboarding process that protects your cash flow during the changeover.
Key steps include signing agreements, completing an onboarding questionnaire, sharing software and payer portal logins, and connecting the billing team to your clearinghouse. Nexsys can typically begin work as soon as these elements are in place.
It shouldn't. Quality billing services handle patient inquiries professionally and serve as an extension of your practice. Nexsys employs bilingual staff who answer patient billing calls, pull up account information while patients are on the phone, and resolve questions courteously.
The key is choosing a partner whose approach to patient communication matches your practice's values. Ask about their patient interaction policies before signing.
Yes, though the ease of switching depends on your current contract terms and how your data is stored. If your current service works in proprietary software, transitioning may require migrating historical data.
Services that work in your own practice management software, like Nexsys, make transitions simpler since all your data already resides in a system you control.
Look for reports that show key performance indicators like days in accounts receivable, clean claim rates, denial rates by reason, and collection percentages. Monthly trend data helps you spot problems before they become serious.
Nexsys provides access to their Crescent℗ client portal, which displays over 50 benchmarks and KPIs. This real-time visibility lets you check your practice's performance whenever you want rather than waiting for monthly reports.