I agree with Jon in Baltimore - we also use an outside billing service. I get tired of them hyping their own ehr, but that's a minor annoyance. We get paid in a timely manner and it's working well.
We would consider doing the billing in house, but . . . if it ain't broke and all that.
I also agree that a working PM module is important for attracting new physician users. In my area, I know of two doctors that decided against AC because there is no PM.
Barb