If your practice has crossed the bridge from self-pay to in-network, you’re likely familiar with insurance billing. It’s a necessary process — without it, you won’t get paid for the care you provide.
But how familiar do you want to be with that process?
No matter your practice size, there will come a time when you ask yourself: “Should I use a biller instead of handling the billing myself?” Unfortunately, this question doesn’t always have an easy answer.
Let’s break down your biller options and how to decide on the best path forward.
Medical Billing Options
Before you decide whether you should use a biller, it’s important to consider the medical billing choices available to your practice.
Some practices find that hiring an in-house biller or billing team is the best way to manage insurance billing. An in-house biller works for your practice, meaning you’ll pay them a salary and offer benefits.
Practices sometimes assign the biller role to an existing administrative employee rather than hiring a dedicated biller. This solution can work but may not be sustainable as your practice grows.
Outsourced (Third-Party) Biller
If you don’t want to worry about hiring and managing an employee, you may want to consider outsourcing your billing to a third-party billing company or vendor. The billing company may work independently of your electronic health record (EHR) or offer billing and revenue cycle management (RCM) services that integrate with the platform.
The Benefits of Using a Biller
Why should you use a biller? There are three primary benefits:
For many providers, the most obvious benefit to using a biller is getting valuable time back. Having a dedicated resource or individual to handle the billing means you have more time to spend on your practice, your family and yourself.
Although a biller will come with costs, a good biller will ultimately help increase your practice’s revenue.
When you hire a biller or billing company, you also get their industry insight and expertise. That means they can take steps to reduce claim rejections and denials, which means you’ll see higher and faster reimbursement from payers.
Better Business Knowledge
Having the expertise of a dedicated biller also means you’ll gain greater knowledge of your practice’s revenue cycle and billing process. With this insight, you can make more informed business decisions that will help you scale your practice appropriately.
The Downsides of Using a Biller
When considering the question “Should I use a biller?” it’s critical that you weigh the disadvantages.
If you’re planning to hire a biller in-house, keep in mind that you’ll need to not only pay that individual a salary, but you’ll also need to cover the cost of benefits. The average salary for a medical biller comes in around $50,000. This All Allied Health Schools resource outlines the average medical biller salary across all 50 states.
Additionally, your biller will need both hardware (computers) and software to complete their billing tasks, which come with a price tag.
You’ll also need to manage an employee, which uses time you may want to spend on patients or other practice-related tasks.
Using a billing company may be a good option for your practice, but it’s important to understand the financial impact it will have. There will be some costs associated with hiring a third-party vendor — the price is typically a percentage of your insurance reimbursements.
But, as we outline later, those costs may not be as much as you’d think.
The Trust Factor
Whether you have an in-house biller or a third-party vendor, remember that this biller will handle your business financials. It’s critical that your biller is not only skilled and competent but that they also foster a transparent and trusting relationship.
Here are some questions to consider when thinking about a trustworthy billing relationship:
- Does the biller give you full access to your practice’s revenue cycle reporting and metrics?
- Does the biller review your practice’s revenue cycle reporting with you? Or do they leave you to figure it out on your own?
- How responsive is your biller to your questions and concerns?
- Does the biller proactively reach out to you when there is an issue?
- Has the biller outlined service level agreements (SLAs) for response time to your emails or phone calls?
- Does the biller have team members with coding certifications, such as certified professional coders (CPCs)?
Should I Use a Biller? How to Decide
You’ve created your pros and cons list — great! But there are a few more factors to consider when deciding whether to hire a biller. We’ve outlined them below and included a handy chart to compare your options.
Make sure you have a clear picture of the services your biller or billing company will provide. The services you need will depend entirely on your practice’s revenue cycle process and workflows.
Here are some features to consider when vetting a billing company. Keep in mind you may not need all of these — it depends on your practice and preferences.
- Insurance eligibility verification
- Rejection and denial management
- Coding review and claim edits
- Payer accounts receivable (A/R) follow-up
- Reporting tools
- Regular check-ins and monthly business reviews
- Dedicated team and account manager
- Certified billers and coders
- Billing professionals with expertise in your specialty
Another critical factor to consider when hiring a biller is how easily the individual or billing company can work with your existing systems. This includes integration with your EHR or practice management (PM) tool.
There are many benefits to having direct RCM integration with your EHR or PM. Among other positives, an integration can:
- Save time and increase productivity
- Boost collections by reducing errors
- Improve the patient experience
How Much Is Your Time Worth?
You may decide not to hire a biller and manage the billing yourself. If this works for you, that’s great! But it’s likely not a sustainable solution, especially as your practice grows.
It’s also important to consider how much your time is worth. Sure, it’s cheaper to do the billing yourself, but what does that equate to, dollar-wise?
For example, if you’re a therapist charging $150/hour with patients and spending five hours a week on billing, that’s $750/week you’re spending on billing — or $3,000/month. By contrast, you would likely only pay a billing company a fraction of that.
|Do Your Own Billing||In-House Biller||Third-Party Biller|
|Estimated Monthly Cost||$3,000||$4,160||$1,000|
|Based on 5 hrs/week spent on billing at $150/hour||Based on $50,000/year salary||An industry average % of collections. Based on 100 claims filed/month at $150/claim.|
Don't Forget About You
Putting dollars aside, it’s also critical to think about what you want to spend your time on. If you enjoy billing work, maybe you don’t need a biller. But many providers and practice owners we speak to would rather spend their time with patients, their business or — most importantly — their families.
When thinking through your billing options, don’t forget to consider your personal needs and priorities. They should come first, above all else. And by employing a biller or billing company, you can focus on what matters most.
Do you need a billing change at your practice? At Gentem, we help physicians spend less time on billing and reduce their time to reimbursement. That means you can focus on caring for patients and growing your practice, instead of worrying about paychecks and payers. Learn more about our revenue cycle expertise and tech-first billing solution.