Billing is one of the most complicated aspects of running a clinic. And now that ICD-10 is in full effect, you could be dealing with an even bigger billing beast (say that three times fast). That’s because in addition to knowing the tongue-twisting details of PT billing, you’ve had to align all of your clinic’s processes—from patient intake to claim submission—with the requirements associated with the new code set. That’s a tall order, and I’m betting you’ve wanted—or needed—at least a little bit of help crossing all of your t’s and dotting all of your i’s, so to speak.

You have a lot to manage during the billing process. So, how do you decide which system is best for your needs? Specifically, should you use an in-house billing software or outsource your billing to an RCM service? Let’s examine.

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Billing Software

When you process your billing in-house using a billing software, you rely on the expertise of your own staff. This means you’re responsible for every step of the billing process, which is great if you’re looking for a more hands-on approach to your practice’s billing. Furthermore, because you handle everything in-house, you can quickly resolve any issues that do arise. So, if your billing process is efficient—and you have a highly trained and capable biller on staff—this option might be your best bet.

Additionally, using a billing software potentially costs less than a billing service, especially if you choose a web-based software, which eliminates the need to purchase costly hardware. Another cost-saving and efficiency-boosting measure: Make sure your billing software integrates with your EMR. That way, you don’t have to worry about any double entry of codes and demographic information—which is especially important with complicated ICD-10 coding.

RCM Service

If you don’t have a solid billing team and software in place, an RCM service can offer some major peace of mind. I mean, the service literally handles all your billing for you. In that sense, having a team of revenue cycle management pros working for your practice seems like a no-brainer. However, there’s one major factor you have to consider with this option: cost. Most billing services charge a percentage of collections (typically 6-12%), which means the more money you bring in, the more you pay out. That can cause issues, as Power your Practice explains in this article: “this can make it hard to budget your practice’s expected billing expenses, since costs differ widely between slow and busy months.”

That said, if you have a quality team of RCM experts on your side, the costs don’t have to outweigh the benefits. As this Greenway Health resource explains, “A good RCM vendor will be able to demonstrate an ROI.” But, there’s more to this decision than financial ROI. Case in point: Practices that switch to an RCM service typically experience a reduced billing burden—and that means fewer headaches. Because when you outsource your billing to a professional billing service, you don’t have to worry about staffing or the time-consuming claims process, which includes maximizing reimbursements and combating denials. Additionally, you can count on timely accounts receivable (AR) collections and a staff of experts who remain up to date on the latest regulations, which can prove vital when it comes to Medicare compliance. (Modifiers, anyone?)


So, which option should your clinic choose? Should you follow the dollar sign$? Well, when it comes to billing operations, you’ll have to consider more than cost. Here are some questions you can ask yourself to help with the decision-making process:

  • Do I have an efficient process in place?
  • Is that process meeting my clinic’s needs?
  • Does processing my billing in-house sound like a good fit?
    • If so, do I have someone capable, well-trained, and technically savvy on staff to process my billing?
    • If not, am I ready to hire someone who is?
    • Do I love a hands-on approach to all things billing?
  • Does a billing service sound like a good fit?
    • If so, am I comfortable with letting an outside team handle my billing?
    • What are my monthly collections?
    • Can my clinic afford 6-12% of those collections as payment for a billing service?

The answers to these questions should help you form a decision. If you already have a process in place, and it’s efficient and cost-effective, that’s awesome. (Just make sure you’re regularly auditing it.) If not, then you might need to restructure how you do things—which can be scary, but absolutely doable. The ultimate goal of any billing process is to maximize payments and get that revenue flowing, so rest assured that while choosing a path can be a chore, there’s light at the end of the tunnel—with no billing monsters in sight.

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