We have 3 in-house billing staff that work charge entry, insurance claims (follow ups, corrections) and one who does self pay accounts. All 3 also fill is as receptionists and help with the phones. For self pay accounting billing, we've made an agreement with our forms company to provide statement paper, sort, stuff and mail out statements for a fixed fee per statement. Claims we've started using Office Ally which I'm loving! They are free and give back good detailed reports on claims that are scrubbed immediately as well as reports back from the insurance companies when the claims are accepted. We looked at alot of PM programs to jump to when we made the move to AC, but everything is so expensive if you want to outsource it. 5% - 10% of collections was the norm. yikes! I just wish AC would get the PM program out.