Over the years, we have tried outsourcing the billing a couple of times. Both attempts were disasters, and James touches on some of the reasons.

First and foremost, all of your billing data... that is, effectively, all of the money you have earned that is not in your bank... can now effectively be held hostage. If you decide that the arrangement is not working and wish to fire your billing service, you have to assume that you will not be on the best terms. Sure, maybe there is an agreement to get a CSV file, etc. but the billing service will at this point have absolutely no incentive to do so quickly or have any interest in resolving issues. ("Here is your CSV file; oh, what do you mean, what do the numbers in each of those 35 columns represent? We said we'd give you the data, and there it is. We consider the description of those fields to be a proprietary part of our source code. We did not say we would translate it for you or assist in putting it into your new program/service. That's your problem.") In a couple of cases, the service suddenly decided to impose huge fees to get our data back. Importing your billing data into a new system is never as smooth as it is supposed to be, and there is always corrupt data. Having been through this maybe 5 times over the years, the only way that works is to keep the old system alive on a computer in the corner someplace and just start fresh, and re-register everyone in the new system. If you don't have access to the old system, then you are left with a mess, or perhaps a foot high stack of printouts.

Yes, it looks a lot cheaper on paper to outsource. But it is necessary to look at this a lot like getting married. You have just handed access to your entire life savings to this sweet young thing, and it is amazing how expensive it becomes when the time comes for a divorce, and how ugly your relationship suddenly becomes. Keeping it in-house is cheap insurance.


David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands