Gastroenterology practices face a choice: in-house billing or outsourcing. In-house teams offer control, familiarity, and direct oversight, but come with hidden costs, training needs, and regulatory challenges. Outsourced billing firms bring GI-specific expertise, clean claims, scalability, analytics, and compliance updates. The decision rests on cost clarity, claim health, adaptability, and staff workload. A hybrid or pilot approach helps practices choose wisely.