Short answer: In-house billing gives you direct control but depends on a few people and their training. Outsourced billing adds a team and reporting, usually for a percentage of collections. The right choice depends on your claim volume, your payer mix and whether you can cover absences and turnover. If you outsource, pick a team that works inside your EHR so setup problems get fixed, not just worked around.
Side-by-side
| In-house billing | Outsourced billing | |
|---|---|---|
| Cost model | Salaries, benefits, training, software | Usually a percentage of collections; flat per-claim fees are another model |
| Control | Direct, day to day | Through reports and a point of contact |
| Coverage when someone is out | Depends on cross-training | Covered by the team |
| Expertise in payer rules | Whatever your staff has learned | Spread across a team |
| Reporting | Whatever you build | Usually included |
| Main risk | One person leaves and knowledge goes with them | Weak communication, or a vendor that does not understand your EHR setup |
What outsourced billing costs
Most outsourced billing companies charge a percentage of what they collect. One industry cost guide puts it at about 5% to 10% of collections, with flat fees of about $4 to $6 per claim as another model (ADSC, 2022). The right model depends on your specialty, claim volume and payer mix, so get quotes in writing.
When in-house tends to fit
- You have an experienced biller or two with backup coverage.
- Your claim volume is steady and your denial rate is under control.
- You want billing staff in the building working with the front desk.
When outsourcing tends to fit
- Your biller left, is overloaded, or is the only person who knows the process.
- Denials and aged claims are building up with nobody working them.
- You want standard monthly reports without building them yourself.
What to ask any billing company
- Do you work inside our EHR, and who fixes setup problems that cause denials?
- What do you charge, in writing, and what is not included?
- How do we get reports, and how often?
- What happens to our data and access if we leave?
About H&A
H&A Healthcare Consulting runs medical billing for eClinicalWorks practices with an in-house team of 150+ billing specialists, working inside your eCW. Most practices are fully transitioned within 2 to 4 weeks, including an audit of your current billing configuration.
Frequently asked questions
Is outsourced medical billing cheaper than in-house?
Not always. Compare the full cost of salaries, benefits, training and software against the percentage or per-claim fee, and factor in the cost of unworked claims.
How is outsourced billing usually priced?
Most companies charge a percentage of collections. One industry guide puts it at about 5% to 10%. Some charge a flat fee per claim.
How long does it take to switch to outsourced billing?
With H&A, most practices are fully transitioned within 2 to 4 weeks.
Do we lose control of our billing?
You keep ownership of your data and your payer relationships. Ask any vendor how reporting works and how access is handled if you leave.
Want a second set of eyes on your eClinicalWorks setup?
Talk to our team about a free consultation.