By Ranadene Tapio, MBA, CMRS, CPCS 

Medical billing and coding is arguably one of the most important aspects of a practice. Quality care, of course, is a priority, but if you don’t bill for the care, your practice won’t succeed.

One of the decisions every practice has to make is whether to keep their billing in-house or to outsource to a trusted partner. A few common characteristics of practices that outsource their billing are:

  • high staff turnover
  • Inefficient billing processes
  • lack of qualified candidates
  • lack expertise among staff
  • high rate of denials, or
  • high days in AR and/or aging bucket balances

If your practice fits any of those criteria, you may want to consider partnering with an outsourced solution to help improve your cashflow.

There are hundreds of companies in the US (not to mention overseas) that provide outsourced medical billing, so how do you decide which partner is the best fit for your practice? Here are five factors to consider when choosing an outsourced medical coding provider:

  1. Experience
    The boom in regulatory demands in the past few years has caused a surge in outsourced partners in the healthcare industry. Medical billing is one of the areas where providers are seemingly coming out of the woodwork.

    Take experience into account when choosing your outsourced partner. Companies that have been in the industry through the formable and transitional stages of healthcare can provide your practice with a greater value than those who just entered the industry.            
  2. Certifications
    One of the biggest challenges in medical billing and coding is staying current on industry changes. Staff that are up-to-date on the changes will be more effective and efficient, leading to greater reimbursements.

    Check with your outsourced partner to ensure their staff are certified in billing and/or coding, and provided with continuing education to stay up-to-date on the ever-changing landscape of the industry. And, even if you keep your billing and coding in-house, ensure your team is going through regular training and education to maintain their knowledge base.
  3. Proven Track Record
    One of the primary goals of outsourcing is to collect more than you would in-house. Quality coding companies will be able to provide statistics and reimbursement numbers for practice’s they’ve worked with in the past.

    Before you engage, know what metrics are important to you and what numbers will make it worth it to outsource. Then, measure your providers’ track record against these numbers.
  4. References
    In addition to the hard numbers provided by their proven track record, outsourced partners should be able to provide references for you to call. This is where you can measure the softer benefits of working with them. Are they easy to work with? Are they responsive? Would you recommend them?

    Checking references before you engage will help eliminate long-term, potentially costly mistakes.
  5. Patient Engagement
    As important as it is to build and manage the relationship with payers, it’s equally, or maybe more, important to ensure patients are being communicated with and updated.

    Check with your outsourced partner to see how they engage patients in the payment process. Some partners will go as far as sending statements or submitting unpaid accounts to collections. This can be an additional value provided by the outsourced provider.

These five tips should help you weed out the good outsourced partners from the not-so-good. The results will be higher reimbursements, less denials, less stress for you and a better patient experience.

Do you think your practice could benefit from outsourced coding – what’s stopping you?

Ranadene (Randi) Tapio, MBA, CMRS, CPCS is the Founder and CEO MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit  You can reach Randi via email at [email protected] or call 320-290-6448.