Most practices do not take the plunge and change their billing system on a dime. Something breaks first. The key biller sends notice; a pile of denials remains unchanged for a month or until, finally, the AR report reveals what’s quietly building. So then the question also comes round: to keep billing in-house or to hand it over to an outside team?
There is no one right answer for all practices. There are no rules that apply to a large group with a very long billing manager that would also apply to a small clinic with claims consequences.
Why Some Practices Keep It In-House
The primary benefit is control. The biller is there, knows what providers need documentation reminders on and which payers are most often, and can answer a question in a matter of minutes. In practices that have an unusual type of workflow or a complex array of payers, that proximity is real value.
What It Really Costs
The largest budgeted amount is salary. Benefits, software, clearinghouse fees, training, and coverage while sick or on vacation are among those other factors that are often overlooked. There’s also a cost that is not shown on a spreadsheet. Rules and codes for the payers are constantly evolving, and when one person is in possession of that knowledge, they leave a big void. The cost of in-house medical billing and collection is only realised when the person has to be replaced.
What Outsourcing Gets You
An outsourced arrangement is a team, not a single employee. The staffing of coding, denial management, and AR follow-up is separated, and work does not stop when an employee is out. Reporting is also usually more robust, with their job being to monitor denial trends and collections, not to get in between other jobs.
Questions to Ask Yourself
● How many claims are being claimed each month, and is it possible for a small team to be effective in that volume?
● What is the current first-pass acceptance rate, and is it believable?
● How much longer would it take to have a recovery if our main biller were to pause next week?
● Are our employees too busy waiting for payers or patients? How can software, training, and compliance be kept current without the budget?
If multiple of these are a concern, it’s a red flag.
Comparing a Few Options
Outsourcing firms typically screen a few names, such as Meridian Billing Solutions, ClearPath Medical Billing, Apex RCM Partners, Harborview Medical Billing, and Capline Healthcare Management.
Some are good at managing primary care, some are well-suited to managing large multi-location groups, and some are focused on one speciality. Capline Healthcare Management is one of the options. It is designed with a focus on coding requirements in a practice and reports on trends of acceptance and denial. Each of the companies on the list should be compared to your own questions, like all companies on the list.
Making the Call
Don’t let a billing crisis be the deciding factor. Work out the actual cost of the practice today; identify the places where the money is going to add up and ask some of the practices that have switched their ways. Those who end up satisfied with their choice usually spend weeks on the decision, not days.
