Author Topic: Medical billing outsourcing  (Read 1560 times)


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Medical billing outsourcing
« on: September 29, 2015, 12:07:31 AM »
Just wanted to know how among you guys have tried outsourcing your medical billing. How was the service?
« Last Edit: September 29, 2015, 12:12:12 AM by gwenyth.bethan »


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Re: Medical billing outsourcing
« Reply #1 on: September 29, 2015, 08:12:50 AM »
Many on the forum are actually billing services, including me.   I have been doing this for over 20 years, and before that I worked at a major health insurance carrier processing medical claims.  What we have found is that billing in house, and outsourcing both have their problems.  I will cover both:


  • Many times it is only one person doing the billing so there is no real accountability other than how much money comes in.  That is not really a good way to measure.  It is important for obvious reasons, but it doesn't tell you if the person billing knows what they are doing or collecting all that they should be collecting
  • If the biller goes on vacation, is out sick, or requires surgery, billing comes to a halt which means income comes to a halt
  • If biller leaves there is no one to train new person
  • when hiring someone to bill inhouse you really have no way of knowing if they know what they are doing by interviewing them.  Many people present very well in an interview but are not actually good


  • Not all billing services are good

I know the list for Outsourcing is shorter, but the one item is huge.  Many providers pick a billing service based on fees and that is a mistake.  For example, many years back when we were charging a percentage we started billing for a provider whose previous service charged 2% lower than we did (and we were not high!).  The provider was very hesitant to come to us, but the previous biller was not doing a good job.  We convinced him to give us a try, telling him that the difference in our fee would be made up by the increase he was going to see in his receivables.  He went from an average of $40,000 AR per month to $90,000 without increasing his patient load.  As you can see by the math, the difference he paid us was well worth it.

So some tips if looking for an outside service:

  • ask for references, see how long those providers have been using the service (providers stay with good services)
  • don't judge based solely on price/fees
  • meet in person if possible, talk on phone for lengthy amount of time if not - then go with your gut.  Many times you can tell if someone is genuine or a used car salesman (not always, but usually)
  • ask questions like "what percentage of AR should be over 30 days?"  "how do you work your aging reports?"  "what will you provide me so I can see what you are doing?"  "who will be working on my account and when are they available by phone?"  "how do you notify me of issues such as denials that cannot be resolved, or requests for information that you need from the office?" "how quickly do claims go out once you receive the information?"  and "how do you handle denied claims?"

That will definitely get a good conversation going.  Most offices (both with inhouse billing & outsourced) lose their money on denied claims and aging reports not being worked.  Focus on those questions.  The answers should be specific and prompt.  If they hesitate on their answer, they probably don't have a system in place and therefore are probably not handling them effectively.

Please post if you have more questions!  We love to educate on outsourcing.  :)
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