In house and outsourced medical billing services are adopted to capture medical industry power and create the ability to enhance medical billing efficiency and revenue cycle management. It is a concern in deciding between in-house and outsourcing medical billing services. It is a diversification strategy used to determine the autonomy of healthcare business units. It is adopted when there is a high gap between the service cost, service efficiency, and maintenance of accuracy. Medical billing outsourcing or in-house services are highly unpredictable, and the company needs more sources to establish the environmental gap. In such a situation, various factors become necessary to consider the execution of business operations. Outsourcing or in-house of medical billing services becomes possible when it helps to reduce the cost overhead, increase billing efficiency and provide assistance in regular processes. The article will discuss the significant differences between in-house and outsourced medical billing and analyze both to make an accurate choice for healthcare providers.