Medical Practice Management Services: Outsource vs "In-house"

A medical provider and/or facility may wonder if it is beneficial to outsource all or part of their administrative tasks to an outside agency. These tasks can include but are not limited to: denial management, billing, collections, obtaining insurance benefit verification and authorizations, credentialing and posting patient and insurance payments.

As an outsourcing company, I can fervently attest to the fact that there are medical practices that benefit greatly from outsourcing all or part of their administrative tasks. On the other hand, I can also adamantly and positively conclude that there are times when a medical practice should maintain all of their tasks in-house. I will discuss later in detail why one might prefer or need to seriously consider one of these options over the other.

If a provider isn't sure which to choose, it's best for the provider and billing agency to try the outsourcing option for at least 30 days on what I like to call a "trial basis". This type of agreement helps to ease the stress of being locked into a long term agreement right away; especially if the medical provider/facility is new to this outsourcing type of arrangement. Before the 30 days is completed, the medical provider and the billing agency will know without a shadow of a doubt whether the business relationship needs to be extended, "tweaked" or terminated. 

The medical provider or the billing agency may decide that outsourcing is not the best option if the medical provider likes to micro-manage and/or is having a difficult time sending the needed information needed for billing over to the billing agency. Some providers I've tried to help were not "comfortable" having someone outside of their office handle their sensitive/private information and they also were accustomed to being able to look over the shoulders of their workers at any given moment throughout the day. Even though I keep an open line of communication via email, phone, fax and text, the provider sometimes will still feel that he or she is "losing control" of their billing. In that case, after a careful assessment, it's usually determined that the provider should keep his/her billing in-house. 

On the other hand, with outsourcing, the provider and his/her staff often soon realize how much more time they have in the office to concentrate on patient care and other duties that may have been previously neglected and/or may have taken a great amount of time to deal with. The system is established as a contact person and the information needed for billing is efficiently and quickly given to the biller and the billing company is able to receive and communicate to the provider's office in a professional and a methodical manner.  

The other aspect of outsourcing that makes a provider reluctant to outsource is he/she is concerned about not being able to continue to use their practice management system. Back in the 90's, when outsourcing billing companies started to become a lot more popular, 10 times out of 10 the billing company would tell the provider that he/she will have to use the software that the billing company was currently using. However, as time and technology progressed, we learned that it was much more time saving and systematic to let the medical practice continue to use the software program that they are already familiar with and sign the biller on as a new user to their account. In this manner, the transition of administrative/billing tasks are seamless and doesn't interrupt the current process at all.

My final thoughts...be sure that the billing company you choose is well trained, HIPAA compliant and easily accessible to answer any questions or concerns. Both the billing company and the medical practice should be very clear as to the expectations of what and how tasks are to be performed.