Top 3 Benefits of In-House Vs. Outsourcing Medical Billing: A Practice Manager’s View

Top 3 Benefits of In-House vs. Outsourcing Medical Billing: A Practice Manager’s View

Having 30 years of experience as a Medical Practice Administrator dedicated to managing medical practices which did billing in-house, I would like to share the benefits of outsourcing versus in-house medical billing. Today I am devoted to developing efficient and cost-effective revenue cycle management (RCM) strategies for my RCM company

Healthcare Provider Time Invested: In-House vs Outsourcing: 

Benefits of in-house vs outsourcing medical billing

In-House:  Time was always in short supply, especially for the clinical providers and the administrative staff.  Time, as a Medical Practice Manager, was divided among several departments performing dozens of various tasks. Many of the tasks were centered on patient care and clinical issues. Had I been able to devote 100% of my time to improving billing and collection processes, my providers probably would have retired a long time ago.

Outsourcing: A dedicated RCM company’s owners and managers invest every minute of every day in identifying methods to improve collections on claims submitted on behalf of their clients. They are the experts in their specific field and spend time perfecting processes. Outsourcing provides more time for the providers to practice rather than get burdened with administrative matters, which promotes a stress-free practice environment.

Healthcare Provider Software and Hardware Costs: In-House vs Outsourcing:

In-House: Although we thought the money spent on our Practice Management System and EHR was a great deal of money, it was indeed a small percentage of our overall operating expenses.

Benefits of in-house vs outsourcing medical billingOutsourcing: An RCM company will utilize advance billing software to monitor and track financial performances. Efficient practice management and medical billing software streamline the entire revenue cycle process which prevents revenue leakage.  Most RCM companies probably spend more on improving, not just maintaining, their IT in one year, than most medical practices spend in ten years. Using the RCM invested tools and techniques with the current medical practice billing software enhances operational workflow and finances. RCM client account executives complete transparencies for clients through online analytics tools that are accessible anywhere. With the increase of payments tied to value-based care models, healthcare organizations must report on numerous measures for quality care, patient satisfaction, IT use and healthcare costs to receive full reimbursement rates from payers. Analytics help predict claim results by tracking the life cycle of each claim.

Healthcare Provider Processes: In-House vs Outsourcing:

In-house: Procedures for processing insurance claims involve steps that are universal to every practice. Medical practices spend very little time or money on proactively improving the back office process. There never seems to be enough time to be proactive. Often the back office is drowning in work due to reacting to the insurance payer demands and administrative burdens. The demands and burdens are far worse than ever before. Each time an employee was not available in the billing department, I experienced sleepless nights. Many practices need to pull staff from other duties to work on billing, coding or collecting when extra hands are needed.

Benefits of in-house vs outsourcing medical billing

Outsourcing: The RCM company invests all its time and money in developing and improving processes related to the revenue cycle. The RCM company’s focus is to be as proactive as possible. A compliant and clean submitted claim promptly enhances revenue which is the #1 goal.  The RCM experts handle all aspects of the revenue cycle, so no sleepless nights. Due to the frequent changes in healthcare, it is difficult to find competent and reliable medical billing and coding employees to handle and manage all the billing processes. Outsourcing companies have the experts and procedures to be effective and efficient, ensuring a constant revenue stream.

My physicians believed if we had a sufficient biller and a good coder we were ahead of the game. An experienced RCM company recognizes this is just a good start. My practice was not prepared to scale when we merged with another group and tripled in size. Especially our back office. It was too small, and we did not have enough experienced staff. We had to rent another space close by and then had two back offices. It was very inefficient and certainly not cost effective. Training new employees on our practice management system was difficult at best. Many RCM companies have seamlessly helped many practices scale their front and back office functions without skipping a beat in the billing and collection efforts. The RCM company has proven success in transitioning practices and scaling. Overcoming the challenges related to scalability is second nature to the RCM company.

Should you outsource your billing department?

It is essential for your practice to factor costs and preferences when deciding whether to outsource or not. In comparison, I found that outsourcing resulted in higher net income. Since the RCM experts handle all aspects of the revenue cycle, why would you not outsource? You would not hire a plumber to wire your office. Why wouldn’t you want to find partners and allies who have proven their devotion to perfecting the processes and tasks required for optimizing your revenue?  Someone who is aligned with your goals to collect every dollar owed to your practice and takes responsibility to have a consistent revenue stream.  The next time you find yourself losing sleep over staff issues, reconciling the money or finding out you must now expand your billing department to two or three times its size, go seek out the experts! Today, more than ever, you need this level of expertise.

Benefits of in-house vs outsourcing medical billingGerry Malloy is founder and owner of Global Health Management Services. Gerry has served over 30 years in healthcare as a medical practice administrator for traditional and non-traditional medical practices. Gerry launched Global Health Management Services which is a firm focused on Revenue Cycle Management. Gerry has extensive skills and expertise in insurance contracting, coding, billing, accounts receivable management and credentialing. She has consistently exceeded the Medical Group Management (MGMA) best practice standards in accounts receivable. Gerry is an active member of various national and regional professional organizations as an elected official and/or a committee member.