IN-HOUSE VS OUTSOURCED MEDICAL BILLING: PROS AND CONS
The question of whether to manage medical billing in-house or outsource it is a critical consideration for many healthcare providers and practice managers. The right choice varies depending on many factors, such as the age of the business, the size of the local labor market, and the state of practice finances. Aside from clinical services, billing, and revenue cycle management are the most critical processes of your practice. Your cash flow depends on them, so the decision to handle these services shouldn’t be taken lightly. Before making a decision, it is, therefore, important to carefully evaluate your practice’s cost, staffing, and volume metrics. To begin with, you should be clear-headed about the benefits and drawbacks of both the in-house and outsourcing billing options.
IN-HOUSE VS OUTSOURCED MEDICAL BILLING: A COMPARISON
In-House Medical Billing
In-house medical billing refers to handling all payment procedures within your healthcare facility. Here are some of the benefits of keeping your billing in-house:
Pros of In-House Medical Billing Retaining Control
Doctors and administrators appreciate having hands-on control of financial operations through in-house billing, especially when trusted, long-term employees are executing medical coding and RCM duties. Having control provides physicians with a direct oversight of their financial operations, which provides a sense of relief.
Return on Investment
Refining existing processes within a practice that has already invested in training medical billers and purchasing billing technology ensures optimal return on investment.
Close Proximity
An in-house billing department is readily accessible within the office and allows for quick observation and resolution of billing issues with minimal effort.
Cons of In-House Medical Billing
While there are benefits to inpatient treatment costs, it’s also important to consider potential drawbacks:
Higher Costs: The expenses of paying billers’ salaries, covering employee benefits, and purchasing technology systems add up to more than is commonly paid to a third-party billing solution.
Liabilities: Ignored encounter forms, discarded superbills, and unpeeled claim denials can go largely unnoticed if managers don’t keep a stringent eye on billing operations.
Support Issues: If your billing department consists of only two or three staffers, your operations and cash flow can be majorly stalled when even one employee gets sick or quits.
Learning Curve: In-house staff may require continuous training to keep up with evolving billing regulations, potentially leading to increased costs and time investments.
Outsourced Medical Billing
Pros of Outsourced Medical Billing
On the other hand, outsourcing medical expenses requires you to work with a specialist to handle your payments. Let’s explore some of the benefits associated with outsourcing:
Less Expensive: Outsourcing can be a smart choice for a new business or a transition caused by an employee’s resignation. Check out this hypothetical cost analysis on the topic from Physicians News Digest.
Transparency: Provide comprehensive performance reports automatically or upon request. This capability grants you unparalleled visibility into your billing operations.
Enhanced Consistency: Your outsourcer will be contractually obliged to perform certain services, such as appealing denials, with a certain level of success for you.
Access to Expertise: Outsourcing provides access to a range of skilled professionals who are well-versed in the latest billing regulations and technologies.
Cons of Outsourced Medical Billing
While outsourcing medical expenses offers some advantages, it’s also important to consider potential disadvantages:
Hands-Off: While many consider outsourcing an advantage because it makes the management of billing someone else’s problem, it’s tough for more hands-on managers to relinquish control of the process to another entity.
Variable Cost: Most medical billing companies charge a percentage of collections, so the more you bring in, the more you’ll pay out. This can make it hard to budget your practice’s expected billing expenses since costs differ widely between slow and busy months.
Hidden Fees: Read any outsourcing contract very carefully. These contracts may come with hidden fees that often go unnoticed and can be an unpleasant experience later. Make sure many “fine print” charges don’t offset the money you save by outsourcing.
Communication Challenges: Outsourcing may result in communication barriers, leading to misunderstandings or delays in addressing billing issues.
Conclusion
Deciding between in-house and outsourced billing depends on several factors: utilization, cost, and efficiency. In-house billing offers enhanced internal control and potential return on investment but entails higher costs and staffing challenges. Conversely, outsourcing is cost-effective, transparent, and consistent but may result in skewed control of financial operations and introduce hidden costs. Ultimately, the choice should align with the specific needs and resources of the practice to ensure the best positive outcomes.
