Round 4 — Running the Operation
Module 3: Choosing Your Revenue Cycle Structure
When your revenue cycle can't afford to stop.
Every practice that manages its own billing eventually faces the same question, whether it asks it on purpose or has it asked for them: should billing live at the clinic, get consolidated into one central office, get handed to an outside company, or some mix of all three? There's no universally right answer — only the right answer for a given practice, at a given point in time, given its size and circumstances.
For RehabWorks, this isn't a hypothetical exercise. It's a conversation that hospital systems like EAMC tend to raise on their own timeline, often as part of a larger technology transition.
Whether billing is centralized, decentralized, or outsourced, the underlying unit of work doesn't change — someone still has to submit the charge, edit and transmit the claim, work the denial, post the payment, and talk to the payer. What changes is who does it, where they sit, and how those tasks are coordinated.
Decentralized
RehabWorks TodayMost revenue cycle functions stay at the clinic itself, close to the providers. The biggest advantage is speed and relationship: a biller sitting near the clinical team can ask a quick question about a modifier or a documentation gap and get an answer in minutes instead of days.
Tradeoff: at a small scale, it's harder to justify dedicated compliance, contract analysis, or advanced reporting roles — those tend to get folded into whatever bandwidth the biller already has.
Centralized (Central Business Office)
Hospital-System ModelA separate, often consolidated office handles billing across multiple sites or departments. This is the model many hospital systems gravitate toward, since it allows focused performance management, dedicated compliance oversight, and an easier case for investing in more sophisticated technology.
Tradeoff: distance from the clinical team slows down clarification requests — a quick hallway question becomes a form or a ticket, and engagement between billers and providers tends to drop.
Hybrid
Most CommonIn practice, most in-house revenue cycles end up somewhere in between. Charge submission and day-to-day clarification often stay local, while functions like coding review, AR follow-up, or reporting get consolidated for consistency and oversight.
Outsourced (Full or Functional)
Already in UseOutsourcing means handing some or all revenue cycle work to an outside company. Few practices outsource everything — most practice some degree of functional outsourcing without thinking of it that way. RehabWorks already does this: Waystar acts as the clearinghouse that edits and transmits claims, and Holloway Credit Solutions handles patient balances once internal collection efforts are exhausted.
Evaluating Any Structural Change
If a centralized or outsourced option is ever on the table, the comparison only works if it's fair. That means separating current billing costs out from general practice overhead, since most in-house billing costs are normally blended into overall expenses and never isolated.
It also means understanding precisely what a vendor or central office would perform, and at what expected level. Pricing usually shows up one of two ways: a percentage of collections, or a per-transaction/per-claim fee. One caution worth remembering: a percentage-of-collections fee tied specifically to coding services can quietly incentivize upcoding, since the vendor's revenue rises when billed amounts rise. Per-transaction pricing avoids that conflict for coding-specific work.
Why This Matters Right Now for RehabWorks
Hospital systems integrating outpatient clinics frequently look to standardize or centralize billing as part of larger technology transitions — and the EPIC migration is exactly that kind of moment. This conversation is more likely to come from EAMC leadership than to be initiated by RehabWorks itself.
That makes the timing matter. Stewart and Mallory understanding the real tradeoffs of centralization now — not just the pitch for it — means they can engage in that conversation from an informed position instead of reacting after a decision has already been framed elsewhere.
Whether moving toward centralization, outsourcing, or back in-house, the safest path is rarely an all-at-once switch. A phased approach — for example, transitioning charge submission first, then migrating payment posting and account follow-up later — minimizes the risk of a revenue dip during the changeover.
Content developed by Continuity Practice Partners, informed by the MGMA Physician Billing Process, 3rd Edition.