Not always..anything that can be outsourced, can also be done in-house. What does a billing service offer in "full practice management" that can't be done in-house, or vice versa?? We will never replace the complete people element in the medical field (at least I hope not). For me the key is growth within your company. We have 3 different locations with the DME company I work for. He has 2 billers, but he really only needs 1. They also do case management, so that occupies their time. The actual time it takes to "submit" the claim isn't long, its the gathering of information, cmn, lmn, admc approval that takes forever. Taking over the billing at a DME company thats my approach. (high end rehab dme). My fee is xx for claims review, submitting claims, documentations, payment posting, however it is xxx for authorizations etc. We bring in over 100k a week in this industry, so even on a low percentage basis of 3%, I could make 3k a week with this one provider.