If your biller quits, your first job isn't replacing them. It's protecting the money already in motion. In the first week, secure every login that touches your revenue, find out what was in flight, and flag anything close to a filing deadline; in the first month, triage your A/R, keep new claims going out, and only then decide whether to hire, bring in temporary help, or outsource.
In my 15+ years in medical practice management, starting at the front desk and working up through practice administration and billing management, I've learned that a sudden billing departure feels like a crisis but is usually fixable. What makes it worse is skipping steps or doing them out of order. Here's the order I'd work in.
Week one: secure access to everything
Before you look at a single claim, make sure the practice can get into every system your biller used. Work through this list:
- Clearinghouse. This is where claims go out and where rejections and electronic remittances (ERAs) come back.
- Payer portals. Your Medicare contractor's portal, Medicaid, commercial payer portals, and any multi-payer portal you use.
- EHR and practice management system. Confirm you have an administrator login, not just a user login.
- Bank, EFT, and ERA access. Confirm payer deposits are landing in the practice account and that you can see the remittances that explain them.
- Credentialing logins. CAQH, NPPES, and PECOS if you bill Medicare.
- Email, fax, and mail. Payer letters, records requests, and paper EOBs often land in one person's inbox or on one person's desk.
If the biller was an employee, have whoever manages your IT remove or reset their access the same day and change any shared passwords. If a billing company is leaving, ask in writing for a transition plan, and confirm that you have admin-level access to every account in your practice's name. Check your contract for what it says about returning data and handing off open work.
This is also when many practices discover that important logins were set up under someone's personal email address. Move those to a practice-owned address as soon as you can.
My rule of thumb: every login that touches your money should belong to the practice, not to a person and not to a vendor.
Find out what was in flight
Next, build a picture of the work that was half-done. In your practice management system and clearinghouse, look for:
- Charges entered but never turned into claims
- Claims created but never submitted
- Rejected claims (these were never accepted into the payer's system, so as far as the payer is concerned, they don't exist)
- Claims submitted with no response
- Denials sitting in a work queue
- ERAs and paper EOBs that haven't been posted
- Appeals, corrected claims, and prior authorization requests that were started but not finished
If you're leaving a billing company, ask them for a current A/R aging report, a list of open claims, any appeals in progress, and their account notes. I walk through that hand-off in detail, including a 30/60/90-day plan, in my guide to switching billing companies without losing revenue.
Protect your timely filing deadlines
Every payer sets a deadline for submitting claims, and once it passes, the claim is usually a write-off. The payer won't pay it, and network contracts typically don't let you bill the patient for it either.
The limits are not the same everywhere:
- Medicare: 12 months (one calendar year) from the date of service.
- Medicaid: varies by state.
- Commercial payers: varies by contract, and some are much shorter than Medicare's. Check each contract rather than assuming.
Corrected claims and appeals have their own deadlines, and they're often shorter than the original filing limit.
Sort every unbilled, unsubmitted, and rejected claim by date of service and compare it against that payer's limit. Bill the oldest ones first. Save the acceptance reports from your clearinghouse for everything you send, because that's often your proof of timely filing if a payer later says it never received a claim.
Triage your A/R by age and dollar value
Once the deadline risks are handled, run an A/R aging report by payer, usually in buckets of 0-30, 31-60, 61-90, 91-120, and 120+ days. Then work it in this order:
- Anything near a timely filing or appeal deadline. These are the claims you can lose for good.
- High-dollar claims over 60 days. One phone call can resolve a lot of money.
- Patterns. If one payer is denying everything for the same reason, it may be an enrollment or credentialing problem. Fix it at the source instead of appealing claim by claim.
- Older, smaller balances. Last, but not ignored.
In behavioral health and therapy practices, individual claims are often modest, but the volume adds up quickly. A few dozen unworked session claims is real money. If the backlog is deeper than your team can handle while keeping up with new work, an A/R cleanup project can run alongside your regular billing.
Keep claims, authorizations, and credentialing on track
Claims and authorizations
Don't let today's work become next month's backlog. Pick one person, often the office manager, to submit claims at least weekly, check the clearinghouse for rejections, and post payments. Keep the front desk verifying eligibility and collecting copays as usual.
If your practice depends on prior authorizations, as many PT/OT clinics and some behavioral health practices do, check which authorizations are about to expire or run out of approved visits. A lapsed authorization can turn a week of visits into denials. If that tracking lived in your biller's head, consider getting help with prior authorizations until it's back under control.
Credentialing and CAQH
Billers often quietly track credentialing dates, and nobody notices until something lapses. Find out where things stand on:
- CAQH re-attestation, generally due every 120 days
- Payer recredentialing, commonly every three years for commercial plans
- Medicare revalidation, generally every five years
- Any new clinician whose enrollment applications are still pending
- Updated licenses, malpractice certificates, and other documents that need to be uploaded
A lapse here can mean denied claims or, worse, being dropped from a network. If no one on your team knows the status, it's worth getting credentialing support to sort it out.
Document everything as you go
Keep a simple running log: the date, what you found, who you called, the call reference number, and what happens next. It feels tedious in the moment, but it saves you from repeating calls, and it gives whoever does your billing next a head start.
While you're at it, write down how billing actually works in your office: who enters charges, when claims go out, where EOBs arrive, and which payers need special handling. Store passwords in a proper password manager, not a spreadsheet on someone's desktop. The goal is that the next time someone leaves, it's an inconvenience instead of an emergency.
Then decide: hire, temporary help, or outsource
Try not to make this decision in the first few days. Triage first, so you know how much work you're actually facing. Then weigh your options:
- Hire a new biller if your volume supports the role and someone in the practice can train and supervise them. Expect recruiting and ramp-up to take time.
- Bring in temporary or contract help to bridge the gap. Anyone outside your own workforce who will handle patient information should sign a Business Associate Agreement (BAA) before they get access.
- Outsource if you want a partner whose whole job is getting your claims paid, with documented processes and experience across many payers. I compare the trade-offs honestly in In-House Biller vs. Outsourced Billing for Small Practices.
If you do outsource, ask how the company is paid. At S2S, we charge a flat monthly retainer plus a per-claim fee, never a percentage of collections. We sign a BAA before any patient data is shared, and you work directly with me.
If you're in the middle of this right now, you don't have to sort it out alone. Reach out and tell me where things stand, and I'll help you figure out what needs attention first.
