Here is my experience,I run my practice with only my wife(front end) and myself (back end). We do/did it all used Lytec for PM we were very good getting initial bills out to ins companies(posted/scrubbed/submitted/accepted/paid usually within 2 weeks).
Problem came with billing the secondary insurance or patients for the remaining balances after the EOB's came in. It was more time consuming and would go way back on the back burner ie not done in a timely fashion.
We then had a hard drive failure on main office computer only to find that the backup system setup by the Lytec certified reseller had never backed up the PM information so we were left hanging.
Decided at that time to look into a billing service @7.5% of collections. They are better at getting the secondary bills out but are not faster getting the initial bills out which may be a system problem and not all on their side. I am awaiting AC7and def consider bringing it back in house maybe hirer aparttimer for 12 -16 hrs a week to free up my wife for concentrated billing time. We will see if the SGR cuts go through who knows how that will change the picture?