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In-house vs Outsourced Medical Billing Services for Physicians

Whether to outsource medical billing operations or keep the process in-house is the question that continues to hassle many physicians and practice managers. Many medical offices struggle with the decision to keep medical billing internal or outsource it to experts. There are benefits to both; hence it can tricky to decide which one is the best for you. There is no right or wrong choice as it depends on multiple factors such as age of the business, size of local employment market, and position of practice finances, among other considerations.

Billing and revenue cycle management (RCM) are the most important processes of your practice after clinical services. Cash flow of the practice is dependent on it. Hence the decision of whether to keep billing in-house or outsource should be taken after careful consideration. The most crucial factors to consider first in any billing solution are cost, convenience, service, and repayment success. You deserve great service, great convenience, low cost and high levels of reimbursement success. Many doctors believe that getting all those four elements covered is impossible hence continue to suffer with high costs, poor service, terrible convenience and low reimbursement rate.

When all billing aspects are followed in-house it is called as in-house billing. An in-house team provides the maximum level of convenience. After all, what could be easier than walking over to your biller and asking for an update? It is also convenient to have biller in cases when patient has any queries about their bills. But reimbursement success rates can be lower with in-house billing team. This is primarily due to constraints on biller as he only has the time and skills to follow up on claims so many times, leaving many claims under-reimbursed. By functioning with your in-house billing team or bringing in a professional to train them, you might be able to boost their reimbursement rate. It requires a continuous investment to maintain the rising expenditure of medical billing and demands expertise. For this, the healthcare provider has to go through the toil of recruiting certified coders and billers which can result in backlogs/pending work if one of them fails to show up or is incompetent, therefore, risking the whole revenue cycle.

When healthcare provider hires a medical billing service provider outside their practice to do all the billing works, often giving a fair percentage cut of the total revenue generated it is called Outsourcing the medical billing service. A healthcare provider experiences timely submission of claims when they opt for an expert medical billing service provider who is familiar with the latest ICD-10 coding and employs skilled medical billers & coders. It also ensures that a physician does not need to worry about staff turnover. You may think that working with an outsourced team will cause lower levels of convenience. However, a good outsourced team is equally on hand (via phone and email) as your in-house team. Another common problem with outsourced medical billing services is that you may not be able to monitor it, mainly because they are outside contractors, and thus you may not really know what they are doing, when they are doing it, and how well they are performing. One fix for this problem is having billing software, which many medical billing services provide to allow physicians complete transparency into the billing process.

Outsourcing also removes the need of training as the medical billing service provider keeps up-to-date with the changes in healthcare regulations and coding system and adheres to the regulations of HIPAA thus, safeguarding the privacy, security, and confidentiality of protected health information (PHI). After separating the medical billing process from their niche business, a healthcare provider can concentrate on their core responsibilities resulting, an increase in the doctors’ productivity.

The expenses for in-house vs. outsourced medical billing service can differ very much. If you have a smaller practice and your biller is multi-tasking, conducting multiple jobs, then it may appear that in-house is a cheaper alternative. However, you should also consider the reimbursement success rate of your in-house team in this equation. Many times a professional outsource team of expert billers is able to gain higher levels of reimbursement, thus offsetting any costs associated with the service.

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