When it comes to managing the revenue cycle, David Kanzler takes a pragmatic approach-he outsources a good chunk of it. "The management of billing and collections has become so sophisticated and technical that it's hard to justify doing it ourselves," says Kanzler, the CEO and CFO of Hinsdale (Ill.) Orthopaedic Associates, a 25-physician group practice which provides a wide range of procedures including sports medicine, total joint replacements, hand surgery and spinal fusions.

Four years ago, Kanzler turned over all post charge-capture activities to Chicago-based Origin Healthcare Solutions. The practice codes its services, then hands over claims submission and related follow-up activities to Origin, explains Margarita Cuadra, revenue cycle director. "Billing gets more difficult every year," Kanzler moans. "And payers come up with new and novel ways to reduce payments and deny claims. So I need to leverage the expertise of a company thinking about this 24 hours a day."

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