14 Feb Outsourced Medical Billing Company vs In-house Medical Billing – Which Is Better For You?

Determining what type of medical biller is most suitable for your office can be a difficult task. Variables such as the number of practitioners, the size of your office, the number of insurance companies being billed, trying to combine job duties for your staff, and the growth opportunities you might pursue all play a role in making the right decision.

Are you just starting out as a solo provider with a small office space that is not conducive to in-house office management?

Or perhaps you have thoughts of doing the administrative tasks and billing yourself, but would like back-up for when your schedule begins to fill?

Maybe you are the administrator of a large office that has been using in-house medical billing but your turnover is high and you are struggling to keep track of consistent hiring and training.

And then of course there are offices that rely on the elusive Office Guru, the all-in-one Mary Poppins employee who is doing everything from changing light bulbs to patient hand-holding to chasing down year-old complex claim denials; the Office Guru is almost always overworked at some tasks and under-utilized in their true skill sets.

There are a lot of variables to consider when it comes to determining what your practice needs are vis-a-vis billing insurance – we cannot stress enough how important smart and consistent insurance billing is to the income, health, and success of your business.

In-house Medical Billing vs an Outsourced Medical Billing Company

Making the right choice for your business can be overwhelming and confusing, but we hope to simplify the process of choosing between in-house and outsourced medical billing services for you.

First, determine the levels of each job duty within your office so you can effectively narrow down your needs before beginning the hiring process. We recommend that offices make lists of the daily, weekly, and monthly tasks and divide them appropriately between the owner/s, staff, and providers.

Below is a list of the billing-related tasks that need to be assigned to make your medical practice run smoothly.

Front of House (reception, office manager)

Patient care, including scheduling, phone calls, arrivals/checkouts, taking payments, entering new patient information, appointment reminders, answering emails, being a communication line between practitioner and patient, practitioner care, office cleaning, laundry and room changeover, ordering/restocking supplies, supplement sales and inventory, daily/weekly/monthly bookkeeping and depositing of money collected, updating patient information and paperwork, acquiring signatures, setting up and maintaining access to various online insurance programs, and mail in/out.

Back of House (medical biller)

Billing, including claims out electronically/paper, posting insurance payments, working claim denials, communicating claim needs to providers, working A/R reports, medical records requests, patient billing questions, updating fee schedules, practitioner credentialing and contracting, information updates with insurance companies, working with claim adjusters for auto/worker’s comp, tracking revenue cycle management, and updating owner/s with reports.

Middle House (those tasks that can be handled by both)

Flexible tasks, including Insurance verifications, sending patient balance statements, working patient A/R, posting patient money, and Insurance Authorizations.

Once you have a clear idea of your office and insurance billing needs, you can consider the number of insurance companies you are billing and the amount of claims that will go out weekly.

There is a massive difference in workload if you are only contracted and accepting patients for 1-2 commercial plans versus a complex variety of Commercial, Medicare, Medicaid, Military plans, Motor Vehicle Accidents, and Worker’s Comp. Understanding this variable will help guide your decision to hire an employee or outsource that work to an independent medical billing service.

Whether you are a brand-new practice or a seasoned veteran, you can still compile data of your past, current, and future workload based on these two specific topics.

Even when you have made your list of needs, estimated your visit number, and chosen your billable insurance companies, you still need to determine what you want to take on yourself and whether or not you want to manage an employee.

Here are some other variables to consider:

IN-HOUSE EMPLOYEE

1. Consistent billing that can be overseen on a daily basis.
2. Immediate answers for the staff and patients.
3. Ability to combine services like insurance verifications and authorizations with reception duties. This is a tricky balance, as we often see offices with only 1-2 employees doing an exorbitant amount of work and burning out or making mistakes because of it (see also: The Office Guru)
4. Quicker claim output and payment postings.
5. Is it less expensive than an off-site billing service? You will be paying employee benefits, taxes, time-off, and bonuses not to mention following strict legal guidelines.
6. Loyalty and Training. Pro: you have it your way. Con: you are responsible for training them and if you have high employee turnover, this can cost you time and money.

MEDICAL BILLING SERVICE – INDEPENDENT CONTRACTOR

1. Enhanced experience and efficiency – already fully trained in the specifics of your
   needs.
2. Save time and money by only paying for the specific tasks that aren’t already assigned to your staff.
3. Practice Management Software – Pro: if the billing service you choose use their own
   PM software, you do not have to pay for and train staff which can be costly. Con: all of your information is with them. This can make it more difficult to get quick and reliable answers, as well as switch back to in-house or another program.
4. Less control – What kind of an owner are you and how detail-oriented are you? Will it bother you not to have an eye on every claim and EOB?
5. You can try it on for size – Starting off with an independent medical billing service is sometimes a great way to begin. It leaves you room to enhance other aspects of your business and determine if your working relationship is right without the hassle of extra training time.

Clear as MUD? There is no perfect answer when deciding between hiring an employee versus an independent contractor. We suggest you take the time to consider all the variables and look into how each option would blend with your business model and style. I have been everything from the Mary Poppins of the office, to sending out 2 claims a week for a therapist I want to see succeed, to creating and running a successful medical billing practice with a full staff. At the end of the day, the billing industry is what I know best.

These are the most important things to consider:

Transparency – whether it is your employee or a hired service, this is ultimately the biggest target you are seeking. All too often I have come into a billing job and found nothing but miscommunication and things “swept under the rug” to avoid conflict or embarrassment. Make sure that whoever you are working with is able to communicate clearly and keep you informed of issues. Monthly meetings and tracking the work with reports will help you to stay in the know.

Trust – This is your livelihood and your money. Be sure that whoever you hire has your best interests in mind and is dedicated to your success. Ask for references and check them. Determine their work history and years of experience in your particular modality.

Time – How much do you have to give? Determining how involved you want to be may be the best way to understand what your specific office needs are regarding medical billing.

Space – Again, this is your livelihood, and insurance billing is the MONEY job. This could just be the most important aspect of keeping your business alive. If you choose to have an employee, be sure to create quiet space in their schedule to focus uninterrupted on the tasks that involve your revenue. If the phone is ringing or patients are trying to check in/out while they posting a complex insurance payment things will get missed. Providing this space and time will ensure better productivity.

Once you have considered all of these topics, you may still be struggling to determine what is right for your office. A consultation with a reputable billing service is a great start and well worth the investment.

We at Resonate Health Medical Billing Services are here to help you succeed as an office and bring balance to your practice, so book a consultation today!