Is In-House or Outsourced Billing Best for You?

Your billing and collections systems are part of the heartbeat of your practice.

Interferences in these systems can be stressful and costly. Having performed roles as both an in-house and outsourced biller, I am an equal proponent of both. Understandably, knowing which method of billing is best for your office requires careful consideration of multiple factors.

In this article, I want to address many of these factors in an effort to give you a bit more solid footing and certainty as you consider your options.

Have you found yourself teetering on the idea of outsourcing the billing for your practice? Yet, at the same time, are you feeling a bit apprehensive about handing the reins over to another person or company to manage this critical function? As you continue to ponder the prospect of outsourcing, additional uncertainties may come to your mind, such as:

  • How can I find the best billing service?
  • Will my billing be properly managed and get the attention it needs?
  • Will outsourcing be cost-effective?

If this is you, rest assured that you aren’t alone!

Chiropractic Billing Guide Office ManagementOr, perhaps you prefer in-house billing, but you’re struggling with establishing effective systems that can be properly maintained. For example, maybe you are finding that staff changes greatly impact your revenue cycle, because often there is only one billing department gatekeeper (one person who knows what’s going on), or perhaps just an overall uncertainty of what’s needed to improve the health of this department.

Either way, far too often, doctors are moving forward with nothing more than blind trust and hope that billing is being handled properly.

So, is there really a best answer for billing? Yes!

The key is in determining what’s best for you and your practice, taking into consideration the necessities for an efficient and compliant billing department.

As we cover these bases, consider your own practice along with the critical responsibilities to an effective billing system, including:

  • A consistent insurance billing schedule
  • Rejection and denial management
  • A consistent follow-up schedule for calls/faxes/mailed correspondence
  • A general working understanding of code description and coding guidelines
  • An ability to communicate with providers and payers on coding/billing/collections-related topics
  • An ability to read an EOB/ERA (Explanation of Benefits/Electronic Remittance Advice)
  • A consistent schedule for preparing and sending patient statements
  • Management of aging Accounts Receivable

I believe that aside from keeping the “headrest paper rolling,” the single most crucial, yet fundamental, aspect to a practice is having sound billing and collection systems.

Let’s take a look at what practices need to ensure a solid billing and collections system, along with the many benefits this provides to you and your practice. As we go through each of these components, carefully consider how your own practice rates in the functionality of these areas.

As you conclude your evaluation of these elements, you should have gained some direction as to whether in-house or outsourced billing is best for you.



 Time Management

No different than doctors scheduling time with their patients and allotting time for other important tasks, time management for billing and collections is essential.

This includes not only a consistent frequency each week that meets your practice needs, but also the appropriate allotment of time to productively execute billing- and collection-related processes. Uninterrupted time also is extremely beneficial to increase efficiency and avoid oversights and errors.


Practices often find themselves learning of updates and changes the hard way: when claims are rejected and denied for noncompliance with updated codes or guidelines.

Health care is a world of constant change. Though the fundamentals of coding and billing are the same, the codes themselves, along with rules and guidelines for properly applying them, are often revised.

Adequate and regular training for billing personnel provides numerous advantages to your practice, such as:

  • Development of practice/patient relationships with regard to billing processes
  • Minimization of risk of errors that could otherwise be avoided
  • Improved provider/biller and practice/patient communications
  • Creation of cleaner billing systems and processes
  • Risk management for audits, record reviews and other investigative actions



Chiropractic Billing & Coding

Best Practices and Resources

 Attention to Detail

Although coding, billing and collection systems can be learned , making sure you have the right person/people executing these responsibilities should be a priority.

Missing modifiers, incomplete diagnoses and claim form fields that aren’t properly completed or updated are just a few of the oversights that lead to denials and rejections and increase audit risk.

The detail-oriented biller provides a heightened level of comfort to the practice and provider, as this person is able to find and fix errors before they’re sent out to third parties for processing. And when the instance does arise when claims do need corrected or the third-party payer needs additional information, again, the training and attention to detail required by this role will likely save time and expense in helping to ensure the tasks related to claims management are taken across the finish line properly.

Reading EOBs/ERAs

The days of submitting a claim and just getting paid for it are now well in the past.

Simply glancing at the total amount paid and posting the amount shown is certain to cost your practice in many ways, and can even cost your patients.

EOBs/ERAs are filled with information explaining one service line item after the next, including exactly what was billed, allowed by insurance, paid, required to be written off and assigned to patient responsibility. Included with each line item are the “reason codes” that define and support the claims-processing details.

Incorrect claims processing, denials that should be appealed and payment posting errors are frequently overlooked by the untrained eye, who may not have adequate time or training to properly review and interpret these important details.

Keeping a pulse on Accounts Receivable (AR)

This area is truly a “hole in the bucket” for many practices.

chiropractic billing and coding resourcesThe climbing AR due to the lack of time to manage it or just simply the uncertainty of what to do, how to do it and where to even begin.

Your practice AR is considered an asset to your practice: earned money that’s due to you. The older these balances become, the more time-consuming to handle and more challenging to collect.

Too often, AR management is a task set to the side, receiving only touch-and-go attention and largely being left untouched for months at a time. A sound billing system, be it with an outsourced billing service or an in-house biller, absolutely must have a systematic and organized approach for AR management.


When was the last time the provider(s) and billing personnel touched base? Are you given new information or brought up to speed on details that may pertain to certain payers or records requests where the doctor needs to provide information? Are doctors aware of what’s taking place with billing in terms of progress and challenges?

Having scheduled opportunities for both the biller and the provider to share updates and ask questions helps to keep your entire team on the same page and better ensures forward progress.

Just as for a healthy body, the nervous system must be free of interference to allow ongoing and proper communication throughout all systems. This applies similarly with your practice systems.

Regular communication between the billing person/service and the doctor(s) is essential for healthy practice billing and collection systems. Practices often find that communications are sluggish and unproductive with in-house billers and more effective with outsourced services.

In many cases, the opposite is true for practices where communication is a team priority.


In closing, whether the practice’s billing department is in house or outsourced, the bottom line is that providers must not turn a blind eye to the happenings of their billing and collections department. Assuming that it’s all being handled and done so properly is not an effective or safe strategy.

The great news is that regardless of your decision to outsource billing or manage it in house, you have many tools at your disposal to make the best decisions for your practice and help your team as a whole.

Brandy Brimhall CPC, CMCO, CCCPC, CPCO, CPMA
CHelpDesk Solutions


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