Quick answer: Switching ambulance billing companies safely takes about 60 days: review your current contract and give notice, agree who works claims already in progress, move electronic claim and payment routing to the new vendor, test with a small batch, then go live and watch the first month’s numbers closely. A common cause of cash-flow problems during a switch is claims that neither vendor owns.
Agencies change billing companies for familiar reasons: collections fall, denials pile up, reports stop arriving, or the contract renewal looks expensive. The switch itself is where revenue is most at risk. A transport billed by nobody, or by both vendors, costs money and staff time. This checklist lays out the order of work so every claim has an owner on every day of the transition.
If you have not chosen the new partner yet, start with our 15 questions to ask an EMS billing company.
Before you give notice
Read your current contract and collect these answers first:
| What to check | Why it matters |
|---|---|
| Notice period and term end date | Sets your earliest go-live date |
| Early termination fees | Can change whether to switch now or at renewal |
| Run-out terms | Whether the current vendor keeps working claims it submitted, for how long and at what rate |
| Data ownership and return | What data you get back, in what format and how fast |
| Patient statement and payment portal setup | Whose name, phone number and portal patients see |
| Deposit account | Whether Medicare and other payers pay into an account in your agency’s name |
The last row matters more than it looks. Medicare will pay a billing agent directly only if the agent’s pay is not tied to the amounts billed or collected, and payment is always made in the provider’s name (42 CFR 424.73). Billing companies paid by percentage of collections therefore work with payments that go into your agency’s own account. If payments currently land somewhere else, fix that before the switch.
Also pull a baseline before anything changes: the last 6 to 12 months of clean claim rate, denial rate, days in AR and AR by aging bucket. You will need it to judge the new vendor. Our guide to ambulance revenue cycle KPIs defines each one.
The 60-day transition checklist
Days 1 to 15: contract and planning
- Sign the new contract and Business Associate Agreement before sharing any patient data
- Give written notice to the current vendor, citing the contract clause and end date
- Set a go-live date: the first date of service the new vendor will bill
- Agree the run-out plan in writing: which claims the current vendor finishes, until when
- Request a full data export: open AR by claim, payment history, denial history, patient balances
- Name one person at your agency who owns the transition
Days 16 to 30: setup
- Connect your ePCR system to the new vendor so completed run reports flow over
- Update electronic claim and remittance enrollment with your Medicare Administrative Contractor, state Medicaid and commercial payers, so claims and 835 remittances route to the new vendor’s clearinghouse
- Confirm deposits stay in your agency’s account, and give the new vendor read access to deposit reports
- Share payer contracts, fee schedules and any payer-specific rules you follow
- Set up patient statements, the payment portal and the patient phone line in your agency’s name
- Agree the monthly report format and KPI definitions
Days 31 to 45: test and go live
- Send a test batch of claims and confirm acceptance at the clearinghouse and payer
- Confirm the first remittances arrive and post correctly
- Go live for new dates of service
- Meet weekly: claims submitted, rejections, holds, and any claim without an owner
Days 46 to 60: stabilize
- Compare charge lag and clean claim rate with your baseline
- Check that the current vendor’s run-out is on schedule
- Review the first monthly report against the agreed KPI definitions
- Close any claims left unassigned
Who does what
| Task | Your agency | Current vendor | New vendor |
|---|---|---|---|
| Notice and contract terms | Leads | Confirms run-out | |
| Data export | Requests | Delivers | Imports and reviews |
| ePCR connection | Grants access | Sets up | |
| Payer EDI enrollment | Signs forms | Prepares and submits | |
| Claims before go-live date | Works to agreed date | Takes over what remains | |
| Claims after go-live date | Bills from day one | ||
| Patient calls | Updates phone and statements | Refers callers | Answers |
| Monthly reporting | Reviews | Final run-out report | Starts first month |
Who works the old AR
Claims already submitted when you switch are the biggest risk. There are three common ways to handle them:
| Option | How it works | Watch for |
|---|---|---|
| Current vendor runs out its own claims | The old vendor keeps working claims it submitted until a set date | Put the follow-up effort and end date in writing; ask for weekly status |
| New vendor takes over all open AR | The new vendor imports open claims and works them alongside new ones | Needs a complete data export; check the rate charged on old claims |
| Split by age | Old vendor finishes recent claims; new vendor takes older, harder claims, or the reverse | Every claim must be on one list only |
Whichever you choose, write the cutoff into both agreements and keep one shared list of open claims, so nothing is billed twice or not at all. Our EMS accounts receivable management service works historical AR alongside new claims at no additional charge during the first 90 days of onboarding.
Watch filing and appeal deadlines during the handoff. Medicare generally requires claims within 1 calendar year after the date of service (42 CFR 424.44), and appeal windows are shorter. Claims close to either deadline should be named in the run-out plan.
Will cash flow drop during the switch?
It can dip for a few weeks, for predictable reasons: claims pause while EDI enrollment updates, the new vendor’s first batches take time to clear, and old-vendor follow-up may slow. You can reduce the dip:
- Start EDI enrollment updates early, because payers process them on their own timelines
- Keep submitting claims under the old setup until the new routing is confirmed
- Clear charge lag before go-live, so the new vendor does not inherit a backlog of unbilled transports
- Budget for a temporary dip in deposits during the first month
The first month live: what to measure
Compare these against your baseline each week for the first month, then monthly:
- Charge lag: days from transport to claim submission
- Clearinghouse rejection rate: claims bounced before reaching the payer
- Clean claim rate and denial rate: by payer
- Deposits: this month vs the same weeks before the switch
- Claims without an owner: should be zero
If any of these moves the wrong way for two weeks in a row, raise it at the weekly meeting rather than waiting for the monthly report. See how we handle onboarding on our ambulance billing services page, or start with a free billing audit to set your baseline.
Frequently asked questions
How long does it take to switch ambulance billing companies?
Plan on about 60 days from signing the new contract to a stable first month, depending on your current contract’s notice period and how quickly payers process EDI enrollment changes. AmbulanceMedicalBilling.com’s onboarding itself runs 14 days.
Who handles claims already submitted by the old vendor?
That depends on your run-out agreement. The old vendor can finish its own claims, the new vendor can take over all open AR, or the two can split claims by age. Write the cutoff into both agreements so every claim has one owner.
Will our cash flow drop during the switch?
It can dip for a few weeks while EDI enrollment updates and the first claims clear. Starting enrollment early, clearing unbilled transports before go-live and keeping one owner for every open claim reduce the dip.
What data should the old billing company hand over?
Open AR by claim, payment and denial history, patient balances and statements sent, payer correspondence, and any appeals in progress, in a format the new vendor can import.
Does Medicare pay the billing company directly?
Only in limited cases. Medicare pays a billing agent only if its compensation is not tied to the amounts billed or collected, and payment is always made in the provider’s name. Agencies working with a percentage-based billing company keep Medicare deposits in their own account.
Do we need a new Business Associate Agreement?
Yes. Sign a BAA with the new vendor before it receives any patient data, and confirm how the old vendor will return or destroy the data it holds when the contract ends.