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Is There Safety in Predictability?

On paper, in-house billing looks cheaper.

A salary feels predictable. A percentage-based billing fee can feel expensive.

But most practices are not comparing the right numbers.

The real cost of billing is not what you pay your biller. It’s what never gets collected.

The Simple (Incomplete) Comparison Most Practices Make

At a glance, the math looks straightforward.

• In-house biller: $60,000–$75,000 salary
• Outsourced billing: 3%–7% of collections

From that perspective, in-house seems more affordable.

But that comparison leaves out the variables that matter most.

The Real (Big-Picture) Cost of In-House Billing

1. Salary + Benefits

Using industry benchmarks (you can use your practice specific numbers in the calculator below):

• Base salary: $65,000–$75,000
• Benefits, payroll taxes, overhead: +25–30%

True annual cost: ~$80,000–$95,000

2. Turnover and Training Costs

Billing roles are not immune to turnover.

Depending on the practice and frequency of turnover, we generally view turnover as between 5-15% of annual salary costs for the role.

When a biller leaves, you absorb:

• hiring costs
• onboarding time
• lost productivity
• knowledge gaps

Even one transition can cost thousands and disrupt collections for months.

3. Time and Capacity Constraints

An in-house biller has finite time to achieve a complex and pivotal role.

They are balancing:

• claim submission
• payment posting
• denial management
• patient billing
• reporting
• patient inquiries

When time runs short, something gives.

Follow-up is critically important to practice revenue, but it’s the easiest thing to put on the back burner.

The Hidden Cost: Uncollected Revenue

This is where the real math changes.

In many practices, claims are:

• denied and never appealed
• written off prematurely
• allowed to pass timely filing limits
• closed to keep reports clean

From the outside, the system can look healthy.

But under the surface, revenue is being left behind.

A Real Example: $120,000 Left Uncollected

In a recent review of a two-provider practice, we identified approximately:

$120,000 in missed revenue over a one-year period

This included:

• claims that passed timely filing without appeal
• denials that were never followed up
• balances that could have been recovered with proper escalation

There was no fraud. No negligence.

Just a system that prioritized closure over recovery.

The reports looked clean, and that’s what the practice was watching. On paper, collections appeared healthy. Days in A/R were within a reasonable range. From a dashboard perspective, there were no obvious red flags.

But when we took a deeper look, the true state of things became more obvious.

Claims were being resolved quickly, but not always correctly. Denials were being closed, not challenged. Revenue was being written off in ways that made reports easier to manage, but harder to question.

What looked like efficiency on the surface was, in reality, lost opportunity.

Why This Happens

This is not a question of whether your biller is capable.

It is a question of what they are incentivized to do.

In-House Billing Incentives

An in-house biller is often evaluated on:

• keeping A/R manageable
• maintaining clean reports
• staying on top of daily workload

These are operational metrics, they do not necessarily reward aggressive collections.

Outsourced Billing Incentives

An outsourced billing partner is typically paid based on a percentage of collections.

That changes behavior.

Every claim matters. Every denial is worth revisiting. Every dollar is pursued.

The incentive is simple:

The more it collected, the more your billing partner can earn.  If it can be collected, it should be collected.

A Better Way to Look at the Math

Instead of comparing salary vs percentage, consider this, the question isn’t “Which costs less? the question is “Which leaves more money on the table?”

Use our “The True Cost of In-House Billing” Calculator to see what this could mean for your practice.

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What Strong Billing Performance Actually Looks Like

High-performing billing environments typically show:

• consistent follow-up on denials
• minimal aging beyond 30 days
• disciplined appeal processes
• clear visibility into write-offs

A/R around 27 days is a strong benchmark.

Collection rates approaching 99% indicate that little is being left behind.

How to Know If You Have a Gap

There’s no need to guess, you can get clarity today.

Some common indicators:

• higher-than-expected write-offs
• low appeal rates on denied claims
• aging balances that are closed quickly
• inconsistencies between collections and patient volume

These patterns are often buried in otherwise clean reports.

Why an Outside Assessment Changes the Conversation

This is exactly why we offer a free financial assessment.

An external review can:

• identify missed revenue opportunities
• highlight breakdowns in workflow
• quantify what is currently being left uncollected

The goal is not to replace your team, the goal is to understand the full picture.

Schedule A Free Financial Analysis

Closing

In-house billing is not inherently flawed, but it is generally not the most efficient method.

The cost comparison is often evaluated using incomplete math.

When you account for uncollected revenue, the equation changes.

The difference between average performance and optimized performance is rarely obvious on the surface.

It is always visible in the numbers.

Use the calculator below to run the numbers for yourself.