What a Medical Billing Performance Guarantee Really Means (And Why Most Vendors Avoid Them)
Many medical billing and revenue cycle management (RCM) providers promise “great service,” “experienced teams,” or “strong results.”
Very few offer performance guarantees. This is especially important when comparing in-house vs outsourced medical billing models.
For independent practice owners, this difference matters. Guarantees separate vendors who manage activity from partners who accept accountability.
Understanding what performance guarantees mean—and why they are uncommon—helps practices evaluate RCM providers more effectively.
Why Most RCM Vendors Don’t Offer Guarantees
Guarantees require providers to stand behind measurable outcomes.
To do this consistently, vendors must maintain disciplined workflows, strong training programs, reliable reporting systems, and experienced staff. They must also accept financial consequences when standards are missed.
Many providers avoid guarantees because:
- Performance varies by staff member
- Processes are inconsistent
- Reporting systems are limited
- Denial management is reactive
- Risk is difficult to control
- Without reliable systems, guarantees become liabilities.
What a Real Performance Guarantee Includes
Meaningful performance guarantees are tied to specific operational metrics that reflect revenue health. These metrics should align with established RCM performance benchmarks.
These commonly include:
- Rejected claim rates
- Denied claim rates
- Appealed claim volumes
- Maximum aging thresholds
When performance exceeds agreed limits, corrective action and financial accountability follow. Vague assurances without defined metrics do not provide real protection.
Common “Guarantee” Language to Watch Out For
Some providers use language that sounds reassuring but lacks substance.
Examples include:
- “We strive for excellent results”
- “We are committed to quality service”
- “We aim to reduce denials”
- “We monitor performance closely”
Without written benchmarks or consequences, these statements offer little practical value.
How Our Performance Guarantee Works
At BlueFish Medical, we offer the BlueFish Medical Performance Guarantee for our revenue cycle management clients.
We establish agreed-upon thresholds for rejected, denied, and appealed claims, as well as maximum aging limits. When these thresholds are exceeded, we credit your next bill.
This structure reinforces accountability and ensures that results—not just activity—matter.
Why Guarantees Matter for Independent Practices
Independent practices operate with limited financial buffers. Even modest increases in denials or aging A/R can disrupt cash flow and contribute to the warning signs of an underperforming revenue cycle. Performance guarantees help reduce this risk by aligning vendor incentives with practice outcomes.
They provide:
- Greater transparency
- Clear expectations
- Financial accountability
- Increased confidence in vendor relationships
How to Evaluate Your Current Billing Provider
If you currently work with an RCM vendor, consider asking:
- What performance benchmarks do you commit to?
- How are denial and aging trends tracked?
- What happens when targets are missed?
- How often are metrics reviewed?
- Are credits or adjustments offered?
The clarity of these answers often reflects provider maturity.
Learn more in our guide: Revenue Cycle Management for Independent Practices
Learn More About Revenue Cycle Management
- Revenue Cycle Management for Independent Practices
- RCM Benchmarks Every Independent Practice Should Know
- In-House vs Outsourced Medical Billing
Explore Options for Greater Accountability
If you are uncertain whether your current billing arrangement provides sufficient transparency and protection, a focused conversation can help clarify alternatives.
At BlueFish Medical, we partner with independent practices to deliver accountable, performance-driven RCM support.
If you’d like to explore how our RCM, CCM, and NextGen® Office solutions can strengthen your operations, we invite you to schedule a free consultation.