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In-house vs. Outsourced: Medical Billing Services Comparison

May 6, 2020

In-House vs. Outsourced Medical Billing ServiceIn the current environment, where every expense is critical to the survival of a business, deciding whether to outsource your medical billing services or keep it in-house is a critical decision to make. The Do-It-Yourself (DIY) model with your in-house billers and coders often works for medical practices, but some providers don’t realize they have many other options besides only in-house billing staff.

Consider your current and future needs, your ability to find, train, and retain efficient and committed staff, and your bottom line when you determine which model suits your needs.

In-house Medical Billing vs. Outsourcing – What’s the Difference?

Both versions of medical billing aim to accomplish the same goals; to prepare and submit bills, ensure receivables are collected promptly, and ensure the brand remains in compliance with major insurer and Medicare guidelines.

When you run your medical billing in-house, you handle these critical tasks on your own. You’ll need  a dedicated staff or team to keep track of your collection, and because billing is essential to cash flow, you’ll have to be sure your team is swift and accurate. Outsourcing removes many of the stressors a provider or practice faces when it comes to billing, since everything from the complexities of an ever-changing regulatory environment to the efficient and accurate processing of bills is completed off-site.

Consider the following factors when you determine where your bills are processed:

How Much Control Do You Want? 

Providers who want to be in close proximity to their medical billing team may choose to employ in-house workers, provided they can afford the additional expenses and have the space. Technology has closed this gap, however. Once, providers who wanted to know exactly where they were in terms of billing or cash flow needed to have their teams in-house. Now, robust reporting tools, enhanced connectivity and dedicated teams mean that outsourcing provides the same amount or a higher level of control when compared to an in-house team.

How Comfortable Are You With Risk?

You face several major risks and liabilities when you have an in-house team. White collar crime can happen even in small practices, and negligent or unmotivated employees can also have a huge impact on your bottom line.

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Your technology poses another risk if you work in-house. Ideally you will have a dedicated IT team to keep things running. If not, your billing could be delayed, impacting cash flow.

When you outsource, your chosen brand should provide you with regular and transparent reporting. You should be able to immediately see where you stand and not have to worry about employee error or wrongdoing derailing your business. Transparency is built right into your contract and you do little more than pressing a button to instantly see the results and status of any bill or claim.

How Large Is Your Medical Practice?

In many cases, a practice that starts small and can easily handle the billing workload and compliance demands in-house eventually reaches a point where there are just too many issues to be aware of and too many bills to process.

When you decide to handle medical billing in-house, you’re also committing to training your team to not only process medical claims, but to also handle denials, appeals, payment posting, reconciliation patient account, and compliance issues as well. In most cases, this means your business office needs to be packed with well trained employees. As your business grows,  you’ll have to hire more employees to keep up. Your office space, the number of employees your practice can support and even your ability to supervise these important staffers should all be considered when you think about billing in-house.

“Your total expense of revenue cycle staff salaries, hardware, software, training, support staff, physical space, etc. should not exceed more than 6.5% of your total net collection.”

If you have an established practice or are starting out but have a growth mindset, then outsourcing allows you to grow at your own pace, without being restricted by the size of your facility or the number of patients you see.

Scalability is one of the key benefits of outsourcing your medical billing; when you outsource, you have a lot more agility and can swiftly accommodate even rapid growth. Depending on the local talent pool you have to draw on, you may not be able to find additional help when you need it most if you rely on in-house workers. 

Can You Find the Right People for the Job?

A dedicated in-house team can do a wonderful job, but in order to serve your billing needs, they need to be superlative. Ideally, you’ll have access to talented candidates (both current employees and a source of new employees when you need them). You’ll also need to be able to provide comprehensive training and ensure that the employees you hire have a grasp of all the aspects of the job — not just the conventional bills, but the appeals and more complex situations that occur regularly in the field. Attracting, training and retaining the right employees takes time and money, so you should be sure you can do so before choosing an in-house model. 

In contrast, a medical billing provider will handle these tasks for you, you’ll never have to worry about replacing an important employee or being left with a mess if someone leaves unexpectedly. You’ll also benefit from the billing brand’s commitment to training. You won’t have to pay to train a team or wait while they attend refresher courses and compliance programs. 

Conclusion

Unless you have a need for proximity to your billing team and you live in an area with abundant talent, you will likely benefit from considering outsourced billing. From the reduced risks and costs to the increased cash flow and reporting capabilities, most providers find that outsourcing offers a more efficient and effective model. 

If you’re not sure or want to learn more about improving your cash flow and decreasing risk, get in touch. We’d be happy to showcase what a dedicated medical billing team can do for you.

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