3 Critical Items for Keeping Billing In-House
In my 25+ years working in revenue cycle management, I have seen practices succeed with in-house billing and I have seen many struggle. The truth is, managing billing internally is not just about having a few people handle claims. It requires a structured framework and a commitment to constant improvement.
If your practice is keeping billing in-house, here are the three critical items you simply cannot afford to overlook:
Billing and coding rules change all the time. From annual ICD-10 updates to payer-specific requirements, your team has to be on top of it. Even small errors can cause major revenue leakage.
- Training can’t be a “one-and-done” event. It has to be ongoing.
- You also need backup coverage. If one or two people are out, claims can get stuck, and your cash flow will feel the impact.
From experience: In-house billing fails more often because of staff gaps than anything else.
2. Technology and Security Infrastructure
You can’t manage today’s billing environment with yesterday’s tools. An EHR add-on or basic software isn’t enough. You need:
- A strong practice management system with claim scrubbing.
- Secure, HIPAA-compliant systems to safeguard PHI.
- Analytics to monitor key revenue cycle metrics like days in A/R and denial rates.
Without the right tools, even the best team will be working with one hand tied behind their back.
3. Processes for Denial Management and Cash Flow
Denials are part of the game but how you manage them determines your financial health. I’ve seen practices lose tens of thousands simply because they didn’t have a structured follow-up process.
- You need clear protocols for identifying denial trends and appealing quickly.
- Someone has to own the follow-up process, day in and day out.
- Cash flow monitoring can’t be reactive; it has to be proactive.
Without strong processes, even good people and good systems can’t keep revenue flowing.
Closing Thoughts
Keeping billing in-house can work but it’s not easy. Without the right team, technology, and processes, it quickly becomes overwhelming.
I often tell practices this: If you’re going to keep billing in-house, invest in it fully. If you can’t, outsourcing isn’t a weakness, it’s a strategy to protect your revenue and keep your practice focused on patient care.
About Author
Derick D. Perkins, MBA/MHA, CSPPM
Derick Perkins, Chief Strategy Officer at GoSource, brings 25+ years of experience in medical billing and revenue cycle management. He partners with healthcare providers to reduce denials, improve reimbursements, and navigate industry shifts with confidence.
