What’s in a Medical Billing Company SLA?

In the healthcare industry, precision and accountability are essential—especially when it comes to managing a clinic's revenue. When a practice partners with a medical billing company, one of the most critical components of that relationship is the Service Level Agreement (SLA). Yet, many providers overlook the importance of this document or fail to understand what it should contain.

An SLA clearly defines what services the medical billing company will provide, the standards for performance, and the remedies if those standards aren’t met. It serves as a blueprint for accountability, transparency, and success. In this article, we’ll break down what an SLA should include, why it matters, and how Thrive Medical Billing uses well-structured SLAs to build lasting and effective client relationships.

What Is an SLA in Medical Billing?

A Service Level Agreement (SLA) is a formal, contractual document between a healthcare provider and a medical billing company. It outlines the expected level of service, performance metrics, responsibilities of both parties, communication protocols, and escalation procedures. Unlike a general contract that may focus on costs and timelines, an SLA dives into operational expectations.

In the case of Thrive Medical Billing, the SLA is tailored to the specific needs of each client, ensuring clarity and accountability in every aspect of the billing process.

Why Is an SLA Important?

An SLA isn’t just a formality—it’s a foundational part of your partnership. Here’s why it matters:

1. Defines Expectations Clearly

An SLA ensures both parties know exactly what to expect. From the turnaround time for claim submissions to how denials will be handled, every critical process is documented.

2. Prevents Miscommunication

Without an SLA, misunderstandings can easily occur. A comprehensive SLA from Thrive Medical Billing helps avoid ambiguity and promotes smooth collaboration.

3. Improves Accountability

By setting benchmarks for performance, an SLA ensures that the medical billing company is accountable for its services. If goals aren't met, the SLA provides remedies or corrective measures.

4. Supports Practice Growth

As your healthcare practice scales, your SLA can evolve to include additional services or adjust performance metrics to meet your new needs.

Key Components of a Medical Billing Company SLA

A well-structured SLA includes specific clauses to ensure all operational areas are covered. Here are the most important elements:

1. Scope of Services

This section outlines exactly what services the medical billing company will provide. For Thrive Medical Billing, this typically includes:

• Insurance verification

• CPT and ICD-10 coding

• Claims submission

• Payment posting

• Denial management and appeals

• Patient billing and collections

• Monthly reporting

Each service should be described in detail to avoid scope creep or misunderstandings.

2. Performance Metrics (KPIs)

Performance metrics set the standards by which the billing company will be measured. Common KPIs include:

• Clean claim rate (typically 95% or higher)

• Days in A/R (aiming for less than 35 days)

• Claim submission turnaround (within 24–48 hours)

• Denial rate (ideally under 5%)

• Reimbursement rate (percentage of total charges collected)

Thrive Medical Billing consistently monitors and reports these KPIs to clients to ensure transparency and efficiency.

3. Turnaround Times

This section defines the timeframes for completing specific tasks, such as:

• Submitting claims after receiving documentation

• Responding to denied claims

• Posting payments

• Sending patient statements

Prompt action helps maintain a steady cash flow and ensures billing stays current.

4. Reporting and Communication Protocols

Open communication is a key part of any SLA. This section should define:

• How often reports will be delivered (weekly, monthly)

• Who will receive them and in what format

• Frequency of review meetings

• Access to real-time dashboards and billing data

Thrive Medical Billing provides clients with monthly performance reports and access to real-time dashboards, making data-based decisions easy and reliable.

5. Compliance and Security

Billing companies are responsible for ensuring compliance with laws such as HIPAA, HITECH, and payer-specific rules. The SLA should outline:

• Data protection protocols

• Staff training on compliance

• Audit trail documentation

• Measures for safeguarding Protected Health Information (PHI)

With Thrive Medical Billing, data security and regulatory compliance are non-negotiable and deeply integrated into every SLA.

6. Client Responsibilities

SLAs should also list what is expected from the healthcare provider to ensure the success of the partnership. This may include:

• Timely submission of documentation and charts

• Clarification on coding questions

• Approval of certain patient billing decisions

• Regular communication with account managers

This shared responsibility helps prevent delays and miscommunications.

7. Dispute Resolution and Escalation

Despite best efforts, issues may arise. A transparent escalation process helps address and resolve concerns quickly. This section typically outlines:

• Who to contact for different types of issues

• Timeframes for issue resolution

• Formal dispute procedures if needed

Thrive Medical Billing believes in resolving issues at the root and has a clear escalation process built into every SLA.

8. Service Reviews and SLA Revisions

Practices grow, policies change, and technology evolves. A dynamic SLA should allow for:

• Periodic reviews (quarterly or semi-annually)

• Amendments to adjust KPIs, services, or responsibilities

• Formal renegotiation if either party’s needs change

Thrive Medical Billing regularly revisits SLAs with clients to ensure alignment with their growth and changing requirements.

How Thrive Medical Billing Uses SLAs to Build Trust

Unlike many generic billing vendors, Thrive Medical Billing sees the SLA as more than a legal document—it’s a commitment to client success. Here's how they stand out:

Customized SLAs

Each SLA is personalized based on the practice's specialty, size, and specific needs. Whether it’s a dermatology clinic or a mental health practice, Thrive Medical Billing crafts SLAs that reflect the nuances of each client’s operations.

Transparent Reporting

Clients are provided with comprehensive monthly performance reports, including collection ratios, denial trends, and aging reports. They also gain access to real-time dashboards for instant insights.

Responsive Support

Thrive Medical Billing assigns dedicated account managers to each client and ensures that clients always have a go-to contact for questions, concerns, or guidance.

Continuous Optimization

Thrive doesn’t stop at meeting SLA metrics—they aim to exceed them. Their team consistently looks for ways to streamline processes, increase collections, and reduce errors through ongoing quality checks.

Common SLA Mistakes to Avoid

When reviewing or signing an SLA with a medical billing company, avoid these common pitfalls:

• Vague language: Terms like “reasonable time” or “as needed” should be replaced with specific timelines and metrics.

• Lack of KPIs: If performance isn't measured, there's no way to ensure accountability.

• Missing compliance terms: Ensure the SLA includes detailed clauses for HIPAA and other regulatory compliance.

• No review process: An SLA should allow periodic reviews and modifications.

• One-sided responsibility: Both parties should have clear roles defined in the SLA.

Conclusion

A well-drafted SLA is one of the most valuable tools in your relationship with a medical billing company. It defines roles, ensures accountability, measures performance, and safeguards your revenue. More importantly, it sets the tone for transparency and trust.

When you partner with Thrive Medical Billing, you're not just signing a contract—you’re entering into a well-defined, performance-driven partnership. Their clear, customized SLAs ensure that your billing is accurate, timely, and compliant, while their ongoing support helps you grow your practice confidently.