Ask what it takes to bill in house and the answer usually arrives as a shopping list. It is a shorter list than the sales conversations suggest, and most of it is capability rather than product.
Worth separating those two, because a practice that knows which capabilities it needs can evaluate anything. A practice working from a product list is buying somebody else’s assumptions.
What software do I need to bill in house?
Less than most vendors will tell you. If you have a practice management system, you already hold most of it. What you need on top is a way to reach payers electronically, a way to check eligibility, a way to take payments, and a way to see what is stuck. Several of those may already be in what you have.
The capabilities
Claim creation and scrubbing. Turning a charge into a claim that passes edits before it goes out. Almost always part of the practice management system already.
Electronic submission and remittance. A route to payers and a route back. Clearinghouse arrangements differ, and enrolment with each payer takes weeks regardless of which one you use.
Eligibility checking. Ideally before the visit rather than after the denial. Often included and frequently unused.
Payment acceptance. Card capture at the desk and stored cards for balances, integrated so payments post against the correct balance without manual matching.
Visibility into what is stuck. The capability practices most often go without, because it is the one nothing ships as a single feature.
That is the list. Everything else is a preference.
What you probably already have
This is where practices overspend, and it is worth an hour before any purchasing conversation.
A practice management system typically includes claim creation, scrubbing, a clearinghouse arrangement, eligibility checking, statement generation, and a reporting layer. When billing was outsourced, several of those were being used by somebody else on your behalf, or configured once and never revisited.
The audit is simple. List the five capabilities above. For each one, ask whether the current system does it, whether it is switched on, and whether anybody is using it.
Most practices find at least two things they were about to buy.
The capability nothing ships
Visibility into what is stuck is the one that has to be assembled, and it is the difference between running billing and watching it run.
Standard reports read one thing at a time. A documentation report reads documentation, a charge report reads charges, an aging report reads open balances. Each is accurate about its own subject.
What you need is the comparisons between them. Completed appointments against created charges. Signed documentation against created charges. Charges posted against claims transmitted. Remittances received against payments posted.
Those four comparisons are what tell you where work has stopped. None of them is a product. All of them draw on records the system already keeps, and building them is a configuration decision rather than a purchase.
A practice that brings billing in house without that visibility has moved the work inside the building and kept the blindness.
What to be careful about
Buying tools before defining the routine. Software supports a way of working. Bought first, it becomes the way of working, and practices end up with something shaped by a vendor’s assumptions rather than their own.
Adding systems that do not talk to each other. Every additional place data lives is another reconciliation somebody has to do manually, and manual reconciliation is where posting backlogs start.
Assuming a feature is running because it exists. Eligibility checking is the common one. Present in most systems, switched on in fewer, actually used before the visit in fewer still.
What this means for you
Audit before you buy. Five capabilities, and for each one ask whether you have it, whether it is on, and whether anybody uses it.
Then build the fifth capability, the visibility layer, because it is the one nothing ships and the one that decides whether you can see what is happening.
Grab 30 minutes with us. Prep nothing. You will see which of the five you already have and which one is missing.
Questions people ask
What software do I need to bill in house?
Less than most vendors suggest. If you have a practice management system you already hold most of it. What you need on top is electronic submission and remittance, eligibility checking, payment acceptance, and visibility into what is stuck.
What do practices already have without realising?
Claim creation, scrubbing, a clearinghouse arrangement, eligibility checking, and statement generation are typically included in a practice management system. When billing was outsourced, several of those were being used by somebody else on your behalf.
What capability is hardest to get?
Visibility into what is stuck, because it is the only one that is a comparison rather than a feature. Completed appointments against created charges, signed documentation against created charges, charges posted against claims transmitted, remittances against postings.
Should I buy software before or after defining the process?
After. Software supports a way of working, and bought first it becomes the way of working. The result is a routine shaped by a vendor’s assumptions rather than your own.
Why is adding more systems a risk?
Because every additional place data lives is another reconciliation somebody performs manually, and manual reconciliation is where posting backlogs start.