This case study will explore the process and reasons behind the decision to bring the billing back in-house after having out-sourced this process for the previous 12 months. This is a group of four physicians and one advanced practice provider who had recently undergone a management change. The deliberations were intense and thorough making by the stakeholders was intense and thorough as they went through the alternatives listed.  Implementation of their decision made will be discussed step by step. Lastly, we’ll discuss some lessons learned and possible impact on future projects.