Medical billing service fees can vary widely; primarily differing in the quality of service provided by the outsourcing company. Outsourcing charges range from 4% to 20% depending upon the qualifications, knowledge, expertise and experience of the medical billing and coding professionals. However it is imperative to decide whether in-house billing or outsourcing an agency makes more sense - if the in-house billing services are costing too high or leaving revenues on the table vis-a-vis outsourcing. As the nuances in billing and coding processes have increased exponentially, it is advised to take a look at the financial health and charges, and then decide about the switch to in-house or outsourcing.
If the in-house staff is capable enough to handle billing and coding efficiently, the systems are integrated well (eg. EHR, medical billing software etc.), and there exists an apt revenue cycle management system, then there must be no worries. Further, it implies greater control on the daily finances with issues being addressed in real-time - changes can be implemented at the earliest too. There exists a certain amount of dedication and trust with the in-house employees while collecting the revenues from insurance providers.
However, if the collections are below average due to inexperience, there exists negligence and nil follow ups on claims, revenues are dwindling, high turnover problems persist, there exists no IT department, there are no trained/qualified personnel, then the right choice would be to outsource. Also, this reduces added costs such as salary, IT hardware and software, up gradation and maintenance costs, or spending on trainings. If the in-house biller is unwell/vacationing, there could be a pause in collections; but this doesn't hold true for an outsourcing company. A well-qualified team with all the tools and technologies available can certainly increase the revenues which might have been left on the table. Also, if the healthcare provider is new, outsourcing the medical billing services are better, so the new provider can take charge of other matters. Finally, many medical practitioners prefer to focus on patients rather than handle all the administrative matters. In such cases it is wise to outsource.
The financial performance of a healthcare facility is totally dependent on billing and coding services, patient accounting and accounts receivables. Hence, in-house staff costs must be compared before hiring an outsourcing agency. The costs of software/hardware up gradation, direct claim processing costs, and the percentage of the billing amount collected must be kept in mind. A cost analysis can be conducted to determine the nature of service to be used. This includes the cost of physicians, medical billing specialists, number of claims filed and the billing conducted per claim on average. Check if these costs are more for in-house or outsourcing. Check the collections and collection costs, number of billing collected and claimed. On the basis of these, services must be determined. If there are other matters more important than hiring an updated in-house medical billing professionals' team, then outsourcing is advisable. This certainly goes along with saving on office space, other office supplies' costs; and as the outsourcing agency works with numerous providers, they are aware of claim denial/rejection reasons, hence resulting in fewer denied claims while achieving accurate reimbursements.
Best medical billing services must be carried out by experts in the field and allow the medical practitioners to focus on patient care. On an average, hiring an outsourcing agency by the healthcare clinics, hospitals, and private practitioners is being considered more lucrative than in-house billing, resulting a higher net income. However, practices must weigh the pros and cons before settling on one.