Outsourced or In-House Billing – What is Right for Your Medical Practice?

For physicians in independent practice, one of the biggest decisions to make is whether to outsource their medical billing to a third-party service provider or assign the task to in-house staff.

There are advantages and disadvantages to both. The size of the practice, the availability of trained billers and coders, and workflow management at the medical practice are some of the main considerations that influence the decision. Other factors that must be taken into account include the budget the medical practice has in terms of technology, software, and training. It’s also important to take into account legal/compliance issues and debt recovery/collections.

Listed below are some of the advantages of both in-house and outsourced medical billing.

Advantages of In-House Billing

•      Faster claim processing due to a quicker entry of charges into the system following a patient encounter.
•      On-the-spot verification of insurance network and credentials by the billing manager.
•      Control over the hiring process of billing staff.
•      Freedom to hire a capable billing manager/supervisor of your choice who is well-versed with the latest regulations, changes, and upgrades, and capable of training the staff.
•      In-house resolution of technological hardware or software issues by IT or billing personnel.
•      Ready follow-up of past-due payments.
•      Quick access to financial reports and insurance information.
•      Reduced expenses on account of fees to third-party billing company, especially for larger practices.

Advantages of Outsourced Medical Billing

•      Hassle-free billing without the need to hire, train, and retain billing staff, check references, or attend to administrative matters related to additional staff.
•      No need to arrange replacements or temporary workers if in-house billers and coders are on vacation, sick, or delinquent.
•      Savings in terms of dedicated space, storage, and equipment for in-house billing staff.
•      Savings in upfront costs on account of software and hardware which are provided by the third-party billing company.
•      Savings on maintenance and upgrade costs for hardware and software.
•      Nominal charges to include credentialing and certification services.
•      Analysis to identify and address the true cause of denied claims at your practice.
•      Submission of cleaner claims by expert billers resulting in fewer denied claims.
•      Savings on salaries, benefits, health insurance, and training costs of in-house staff.
•      Fewer problems with compliance as coding and billing specialists at professional billing companies are trained in the latest regulations.

Sooner or later, your independent medical practice will have to make the decision about how to handle billing and coding. There’s no right or wrong answer. Every practice is different with unique billing issues and budgetary constraints. The right choice of billing, coding, and documentation services can save time and money and make the revenue cycle management at your practice more efficient. This critical decision may very well determine whether your practice can survive in an increasingly competitive healthcare landscape.