Should I do my medical billing in-house or outsource?

As the CEO of a pediatric billing company, I meet with a lot of practices that are considering switching to our service. Lately, I have been speaking with more practices that are actually considering a billing company for the first time their in practice history.

Hiring for all positions has become more difficult and billing is no exception. You need a strong person with lots of experience who can work with little-to-no supervision, and hiring the wrong person can impact the cash flow for your entire office.

At Altus, we work with practices across the country, and we know each practice is unique, so there isn’t a simple answer. By reviewing the advantages and disadvantages of in-house and outsourced billing listed below, you will be better positioned to make the right decision for your office.

Advantages of Keeping Billing In-House

  1. Retain control of the billing process. When you directly supervise the billing staff, you can determine exactly how you want the billing done. Each step of the process, from claim submission to follow-up to payment posting, can be created and overseen by you.
  2. Maintain better communication between teams. Having the billing team in your office means any problems or concerns that come up with the front desk for eligibility, or with providers about their coding and notes, can be addressed right away.
  3. Make changes easily when needed. When you oversee the billing team yourself, you can make quick changes to the process as needed for the circumstances you face in your office.
  4. Obtain patient involvement for faster payments when needed. An in-house billing team member will be more likely to develop patient relationships, which can facilitate faster patient involvement with payers when issues like terminated coverage of coordination of benefits arise.

Disadvantages of Keeping Billing In-House

  1. You have more work to do. Supervising a team member and the billing process can take a lot of time to ensure the process you created is followed, and billing can have a lot of areas that need to be reviewed and followed up on.
  2. Maintaining constant coverage is difficult with a limited staff. If you only have one or two billing team members, when someone resigns or goes on vacation, cash flow can be severely impacted if no one can take over for that person in their absence.
  3. Quality cConcerns can be difficult to find and remedy.  In-house billing teams generally have less supervision, and if someone is making mistakes or is unsure how to handle certain situations, it can take a lot of time to diagnose and correct the problem.
  4. Miss out on iIndustry cChanges: When billing changes, whether it is payer rules or CPT changes, in-house billing teams usually have less visibility of these changes because they don’t have the teammates or resources to share knowledge.
  5. Pay more when you add it all up. It is generally more costly for small to mid-size practices to employ a billing team once you consider the team’s salary, benefits, and the technology needed for the team.


Advantages of Moving to an Outsourced Billing Company

  1. Benefit from more expertise in your specialty. Because many billing companies work with specific specialties, they stay on top of payer and coding changes, attend conferences, and maintain subscriptions to trade publications that help them understand industry changes and their impact on payments.
  2. Learn what your colleagues are doing: When a billing company works with many practices in the same specialty, the team can share experiences with one another, like who pays for which developmental screenings or new vaccines.
  3. Experience more consistent cash flow with fewer errors. Most billing companies establish strict processes for their billers and incorporate management supervision so the billing staff constantly gets feedback, and is evaluated for accuracy and thoroughness.
  4. Better understand what drives your practice profitability through great reporting: Most billing services provide monthly reporting that gives insight into your practice and how your numbers compare with other practices. They can also help you evaluate where you can make improvements to your workflow to increase revenues.
  5. Enjoy continuous service amidst staffing changes. When someone goes on vacation or resigns from their position, it is the billing company’s responsibility to make sure your billing is complete, and you will not experience a lapse in coverage if someone unexpectedly leaves their position or is out of the office for an extended period.

Disadvantages of Using an Outsource Billing Company

  1. Experience less control over the process. Billing companies have their own processes they follow, and your office will have less control over how they work.
  2. Building trust can take time. As you work together, you will learn how the process works and will be able to see how well they are working for you, but it will take time to build that relationship.
  3. Expose practice’s protected health information to security threats. Any time patient data leaves your office, data security is a concern, and even many seemingly US-based billing companies outsource to overseas teams, leaving you with hidden exposure.
  4. May find hidden fees. Companies may have different invoicing structures and some may charge for things that other companies include. Some items to look into include start-up fees, contract cancellation penalties, and fees for working on eligibility or sending statements.
  5. Experience communication delays.  Because the billing team is not in your office, you and your team may not have the same real-time communication as you could with someone you see every day, leading to delays in addressing process, coding, or eligibility concerns.


Which one is right for you?

If you are currently trying to decide if now is the time to transition to a billing company, you know that it is a difficult decision that has many factors to consider, and the cash flow of your entire organization is at stake.

As you meet with billing companies to find the right one for you, consider taking this cons list to ask them how they handle these things, or take a look at some questions you can ask in our guide here. At Altus, we are committed to giving you a dedicated billing specialist and a customized process so you can get the advantages of both in-house and outsourced billing.

Are you interested in talking to someone about your unique situation? Book a call to talk to someone about whether a billing company might be right for you.