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Medical Billing - Is In-house or Outsourced better?

From the time a patient submits insurance details in a hospital to the time the insurance company actually settles the bills, the number of processes and technicalities involved are astoundingly complicated. Apart from providing quality healthcare services to patients, healthcare organizations have to take up the backend task of getting bills settled as well, which can get overwhelming with time.

Here is where Medical Billing and Coding services help. These are services especially dedicated to taking up the billing and settlement process between the healthcare organization and insurance providers. Now remind yourself that the number of Americans with healthcare insurance coverage is 92%! This includes both private and public insurance covers. This means that most of the patients who get treated will opt for insurance, which keeps the medical billing team on its toes.

There are two ways you can handle Medical Billing services – get them done in-house or outsource them to a 3rd party service provider.

Check out this list of features to decide which one may work for you.

The cost of maintaining a Medical Billing team

When you want to start handling Medical Billing in-house, you would need a couple of coding experts and billing experts to handle the process. In addition, you will require people who can handle queries, rejections and appeals. These coders and billers will become a part of your payroll and despite how much money you make every month in the healthcare practice, you will have to pay them.

On the other end, hiring a 3rd party Medical Billing and Coding service provider is also a considerable investment. However, the advantage is you pay the fees and sit back and relax, while the service provider handles the human and technical aspects of the business.


Let’s say you want to make certain changes to the billing process. If you have an in-house billing system in place, then you make the rules. You can make process changes, train your employees and call it a day. If you decide to outsource the process, the service provider, who is already in an existing SLA with you, may need to agree, especially if the process changes are extensive.

However, many of the leading Medical Billing and Coding companies are open to such changes and are used to them. In fact, as a client, you may be able to request for specific changes in the process to suit your requirements.

Ease of scalability

Most healthcare businesses scale their processes with time. This may happen organically when the number of patients increases, when the company acquires another brand, or opens up new branches. Either way, when you scale up, you need to hire more coding experts, billers, quality checkers, and other staff who are a part of your medical billing team. Studies show that the average cost of hiring an employee in the United States is $4,425. It also takes about 42 days to fill a position.

The conclusion is that hiring and training your team may get time-consuming and expensive. Scalability is a breeze when you hire medical billing service companies, though. This is their core business and they usually have enough staff to handle extra work quickly.

The stress of handling an additional team

The healthcare team already struggles with excessive workload and stressful timelines. Handling an additional unit altogether shouldn’t lead to physician burnout. Hiring and managing a Medical Billing and Coding team is a considerable task, and not having the time to monitor the team is going to bring down the team’s effectiveness. It would be better to outsource the work instead.

Using best-in-class talent

A company that does just medical billing for clients of various sizes gets experienced in the process very quickly. These companies also hire the best of talent to attract customers. As a result, when you choose an outsourced medical billing service, you automatically get to use the efforts of highly skilled and experienced employees without having to go through the process of identifying, hiring, and retaining them. This is definitely a benefit that companies with in-house medical billing teams will not be able to enjoy.

Process speed and accuracy

Let’s assume there is a grocery store that sells all kinds of products, including bread, and another exclusive bakery that sells just bread. Which place would you choose to pick your bread from? Most people prefer the latter because the bakery offers exclusivity and hence has a better chance of providing the best quality products.

It’s the same logic. A company that only does Medical Billing and Coding, has a better accuracy rate and speed, thanks to the thousands of hours it spends in the process. This is a simple reason why an outsourced Medical Billing company may be able to improve good touches, reduce the rates of appeals and rejections and bring down overhead costs.

A practice with an outsourced medical billing team will most probably collect more claims than a practice with an in-house team.

Quintessence offers to match your SLA requirements from day one, so that over time, the savings you make will pay for our services themselves!


So will an in-house medical billing team never work? Absolutely not. However, there may be additional challenges in making the team work as effectively as an outsourced Medical Billing and Coding company. If you are considering letting a team handle your billing process for the first time now, then opt for service companies before you try doing this in-house. This way, you get to understand the industry’s best practices and get a chance to work will medical billers with decades of experience.