In-house vs. Outsourced—Which Billing Option is Best for You?

michelle-tohillBy Michelle Tohill

Many medical offices grapple with the decision to keep medical billing in-house or outsource it to experts. There are positives to both, so how do you find what’s right for you?

First, you should consider the most important factors in any billing solution: cost, service, convenience and reimbursement success. It should go without saying that you deserve low cost, great service, great convenience and high levels of reimbursement success. However, many physicians believe that they can’t possibly get all four of those elements covered, so they suffer with high costs, poor service, terrible convenience and low reimbursement success.

Usually an in-house team provides the highest level of convenience. After all, what could be easier than walking over to your biller and asking for an update? It also makes it easy for patients to ask question about their bills when you have the biller right there on-site. However, many physician practices experience very low rates of reimbursement success with their in-house team. This is usually due to the fact that the biller only has the time and skills to follow up on claims so many times, leaving many claims under-reimbursed. By working with your in-house billing team or bringing in a consultant to train them, you might be able to increase their reimbursement success.

When working with an outsourced team, you may expect that you will receive lower levels of convenience. However, a good outsourced team will be just as available (via phone and email) as your in-house team. Another common problem with outsourced billing services is that they may not deliver great service, mainly because they are outside contractors, and thus you don’t 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 some medical billing services provide to allow physicians complete transparency into the billing process.

The costs for in-house vs. outsourced medical billing service can vary greatly. 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 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.

Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

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