Pros and Cons of In-House Physician Billing Services vs. Outsourcing (2024)

The nature of episodic patient visits within an emergency department and urgent care center creates special challenges for medical billing, reimbursem*nt and cash flow. Cash flow can slow down considerably from patient eligibility verification, claims submission, sending statements to patients, billing insurance and troubleshooting coding issues that cause claims to be denied.

In-house physician billing services may be performed by employees trained to work in the billing department or staff who also answer the phones, perform scheduling and also assist with patient exams. When medical billing is outsourced to a company outside of the practice, the outcome will vary considerably based on the company’s scope of service and knowledge of emergency and urgent care specialty needs.

The Downside of In-House Physician Billing Services

• Billing operations can slow down –Whether an in-house billing staff is made up of one person or three, if someone is out of the office, the billing department can see a sharp decline in productivity. This may have a negative impact for a few reasons. First, those left behind at work will have more work to do. Second, the biller will have a lot of work to catch up when they return to the office. Third, cash flow into the office could significantly decrease because of this stall in billing operations.
• Higher costs –While it may not be easy to budget for outsourcing, it may be less expensive than hiring an in-house billing staff. Why? When a doctor has an in-house staff, they have more overhead. They have to pay an hourly wage, benefits such as medical insurance, sick time and paid vacation time. In addition, there is the cost of setting up a billing system. Other costs include the software and tech support needed to process and send claims and to create billing statements.
• More opportunity for liability –In-house billing can result in some liabilities for the company. If a doctor hires a biller who doesn’t perform accurately, they can end up with miss-billings or incorrect billings. This can result in patients receiving inaccurate estimates or being billed for more than they actually owe.

Disadvantages of Outsourcing Physician Billing Services

• Budgeting can be more difficult–Many billing companies base their fees on how many claims are sent. So, if the provider is doing more business one month, they will be charged more. If they have a slow month or take some time off, the fees charged that month will be less. This can make it incredibly difficult to create a billing budget.
• The possibility of hidden fees –It’s always important to ask about extra fees prior to hiring a medical billing company. Some companies charge a sign on or start-up fee. Because more billing is being done electronically, some billing companies will charge extra for any bills they have to print and mail. The provider may also be charged a printing rate plus the cost of postage. Another possible fee is that of cancellation.
• Most medical billing companies are not specialists in meeting the unique needs of emergency and urgent care facilities –companies not accustomed to these specialty areas are likely to have more claims rejected, causing delays in reimbursem*nt with associated cash flow issues. Moreover, they do not offer additional services that add tremendous value for streamlining office operations.

The Pros of Outsourcing Physician Billing Services

• Consistency in billing –Not only will a medical billing company regularly send claims to insurance companies, they follow up on all unpaid and denied claims. Often, claims will be denied because of a lack of information or inaccurate documentation. Once the issue has been fixed, the claim can be resubmitted.
• Regularity of billing –Providers do not have to worry about bills not being sent out in a timely manner because of staff illness or heavy workload. Bills and claims are sent regularly and on time through a medical billing company.
• Improved billing operations – medical billing companies routinely give a provider performance reports. These reports provide valuable information on the financial health of the practice as well as the performance of the billing company.

Not all medical billing companies provide the same type and quality of services. 360 Medical Billing Solutions are specialists in medical billing for emergency and urgent care groups. Besides specialty billing, we offer additional services including assistance with negotiating favorable managed care contracts, methods to account for all medical records generated, and providing detailed reports that assist in practice management.