One Year In: Lessons, KPIs, and Surprises from Moving Billing In-House

When behavioral health providers talk about bringing billing in-house, the conversation usually centers on control and cost. But as we learned in our recent webinar with Drew LaBoon, there’s far more to the story. One year after making the shift, Drew offered an unfiltered look at what it really takes to own your revenue cycle—and why he’d make the same decision again in a heartbeat.

For Drew, the initial motivation was simple: gain control, boost compliance, and improve financial outcomes. But that decision wasn’t made lightly. It meant building infrastructure, staffing up, and navigating a complex transition. And yet, even after a year of hard-earned lessons, he’s clear: “We’d absolutely do it again.”

The real payoff? Visibility. Flexibility. And the ability to tailor billing practices to clinical reality—not the other way around.

What that flexibility unlocks is real-time problem-solving. Instead of waiting weeks for outsourced teams to flag issues or bounce back denials, Drew’s team can spot gaps in documentation, trends in payer behavior, or process breakdowns as they happen. That visibility allows leadership to course-correct quickly and keep the focus on continuity of care, not claims cleanup.

Going in-house isn’t just flipping a switch. It’s a system-wide transformation. Here are some of Drew’s most valuable insights:

• Multi-site billing is a beast. Be ready for complexity.
• Cash reserves are critical—plan for at least six months of operating expenses.
• Transition UR and billing together or risk major revenue disruptions.
• Third-party exits vary: some partners will support the transition; others may not.
• Data and access matter: Ensure you have control of your insurance portals and historical billing records before the switch.

“There are two sides to billing,” Drew noted. “Before admission and after. Neglecting either side creates gaps that cost real money.”

One unexpected upside of going in-house? The opportunity to completely reframe relationships with payers.

By proactively engaging with payers—asking how they prefer claims to be submitted, getting ahead of potential issues—Drew’s team reduced denials and sped up resolutions. The approach moved from adversarial to collaborative, and it paid off.

“We stopped thinking like bulldogs and started acting like business partners. The difference is night and day.”

That shift, however, didn’t happen overnight. One of the biggest hurdles was simply finding the right person at the payer to talk to. Call centers were a dead end more often than not. Drew’s advice? Skip the scripts. Instead, use LinkedIn or professional networks to identify regional reps or provider relationship managers. Once you find a name, ask your peers if they have a direct contact or escalation path. Persistence pays off—but so does politeness. “We started every call with: ‘I know this isn’t your fault, but we need help.’ That tone makes a difference,” Drew said.

And once you do get through, don’t stop there. Document everything—who you spoke to, what was discussed, and any promised follow-ups. Treat payer relationships like any other partnership: nurture them, stay transparent, and follow through. When payers see you as organized and solutions-focused, they’re more likely to engage constructively the next time there’s a hiccup.

The shift to in-house billing isn’t just about philosophy. It’s about outcomes. And to know if it’s working, you have to track the right KPIs.

Here are Drew’s go-to metrics:

1. A/R Days
   1. How fast are you turning billed charges into cash? This number reveals it all.
   1. Formula: Total AR balance / Average daily revenue
   1. Why it matters: Faster AR = healthier cash flow = greater operational stability
2. Clean Claims Rate
   1. What percentage of your claims go through on the first try?
   1. Higher is better. It means less rework, fewer denials, and quicker payments.
3. Denial Rate
   1. How often are your claims denied?
   1. Lower rates mean better documentation and process discipline.
4. Collections Rate
   1. Of what you bill, how much do you actually collect?
   1. This shows how efficient and effective your billing operation really is.
5. Total Outstanding AR
   1. How much money is still “in limbo”?
   1. Create a snapshot of what’s at risk and what needs attention.
6. Reimbursement Per Admission
   1. What are you actually being paid per client?
   1. Helps gauge payer reliability and financial performance.
7. Claims Processed Per Biller
   1. How productive is your team?
   1. Great for spotting workflow bottlenecks or training needs.
8. Days to Payment by Payer
   1. Who pays quickly? Who drags their feet?
   1. Use this to prioritize follow-ups and identify patterns.

As Drew says, “Reducing AR days isn’t just a finance win. It’s a clinical one. It frees up resources to reinvest in patient care.”

At the end of the day, bringing billing in-house is about more than revenue. It’s about ownership. When you control the process, you can optimize every step of it. And that leads to:

• More accurate reimbursements
• Retention of previously outsourced fees (3.5% – 7%)
• Faster, more predictable cash flow
• Better payer relationships
• And perhaps most importantly: data clarity to fuel smart decisions

Drew wrapped the conversation with this reminder: “If you don’t know your numbers, you’re flying blind. Cost per admission, cost per readmission, payer mix, care-level mix—they all matter.”

Ready to take control of your revenue cycle? We can help you benchmark your KPIs, build a transition plan, and align your billing strategy with your clinical mission. Reach out for a growth assessment today.

About the Authors

Travis Moon Travis Moon, Kipu's Content Strategist, is a seasoned leader in healthcare IT and content marketing, specializing in the behavioral healthcare sector. As a Lead Editor at Kipu Health, Travis develops impactful, data-driven campaigns that support healthcare professionals and enhance patient outcomes. With over a decade of experience, he has led strategic content initiatives for major healthcare organizations, including the launch of data visualization tools and thought leadership campaigns.