The True Cost of In-House Billing
MGMA data reveals the average practice spends $58,000 annually per in-house biller when accounting for:
Direct Costs:
• Salary (45k−45k−65k)
• Benefits (22% additional)
• Software (300−300−800/month)
Hidden Costs:
• Claim lag during vacations/illnesses
• Ongoing ICD/CPT training
• Reconciliation time (10-15 hrs/week)
Outsourcing Financial Model
Typical Fee Structures:
- Percentage of collections (4-7%)
- Per-claim pricing (2−2−5)
- Hybrid models with base + incentive
Break-Even Analysis:
| Practice Size | In-House Cost | Outsourced Cost | Savings |
|---|---|---|---|
| 2 Providers | $72,000 | $41,000 | 43% |
| 5 Providers | $165,000 | $87,000 | 47% |
Quality Control Comparisons
| Key Metric | In-House | NexaPulse |
|---|---|---|
| Clean Claim Rate | 82% | 96% |
| Denial Resolution Time | 14 days | 4.2 days |
| Patient Billing Inquiries/Month | 120 | 38 |
Transition Considerations:
- EHR integration requirements
- 90-day parallel processing period
- Custom reporting needs