In-house vs. Outsourced RCM: What's Best for Gastroenterology Billing?

You will inevitably become confused by the intricacies of gastroenterology billing as your gastroenterology practice grows. Medical billing or revenue cycle management (RCM), as it is commonly known, is a crucial part of the business side of your practice. Undoubtedly, you must invest a good amount of time and resources in gastroenterology billing and coding services. However, looking at the consistent labor shortage and skyrocketing wages, you might wonder whether to maintain an in-house staff or to outsource the RCM services to maintain the functional and financial stability of your practice.   

There is no one-size-fits-all answer to this concern. While both methods have proved successful with many practices, your choice should be solely based on your requirements.   

To help you make the right decision, let's examine the main benefits and drawbacks of both in-house and outsourced gastroenterology billing services!   

Pros and Cons of In-house Gastroenterology Billing  

Pros  

1. Direct control over RCM: In-house gastroenterology billing services allow you to hand over the job to the people you know. The billing and coding staff could have been associated with the organization for many years, giving them an insight into how you like running the process and they keep you posted about the smallest details. Thus, you have control over your revenue cycle.   

2. Close proximity: Having your billing staff under the same roof allows you to connect with your staff and address any issue faced by them at a moment’s notice. Direct communication will enable you to eliminate billing errors and resolve emerging issues.    

3. Return on investment: If you have been in healthcare practice for a while, you have inevitably invested time and resources to manage a solid billing infrastructure. With that in place, you just need to fine-tune the weak areas of operation and refine its strength for better results.   

Cons  

1. High cost: Every additional in-house headcount means additional expenses in terms of salary and other benefits. Furthermore, consistent skill shortages and higher wages in the healthcare realm have increased the difficulties of maintaining an in-house staff.   

2. Increased dependency on limited staff: If your gastroenterology billing team consists of two or three employees, then you run the risk of stalled operations in case of an emergency. Or even worse, if two of them decide to quit at the same time, you will have a tough time keeping the process going. Getting new recruits will burden your practice with additional costs for hiring, training, and retaining them.    

3. More scope of errors: Compared to an expert RCM organization, individual staff increases the risks of errors within the billing and coding process. There is also an increased chance of general employee neglect which might result in revenue loss.    

4. Time-consuming: When you are handling your RCM directly, it eats up your time for patient care. Being a specialty service, gastroenterologists need to invest a major amount of time in patient care. Or else, quality of services will decrease which will directly impact health outcomes. Your practice will lose its reputation, the patient’s confidence, trust, and revenue.   

Pros and Cons of Outsourced Gastroenterology Billing  

Pros  

1. More time for patient care: By outsourcing an RCM, you do not need to invest time in hiring, training, and retaining your billing staff. All your RCM needs can be handled by industry experts. Hence, you will have more time to focus on high-quality patient care.   

2. Expertise and efficiency: Employees from outsourced gastroenterology billing and coding services will have extensive knowledge about the requirements and understandability of the processes. This will help you to avoid costly mistakes and ensure appropriate reimbursements.   

3. Better revenue optimization: One of the biggest advantages of partnering with an outsourced team is that it will help your staff focus on patient care. Also, you do not need to worry about paying software, supplies, administrative costs, salaries, and benefits for the in-house billing staff. Additionally, a third party managing your gastroenterology billing processes will cover all the possible avenues of revenue generation. Be it contracting with insurers or following up with claim denial issues.    

4. Access to technology: Outsourced medical billing organizations have the latest billing software and technology which can streamline the billing process and enhance revenue. You can have the benefit of increased access to technology without having to invest in expensive software systems.   

Cons  

1. Variable cost: The payment method of every RCM company varies. While some may charge you a fixed price, some might ask for a percentage of your earnings. The more you earn, the more you must pay your billing partner and vice versa. This can make it difficult to budget your expenses as the cost to the RCM provider may vary every month.    

2. Hidden fees:Similar to other contractual services, there could be some hidden fees that may not show up during the negotiation. You need to understand the contract and be aware of the terms and conditions of the deal before signing the documents.   

Final Thoughts  

It is evident that the decision-making solely depends on the requirements of your practice. If you are overwhelmed with administrative burdens and your practice is losing revenue due to a lack of expert staff, you can go for outsourcing. Outsourced RCM has been proven as a strategic approach to managing medical billing and coding tasks.     

A reliable organization like Sunknowledge Services Inc. can be a feasible answer to your dilemma. They offer streamlined gastroenterology billing services as per your requirements at just per hour. They have been providing RCM solutions to some of the biggest players within the industry for more than two decades. With 100% HIPAA compliance and 99.9% accuracy, they can increase your collection up to 97%. You can see a reduction in overhead expenses of 80% almost immediately.    

While providing care is your utmost priority, your practice’s financial stability is also crucial to keep the processes going. Just remember, whatever you choose should be in tandem with the goals you have set for your practice.