If you’re like many physician practices, you may be weighing whether to keep your revenue cycle management (RCM) / billing in-house or outsource it to a specialized partner. You’ve likely already outsourced services like payroll, transcription, or marketing; but billing often feels different. The stakes are higher and the idea of handing over control of your cash flow can be unsettling.
But the reality is there may be issues in your practice that could be having a negative effect your bottom line.
RCM is far more than just sending out claims. It requires a coordinated team and system that includes insurance eligibility verification, documentation and coding accuracy, timely submissions, denial management, A/R management, reporting, and much more. When any part of this system breaks down, it affects your collections, cash flow, and profitability.
Here are Five key signs it may be time to seriously consider outsourcing your RCM:
1. Your Billing Costs Are Too High
A common misconception is that outsourcing RCM is more expensive than keeping it in-house. In truth, in-house billing often comes with hidden costs that quickly add up.
– Payroll taxes and employee benefits can increase total compensation by 30% or more.
– Non-productive time, breaks, and casual inefficiencies can drag down team output.
– Office space used to house billing teams is often your most expensive real estate and isn’t generating revenue.
– Opportunity cost: Every square foot used for billing is space not available for patient-facing, revenue-generating activities.
When you factor in all these elements, outsourcing to a specialized RCM partner can deliver better performance at a lower cost and free up your team and your space to focus on growth.
2. You’re Dealing with Frequent Staff Turnover
Turnover is disruptive in any department, but especially in billing. In-house billing teams often wear multiple hats, so when someone leaves, it can cause systemic delays in charge posting, claim submissions, and follow-up.
Replacing staff takes time and resources and in the meantime, cash flow suffers. Outsourcing to a seasoned RCM team reduces this vulnerability by ensuring continuity, scalability, and redundancy.
3. Denials Aren’t Being Managed Effectively
Many practices lack the infrastructure or bandwidth to implement a structured denial management process. As a result, denials pile up, go unresolved, or are written off entirely.
Often in-house staff operates on last in first out (LIFO) basis meaning staff prioritizes getting claims out as they come in. While on the surface this seems the proper effcint “inventory management” strategy, many issues can arise with this approach.
– Denials and appeals can fall through the cracks
– A/R balance can inflate
– Timely filing issues
– cashflow unpredictability
– Lack of reporting and trending on systemic issues
– Staff burnout and turnover
A high-performing RCM partner manages A/R strategically rather than simply inventory management. They need to use a proactive, data-driven strategy that actively works to reduce aging receivables, accelerate cash flow, and optimize reimbursements including denial management protocols built into their workflow. They trend denials by payer and denial type, act quickly to resolve issues, and implement strategies to prevent recurrence.
4. You Don’t Have Access to Clear, Actionable Reporting
If your current team or vendor can’t easily provide clear, timely, and actionable revenue cycle reporting, you’re flying blind.
A strong RCM partner delivers transparent, digestible monthly management reports that include:
– Key revenue cycle KPIs (Charges/Payments/Adjustments, A/R aging, denial rates, clean claim rates, net collection percentages)
– Trends by payer and service line
– Denial Management report
– Opportunities for improvement and potential risks
– Benchmarking against industry standards
The right reporting gives you control—not less of it—and helps you lead with confidence.
5. Your Revenue Feels Off, Even if You Can’t Prove It
Sometimes the most telling sign is instinct. If you’ve found yourself saying, “I’m working harder than ever” or “We’re busier than we’ve ever been” followed by “But we’re not making any more money,” it’s time to take a closer look at your revenue cycle.
There should be a direct correlation between volume and reimbursement. If your patient volume is up but your collections are flat or falling, you may have a serious issue hiding in plain sight; whether it’s in documentation, coding, claim follow-up, or denial resolution. Trust your gut. If something feels off, it probably is.
Final Thoughts
Outsourcing your RCM is a significant decision, but it doesn’t have to feel like a loss of control. With the right partner, it’s a strategic move that reduces costs, increases collections, and frees your team to focus on patient care and growth.
Look for an RCM partner who treats your revenue like it’s their own. One who brings not only expertise but accountability and views your relationship as a long-term partnership, not a transactional service.
If you’re ready to explore what that partnership could look like, we’re here to help.
Healthcare Information Services (HIS)
We’ve spent 30+ years helping orthopedic practices optimize their revenue cycle performance.
If you’re considering outsourcing or just want a second opinion, we’d be happy to provide a complimentary assessment.
Contact Us:
Phone: 847-720-7007
Email: asalmen@healthinfoservice.com
Web: https://www.healthinfoservice.com