I can't really say any of the responses here surprise me at all. There are a lot of billing centers are there that just plain suck. I know because I've had to clean up their messes. At the same time, I've also met what I thought where potential clients that had no reason to use our services. They had things they way they wanted them and had a good biller on staff. Although we could save them some money, it's hard to make such a big decision when things are overall good.
On the other hand, out of the 80 clients we have many of them were near bankruptcy when we met them. Either they were working long hours (seeing patients during the day and doing billing at night), conscripted a spouse who didn't want to be there to begin with, or had some incompetent dolt doing their billing in-house.
So when you add all this up what do you have? Simple. Outsourcing isn't for everyone but a godsend for some.