We suddenly faced the proposition of converting to internal coding and billing when the hospital learned at the eleventh hour that their new software wouldn’t support pro-fee coding and billing. A chance conversation with the managing members of BSA Healthcare at the ACEP Scientific Assembly led us to use their services, without which we would have never gone through methodical deliberations in selecting a coding/billing vendor. The cost savings to us in our selection vastly exceeds the cost of BSA Healthcare’s services. They also provided strong evidence-based guidance in negotiations with our hospital which led to a sound contract satisfying both the hospital, and the group members.