Whether to in-house or outsource your medical billing is what’s confusing healthcare practitioners. Besides clinical services, revenue cycle management is one of the most complicated aspects of running a medical practice. Your entire cash flow depends on how effectively you manage your billing, especially as your practice grows. So, the method you choose to handle your billing services should be efficient and reliable.
There is no one-size-fits-all solution when it comes to medical billing, the method you choose differs from practice to practice and depends on a broad range of factors such as the age of your practice, the size of the clinic, financial health, and other key metrics. Most importantly, you have to weigh the costs associated with billing for both in-house and outsource to determine which is right for you.
A health care practitioner should evaluate the following points before choosing any of the methods.
Pros
Hands-on Control
By having your in-house team working on medical coding and RCM responsibilities, you can
gain hands-on control of your financial operations. Some practitioners prefer to manage
every aspect of their practice, right from billing to purchase of supplies. Be sure if you are
comfortable in handling such financial operations to third-parties. In such cases, in-house
billing would be the best.
Accessibility
With in-house billing, should any issues arise doctors can access the billing-related
information within minutes. Practitioners will have the ability to discuss with the team,
address any issues or take a look at a claim or documentation easily. This adds up to an
advantage and issues can be easily resolved when billing is handled by the internal team.
Return on Investment
If you have invested in purchasing billing technology and providing adequate training to
medical billers, outsourcing billing services can cost you more money. When you have the
right technology, it is worthwhile to refine existing billing procedures to generate the return
on investment. As many web-based practice management systems are available, leveraging
these systems can eliminate the need to purchase expensive hardware and other
networking systems. More on, the systems can be updated automatically.
Cons
High Costs
It is evident that if your in-house team manages billing services, you will have to bear a lot of
upfront costs such as labor costs, technology & hardware costs, software & training costs,
and maintenance costs. Also, updates to the billing software will again get add up to the
existing costs.
Liabilities
Billing department takes the hotbed in any medical practice. Employee negligence can go
unnoticed if you don’t have a detailed eye on billing operations. If persists, this would result
in significant costs over the long run.
On-going Training Needs & Support Issues
If your billing staff is not up-to-date with the legislations, you can experience denials and
unappealed claims. Your billing staff should be able to effectively manage the cash flow
even if there is no adequate team to handle the issues.
Pros
Cost-effective
Outsourcing deems to be more cost-effective, especially when you are starting a practice or
have a one with a specific number of annual claims. Also, outsourcing features effective
accounts receivable management, which can help you while running the billing operations.
Transparency
When outsourced, the medical billing company will provide the clinic with comprehensive
performance reports and other essential data so that you can make informed decisions. This
gives you unparalleled visibility into the billing functions, without requiring you to
micromanage your billing activities. Also, you can easily figure out coding or registration
problems and be able to communicate those issues to the appropriate staff to avoid further
problems.
Consistency
As your outsourcing company will be contractually obliged to perform certain tasks, you
need not have to worry about sending claims to insurance companies, following up on
unpaid & denied claims and getting things done on time as it is their job to support your
needs year-round.
Leverage the Staff Experience
As outsourced staff work with a large number of clinics and third-parties, it would be easy
for them to identify denial trends, new legislations or other reimbursement issues than your
clinical staff. Also, they will ensure coding, documentation, and quality assurance
mechanisms are in place to effectively manage your billing.
Cons
Lose Control
Outsourcing your medical billing wouldn’t allow you to have hands-on control of the billing
operations. You will lose control over the work being done and a possible misunderstanding
of contractual agreements. Also, some of your clinical staff must oversee the contract and
ensure that contract obligations are met.
Compliance
Healthcare practices should meet some guidelines and adhere to compliance as per the
legislations. So, if your billing is outsourced, adhering to the HIPAA privacy and security
becomes a big concern for your practice.
Hidden Fees
Generally, billing service fees will be based on a percentage of claims and the fee is high per
claim and lower for a large volume of claims. Make sure you ask about extra fees, if any,
prior choosing a medical billing company. Some billing agencies charge start-up fees,
whereas, some will charge extra for any bills they have to print and mail. Another possible
fee might be a cancellation fee. Ensure the money you save by outsourcing doesn’t offset by
hidden fees.
For any medical practices, in-house vs. outsourcing medical billing comes down to one
factor: Cost. So, compare costs between in-house and outsource and consider choosing the
most cost-beneficial method for your clinic
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