Introduction

If you deal with insurance in your mental health practice, you may be struggling with deciding whether to manage the insurance billing in-house or to outsource it. Working with an excellent biller (in-house or outsourced) can help you make more money and help you serve your ideal clients with peace of mind. A bad biller can push your practice to – or over – the edge towards financial distress.  It’s an important decision to make; not one we think you should make lightly. Use this guide to help you decide which path resonates best for you and then what action steps to take to implement your decision.

1. In-House Billing

In this scenario, the practice handles all billing operations internally, usually with a dedicated staff member or a small team.

Pros:

  • Greater Control: The provider has full oversight of the process and access to real-time financial data.
  • Direct Communication: Coordination between clinicians and billers can be smoother if efficient systems are in place.
  • Customization: Easier to tailor processes to practice-specific needs (e.g., tracking unique billing codes for specialized services).

Cons:

  • High Overhead Costs: Salary, benefits, training, and software costs can add up. Cost can also increase if the practice splits up the roles of biller, office manager, and receptionist. 
  • Risk of Errors: Staff turnover or lack of training can lead to mistakes and denials. Errors can increase if the biller is also expected to be the office manager and/or receptionist.
  • Time-Intensive: For providers without admin staff, managing billing takes significant time away from clinical work, especially when claims don’t process correctly. Plan on 10-15% of claims not processing with correct benefits. 

Who Should Choose In-House Billing?

  • Larger practices with multiple clinicians willing to invest in administrative staff.
  • Those willing to invest in training and software (like EHRs with built-in billing modules).
  • Solo providers who are good will details, numbers, and administrative tasks and are willing to sacrifice clinical time to handle the billing.

Recommended Tools & Setup:

  • Software: EHR platforms with integrated billing modules (TheraNest, SimplePractice).
  • Training: Staff trained on mental health-specific billing codes and insurance requirements.
  • Best Practices: Use dashboards to track processes and reports like aging reports to ensure timely follow-ups.

2. Outsourced Billing

In this scenario, the practice hires a third-party billing service to manage claims submission, insurance follow-ups, and collections.

Pros:

  • Expertise: Professional billing services (like MindEase Billing) specialize in claims management, denials, and payer rules.
  • Cost-Efficient: No need to hire dedicated staff, pay for benefits, payroll, or workers comp insurance. The billing service is a contractor whose services are typically paid through a percentage of your revenue or claim volume.
  • Time-Efficient: Reduces administrative work, freeing clinicians up to focus more on patient care.

Cons:

  • Less Control: Providers could have less visibility into day-to-day billing operations.
  • Communication Deficiencies: Communication is key and one of the most-sited reasons for billing service dissatisfaction. 
  • Cost: Typical charges are 5-10% of collections, which can add up depending on volume.

Who Should Choose Outsourcing?

  • Solo practitioners or small practices that don’t want to invest in dedicated in-house billing staff.
  • Providers with inconsistent cash flow or high claim rejection rates.
  • Those looking to minimize administrative burdens and streamline operations.

3. Key Considerations for Decision-Making

  • Practice Size and Growth Plans: A large or expanding practice might benefit from an in-house team, while smaller practices may prefer outsourcing.
  • Software and Technology Needs: Some billing companies integrate with specific EHR systems, while others are agnostic.
  • Financial Impact: Compare the costs of hiring staff vs. outsourcing fees. 
  • Level of Control Desired: Providers who want hands-on control might lean toward in-house billing. Those who prefer focusing on clinical care may find outsourcing more appealing.

4. Action Steps for Providers

After choosing the path that’s right for you, it’s time to take action.

Option 1: Transitioning to In-House Billing

  • Create an Implementation Timeline: Include hiring, training, and system setup phases.
  • Line Up Staff Training: Identify training opportunities on insurance verification, coding, and claims processing.
  • Document Processes: Create templates and workflows for the billing processes {or borrow ours-coming soon!}.

Option 2: Outsourcing Smoothly

  • Generate a List of Candidates: Ask for referrals from colleagues and list servs and/or Google “billing services in [my area]”
  • Schedule Screening Interviews: Explore the candidate’s website for instructions for scheduling an interview so you can ask questions. Develop (or download our) vetting checklist.
  • Choose Wisely: When it feels right, choose the company that aligns best with your timeline, goals, budget, and practice needs.

 

 

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