"Should we hire a biller or outsource?" It's the most common question practice owners ask us. Let's do honest math for a practice collecting $1M a year.
Option A: In-house biller - ~$72,000+/year all-in
A $55–60k salary becomes $70k+ with benefits, payroll tax, training and turnover. You get one person, one skill set, 40 hours a week - and when they're on vacation or quit, billing stops. Management time is extra.
Option B: US billing company - $70,000–90,000/year
At the typical 7–9% of collections, a $1M practice pays $70–90k - often plus setup fees and annual contracts. You get a team, but at the highest price point and frequently the least flexibility.
Option C: Zaxis Health complete RCM - $50,000/year
At 5% of net collections: $50k on $1M collected. Full team, full cycle, month-to-month after a 90-day ramp, no setup fees. And because it's a percentage of collections, we only earn more when you do.
Option D: Dedicated specialist - $18,000/year
A full-time billing specialist working only your accounts for $1,500/month. Compare that with $5,000+/month for an in-house hire. Best for practices that want control plus leverage.
The decision framework
Stay in-house if you have a genuinely excellent biller and clean metrics to prove it. Outsource fully if billing is a distraction, AR is climbing, or you're growing. Go hybrid (dedicated specialist) if you want your hands on the wheel with an expert engine underneath.
Still unsure? Our free revenue-leak review shows you exactly what better billing is worth for your numbers - then the math decides itself.