In-House vs. Outsourced Billing for ODs: How to Choose the Right Model for your Practice
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The conversation in optometry offices this fall isn't just about scheduling—it's about cash flow. Every OD knows that providing excellent patient care is your core mission, but securing the revenue for that care is the single most significant factor in your practice's long-term sustainability. This requires a robust Revenue Cycle Management (RCM) strategy.
As we close out 2025, the pressure on RCM teams is at an all-time high. Why?
Rising Denials: Industry surveys show that over 40% of providers are facing claim denial rates of at least 10%, according to Experian Health's 2025 State of Claims report. That's a massive amount of rework and lost revenue that must be chased down.
Staffing Shortages: Replacing skilled billing staff is difficult and expensive. Data from the Medical Group Management Association (MGMA) indicates that business-office roles are consistently among the hardest to fill, with turnover exceeding 30% in some groups.
Payer Complexity: Commercial and Medicare Advantage plans are aggressively using AI and automation to flag claims, creating an arms race where only the most sophisticated billing infrastructure can keep up.
This environment is precisely why the U.S. medical billing outsourcing market is expanding rapidly, projected to grow at a Compound Annual Growth Rate (CAGR) of over 12% through the end of the decade. More and more ODs are looking to shift the operational burden.
So, how do you decide what's best for your practice: In-House, Outsourced, or Hybrid? Let's break down the advantages and trade-offs of each.
The Case for In-House Billing: Control and Visibility
The primary appeal of keeping your billing in-house is the control it offers. Your billing staff is physically present, part of your team, and knows the specifics of your operation. The benefits here are tangible:
Familiarity: Your internal team understands your patient demographics, your local payer contracts, and the unique challenges of optometry—such as properly differentiating between medical and routine vision claims. This familiarity often leads to faster resolution of simple issues.
Transparency: With the billing process under your roof and integrated with your EHR (like MaximEyes), you have complete, instant visibility into the claim lifecycle, allowing you to spot bottlenecks immediately.
Culture: You maintain the patient-facing billing elements, ensuring patient collection discussions align with your practice's culture and patient care standards.
However, the risks are significant. That control comes with immense responsibility. Turnover is the biggest threat. When a trained biller leaves, the cost goes beyond the salary; you face lost productivity, increased A/R days, and the financial burden of recruiting and training a replacement, which MGMA data suggests can cost thousands of dollars per employee. You also take on the burden of compliance. Staying current with all those payer rules and coding changes takes constant effort and training, which turns out to be a much bigger, unrecognized drain on your budget than you think.
The Case for Fully Outsourced Billing: Expertise and Scale
For practices facing high claim volume or persistent staff turnover, outsourcing offers a strategic solution by transferring the entire billing burden to specialists. When you partner with an expert revenue cycle management partner, you can transfer the RCM burden to specialists, and these are some of the benefits:
Specialized Efficiency: You get a team focused solely on RCM. They leverage advanced claim-scrubbing tools and analytics, which often result in faster reimbursement cycles and a lower denial rate than most internal teams can achieve.
Scalability: Outsourcing offers a crucial layer of flexibility. If you add a new provider or open a second location, your billing capacity scales instantly without the need for additional hiring, training, or capital investment.
Regulatory Focus: The vendor is responsible for tracking constant payer rule changes, allowing you and clinic staff to focus strictly on patient care.
The trade-off is giving up control. You must rely entirely on the vendor for accuracy and reporting. Fees are typically a percentage of collections, which can seem steep, but must be weighed against the internal costs of uncollected revenue and lost productivity. Crucially, any vendor you select must have specific, demonstrated expertise in the complexities of optometry billing.
The Rise of the Hybrid Model: Balancing Control and Expertise
More and more practices are skipping the either-or decision and opting for the Hybrid Model. Think of it as co-sourcing your revenue cycle—it's a smart middle ground that balances your desire for control with the need for specialized experts. The main idea is simple: You keep the patient-facing work, and you outsource the disputes.
You can keep charge entry, coding, and direct patient collections in-house. Why? Because your team knows the patients, controls the process integration, and communicates balances effectively. However, the game has changed: your internal team no longer has to handle the process manually. The hybrid model is now defined by bringing in a solution like the AI Billing Assistant to support them.
By deploying a partner like the EVAA Billing Assistant, which is fully integrated into MaximEyes AI, you effectively give your in-house staff an always-on, autonomous RCM specialist. This assistant works in the background to handle the repetitive, time-sucking tasks that lead to burnout. Specifically, it runs automated insurance eligibility checks for scheduled patients, automates the posting of ERAs and EOBs directly into your PMS, and uses AI-powered claim scrubbing to ensure accuracy before submission, accelerating reimbursements and reducing denials. Your staff will instantly have free time for other tasks.
Meanwhile, you hand off the hardest, most complex parts of the job to an outside partner—things like denial management, aggressively chasing old accounts receivable (A/R), and managing payer credentialing. The EVAA Billing Assistant even assists here, flagging and categorizing denied claims and prioritizing your A/R list to streamline resolution.
The only real catch? Communication has to be perfect. For a hybrid model to work, your EHR system needs to be fully integrated. It's essential that your staff, your AI tools, and your outsourced RCM vendor can share data, post payments, and pull accurate reports instantly, without delay.
Choosing Your Path: A Data-Driven Decision
There is no universal solution. The right RCM model is the one that best aligns with your practice's unique size, staffing, and growth goals.
As you evaluate your options, you could sit back and consider these questions:
Staffing Resilience: Can your in-house team maintain performance if turnover in the business office hits 20%? If not, outsourcing offers necessary stability.
A/R Performance: What is your current denial rate, and how long does it take you to collect on claims? If your A/R days are high, the cost of an outsourced expert might easily pay for itself through faster and higher collections.
Technology Alignment: No matter the model, your technology is the foundation. Does your EHR/RCM platform (like MaximEyes) provide the necessary tools—from automated claim scrubbing to customizable reporting—to support either an entirely internal or a co-sourced workflow?
Ultimately, there is no universal "best" solution for RCM—only the model that is best for your practice. The correct choice is the one that supports consistent, healthy cash flow, fits your staffing realities, and frees your doctors to focus on exceptional patient care.
Whether you decide to keep billing completely in-house, fully outsource, or implement a balanced hybrid model, your success depends on the technology that drives that decision.
Fast Pay Health, Your RCM Partner
That's where Fast Pay Health comes in. We understand that your biggest challenge is not just processing claims, but maximizing collections and gaining visibility into your revenue cycle performance. Fast Pay Health provides the RCM tools, expertise, and insights necessary to strengthen cash flow across all three billing models:
For In-House Teams: Our tools are designed to facilitate internal workflows. By seamlessly integrating with MaximEyes, we automate eligibility verification, scrub claims for optometry-specific errors before submission, and drastically cut down on the manual administrative work that leads to staff burnout.
For Outsourced or Hybrid Teams: Fast Pay Health ensures that the data flows ideally between your EHR and your chosen billing partner. This means no more manual reconciliation or communication breakdowns that typically slow down hybrid teams. Our reporting dashboards give you instant, accurate oversight of your vendor's performance, so you can always monitor key metrics like denial rates and A/R days.
By leveraging Fast Pay Health, you are guaranteed a high-performance RCM foundation, ensuring you always have the visibility and control needed to drive financial performance, regardless of who is processing the claim.
Ready to Find Your Ideal RCM Strategy?
Don't let the complexity of billing hold your practice back. Schedule a free practice analysis with a Fast Pay Health RCM specialist today. We'll help you analyze your current denial trends, evaluate your staffing capacity, and determine which billing model is the right fit to maximize your practice's revenue.