Before You Renew: Is Your RCM Partner Still Earning the Relationship?

Renewing an incumbent Revenue Cycle Management (RCM) partner can feel like the safest decision. The partner understands your systems, workflows, people, and organizational history. Replacing it could introduce transition complexity at a time when revenue cycle teams are already navigating financial pressure, staffing constraints, changing payer behavior, and rising operational demands.

But familiarity should not be mistaken for performance.

Every renewal is an investment decision. Before extending an existing relationship, healthcare providers should ask whether the partner is still improving financial outcomes or simply maintaining an established operating model.

The question is no longer, “Would switching be difficult?” It is, “Does the financial and operational value of staying justify the cost?”

Incumbency Is No Longer a Competitive Advantage. | Why Incumbency Is Not Enough

Historically, healthcare providers often extended incumbent relationships to avoid technology friction and workflow disruption. That thinking is changing.

Research reported by HealthLeaders found that 73% of healthcare buyers evaluate new vendors whenever a project arises. Only 27% typically remain with an existing vendor. The same research found that 76% of executives require evidence of ROI or cost savings before engaging a vendor.

This does not mean healthcare providers are changing partners constantly. It means they are increasingly unwilling to treat incumbency as sufficient evidence of value.

A long-standing partner may understand how work moves through the organization. But that familiarity can also make persistent problems appear normal. Repeated touches, manual workarounds, unresolved denials, delayed follow-up, and inconsistent reporting can gradually become accepted as part of the process.

The absence of visible disruption does not necessarily indicate that the current model is working. It may simply mean the organization has learned to operate around its limitations.

What Is the Real Cost of Staying? | The Cost of Staying

The cost of an revenue cycle partnership is not limited to the amount on the invoice. It also includes the financial and operational consequences of work that is delayed, repeated, missed, or insufficiently resolved.

Consider what happens when a claim does not move correctly the first time. Someone must identify the issue, determine its cause, send it back for correction, resubmit it, monitor its status, and potentially escalate it. Every additional touch consumes capacity and delays cash.

The same pattern appears in coding, prior authorization, charge capture, billing, denial management, payment posting, and accounts receivable follow-up. Individually, these exceptions may appear manageable. Across thousands of encounters, however, they create a significant layer of invisible work.

The status quo may also require internal teams to supervise the partner, validate its reports, identify missed issues, coordinate corrective action, and resolve ownership disputes. When healthcare leaders must continuously intervene to keep the operation on track, responsibility has effectively shifted back to the organization.

Staying with an incumbent is therefore not a passive choice. It is an active financial decision with recurring costs and risks.

When Should You Consider a New Revenue Cycle Partner? | When to Consider Switching

A contract renewal should not be the only trigger for evaluating the market. Several developments may indicate that the current model is no longer keeping pace with the organization’s needs.

1. Performance has plateaued.

A partner may deliver acceptable results without delivering continuous improvement. If clean claim rates, denial rates, AR days, coding accuracy, productivity, or cost-to-collect have remained unchanged across several review periods, the operation may have reached the limits of its current model.

Stable performance can be valuable, but stability without improvement may conceal unrealized opportunity. A high-performing partner should continually identify the next source of preventable loss, rework, or delay. It should bring forward a measurable improvement agenda rather than wait for the provider to request one.

The question is not simply whether performance is within an acceptable range. It is whether the partner is actively raising the standard.

2. Reports measure activity rather than financial impact.

Large volumes of dashboards do not necessarily create transparency. Reports may show claims worked, accounts touched, calls completed, or cases closed without demonstrating whether those activities improved collections, prevented denials, accelerated cash, or reduced cost-to-collect.

A thousand accounts touched is not inherently a positive result. The meaningful questions are what changed, how much value was created, what remains unresolved, and what intervention is required next.

Reporting should enable decisions. If executives must independently connect operational activity to financial outcomes, the reporting model is incomplete.

3. Your team discovers problems before the partner does.

Provider teams will always play an important oversight role. But if internal leaders repeatedly discover backlogs, payer trends, quality issues, or performance deterioration before the partner raises them, the relationship is operating reactively.

A strategic partner should identify emerging problems, determine their root causes, quantify their impact, and recommend corrective action. It should tell the provider what is likely to happen next, not merely explain what has already gone wrong.

4. Rework remains embedded in the revenue cycle.

Automation can make individual tasks faster without improving the overall outcome. If claims still require repeated corrections, exceptions continue circulating between teams, or the same denial causes recur, technology may be accelerating activity rather than eliminating failure.

This is why healthcare providers should focus on First-Pass Performance.

First-Pass Performance measures how consistently work is completed accurately, completely, and at the right point in the workflow, without avoidable downstream intervention. It shifts attention from processing rework more efficiently to preventing rework from occurring.

Higher First-Pass Performance means fewer touches, cleaner claims, faster reimbursement, lower operating costs, and greater capacity for high-value exceptions.

5. Accountability becomes unclear when outcomes fall short.

Revenue cycle operations involve healthcare provider teams, EHR platforms, clearinghouses, payers, automation tools, and service partners. This complexity can make responsibility easy to fragment.

When performance falls short, buyers should not have to navigate a chain of explanations. They should be able to see what happened, why it happened, who owns the response, what corrective action is underway, and whether it is working.

This is Open Accountability: operational ownership made visible through shared facts, transparent measures, clearly assigned actions, and direct follow-through. It is not accountability used to assign blame. It is accountability designed to accelerate resolution and build trust.

6. The relationship requires disproportionate oversight.

An outsourced model should create capacity for the healthcare provider. If internal leaders spend significant time checking work, correcting reports, managing escalations, coordinating handoffs, or reminding the partner about commitments, the relationship may be adding management burden rather than removing it.

The partner’s understanding of the organization should make the operation easier to manage over time, not create dependence on a few individuals who know how to navigate the arrangement.

7. The healthcare provider is undergoing material change.

An acquisition, EHR migration, leadership transition, service-line expansion, operating-model redesign, or major payer shift can alter what the organization needs from its partner.

A model built for yesterday’s workflows, volumes, and organizational structure may not scale to the next phase. These events create a natural opportunity to reconsider the capabilities required before extending an existing arrangement.

The evaluation should begin with the future operating model, not the incumbent contract.

8. Your EHR is moving faster than your operating model.

EHR companies are introducing advanced AI and agentic capabilities that can reason across workflows, recommend actions, and increasingly execute multistep processes.

In March 2026, Epic introduced Agent Factory, a visual, no-code environment designed to help healthcare providers build and orchestrate AI agents that can reason, decide, and execute steps across workflows.

Epic has also organized capabilities around three named AI agents: Penny, focused on revenue cycle and operational work, including prior authorization, coding, denials, and appeals; Art, focused on clinicians, including documentation, chart insights, coding, and clinical workflows; and Emmie, focused on the patient experience, including scheduling, visit preparation, billing questions, and other patient-facing interactions.

However, access to advanced capabilities does not automatically produce operational value. Healthcare providers must still determine which workflows should be redesigned, what payer rules need to be codified, how human and digital work will interact, what controls are required, how exceptions will be managed, and how performance will be measured.

The right services partner should help standardize processes, improve data quality, document decision logic, redesign roles, establish governance, prepare teams, and measure whether AI is improving First-Pass Performance. Providers should ask whether their current partner is helping them capture this opportunity or has an economic incentive to preserve manual work.

Switching Partners Does Not Have to Mean Disruption. | How to Switch Safely

The perceived risk of switching partners often protects an incumbent more effectively than its performance does. Providers may recognize an opportunity for improvement but hesitate because a large transition could affect cash flow, employees, workflows, or integrations.

That risk can be reduced by separating evaluation from replacement.

Instead of moving the entire revenue cycle at once, a provider can select a bounded opportunity. It might begin with one specialty, facility, payer segment, ageing category, denial type, or workflow where performance can be measured clearly.

The existing baseline should be documented before the pilot begins. Both parties should agree on target outcomes, implementation responsibilities, governance, escalation, data requirements, and timing. Parallel operations and phased migration can protect continuity while the alternative model is tested.

This replaces broad promises with evidence from the healthcare provider’s own environment.

What Should Healthcare Providers Do Next? | What to Do Next

1. Establish an objective baseline.

Document current performance across financial, operational, quality, and workforce measures. Include clean claim rate, denial rates, days in AR, coding accuracy, authorization turnaround time, cost-to-collect, productivity, and the volume of work requiring repeated touches. Do not rely exclusively on standard vendor reports. Validate performance using EHR, patient accounting, finance, quality-review, and internal operating data.

2. Quantify the cost of underperformance.

Connect operational metrics to their financial consequences. A denial rate should be evaluated against avoidable write-offs, delayed cash, appeal effort, and upstream correction costs. Productivity should be assessed alongside quality and First-Pass Performance, not simply by counting accounts touched. Include hidden costs such as internal oversight, manual workarounds, technology duplication, repeated handoffs, and delayed strategic initiatives.

3. Identify one high-value starting point.

Do not begin by asking whether the entire revenue cycle should be transferred. Identify the most consequential problem that can be addressed within a controlled scope. The starting point should have a reliable baseline, material financial impact, and clear implementation boundaries. This allows the provider to test the partner’s operational discipline, responsiveness, governance, and ability to collaborate.

4. Assess readiness for EHR-native AI

Inventory the AI and automation capabilities already available through the EHR and supporting platforms. Identify which workflows could benefit, what process or data weaknesses must first be addressed, and where human judgment remains essential. The services partner should support this preparation. Its economic model should not depend on preserving manual work that the EHR can automate.

5. Evaluate every partner using the same scorecard.

Assess the incumbent and prospective partners against the same criteria. Longevity should not exempt the incumbent from demonstrating value. An impressive presentation should not exempt a prospective partner from proving its claims. Evaluate measurable outcomes, First-Pass Performance, Open Accountability, EHR alignment, AI readiness, transition requirements, transparency, improvement discipline, and commercial flexibility.

6. Validate the model before expanding.

Require the prospective partner to prove value in the provider’s environment. Establish the baseline, targets, timeframe, responsibilities, governance, and escalation path before beginning. Expansion should follow demonstrated results. A partner may possess end-to-end capabilities, but broader scope should be earned through performance rather than required as a condition of engagement.

Questions to Ask Every Revenue Cycle Partner | Questions to Ask Partners

Before renewing or replacing a revenue cycle partner, ask:

1. What measurable improvement will you commit to delivering?
2. How will you improve First-Pass Performance and reduce rework?
3. How will you use our EHR’s native automation and AI capabilities?
4. How will you help us prepare for agentic workflows?
5. How quickly should we expect measurable results?
6. How will financial impact be validated?
7. Who owns the outcome when performance falls short?
8. What will the transition require from our internal teams?
9. Can we test your approach before making a broader commitment?
10. How will your commercial model change as automation reduces manual work?

These questions put every partner on the same evidence-based scorecard.

Do Not Renew the Relationship. Revalidate the Results.

Changing a revenue cycle partner can introduce transition risk. Continuing with an underperforming model creates recurring financial, operational, and strategic risk. The right first step is not immediate replacement. It is an objective evaluation that benchmarks current performance, quantifies the cost of underperformance, tests an alternative in a controlled environment, and establishes a phased path to improvement. The partner that helped operate yesterday’s revenue cycle may not be the partner best equipped to build tomorrow’s.

Before renewing the relationship, determine whether the results have earned it.

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