Outsourced Billing: The Pros and Cons

By Mary Hollis Stuck March 18, 2020

In this day and age, the staff numbers for an optometric practice will vary greatly. If a practice does mostly routine exams, but has a booming optical, they will be heavy on optical staff. Likewise, if the practice focuses more on medical visits, they may implement a greater number of technicians and front desk staff to assist in the doctors’ schedules. However, every office has one area in common: billing. Some offices have trained certain staff to be insurance and billing specialists, while others do more cross training, and expect different employees to handle such tasks. This brings us to the option that many offices may handle differently: outsourcing your billing. Let’s take a look at the pros and cons for this option.



Reduce staff time spent on billing

Of course, someone must be paid to handle these claims. While the owner may send them to trainings and have them review updates regularly, it’s likely that the person doing the medical billing may get pulled in other directions in the practice as well. Outsourcing this can reduce the need to have highly trained billing personnel, which is a position that tends to be well compensated.


Of course, the cost for these services varies. Certain companies may offer more or less services and will arrange their fees differently. While Company A may have a set rate per month, Company B may charge a percentage based on the reimbursements. It’s very important to read the fine print in these contracts to make sure it is worthwhile.

Decrease risk of delays due to staff vacations

If you have one employee that handles billing for the practice, and he or she goes on vacation or gets sick, this can drastically affect your billing process. Claims are likely to not be filed for that entire period, and could also end up being filed improperly when the person returns, due to the need to quickly process the backlog of work.

Lack of control

While you would like to be able to put all of your trust in a billing company, in most cases these claims are handled by employees working remotely for XYZ Billing Agency. You are unable to oversee their work, and may be uncomfortable having someone you do not know handling your business.

Streamlining the billing process

Instead of multiple people being involved in billing, as is the case at some practices, one company, and usually one point of contact within that company, will handle all claim filing for you. There is less back and forth between the staff and the doctors.

Delays in editing claims

If a biller has a question about a claim he or she is filing for you, they must then contact the office directly to seek answers. Depending on the process, this delay could push back the filing up to a few days, which will delay reimbursement.

Decreased denials and rejections

If you have a company whose entire focus is optometric billing, be it medical or routine, they will be highly trained in that topic. They will be much more likely to catch any improper coding, which could cause denials and rejections. They are also more likely to catch any errors that could lead to insurance audits, which can cost a vast amount of both time and money.

Patient/Practice relations

While it may be convenient for a third party to handle your billing and reimbursements, your patients may not appreciate it. Patients like being able to call the office if they have a question about their statement. Being given an 800 number to call for that information may make them feel less valued as a patient.

Possible increase in reimbursement

Like the idea behind the point made above, a trained biller will be more likely to catch something that may be under-coded, which could result in a higher reimbursement.



Familiarize yourself with the plans you accept, and know what their average reimbursement time is. Look into the percentage of claim rejections or denials for the last year. Most clearinghouses will provide this information in monthly reports, and provide a comparison chart for months or years. In addition, review your A/R for the practice. Look at the percentage of A/R that is aged 120+ days. Delve into the problem areas that may have created this delay.As you can see, there are many reasons why one might choose or not choose to outsource billing for their practice. It is recommended that you conduct a billing assessment before moving forward in this direction. Set a goal for yourself. Most doctors want their reimbursement goal to be under thirty days. We know, however, that some insurance companies take longer to reimburse than others. This must be considered during the assessment.

Upon running your billing assessment, do your research. Reach out to colleagues and take advantage of social media forums to get input from other doctors on companies you may be considering. Any feedback should be considered, but remember: every practice is different, and only you can determine the best method for your practice.

Mary Hollis Stuck

Mary Hollis has been in the optical field since 2005. She has filled many roles within optometric practices and is a billing guru. She is passionate about providing excellent customer service for patients, which she helps to achieve while finding ways to increase practice productivity. Currently, Mary Hollis manages the billing department at Eye Associates of Cayce, a multi-doctor private practice in Cayce, South Carolina.

Learn More

1. Create Profile
2. Profile Options
3. Checkout
4. Publish Listing