How to Choose the Right Revenue Cycle Management Partner?

Aaron Garcia
August 25, 2022
 Mins Read

Challenges Faced When Selecting an RCM Partner

The greatest challenge faced by healthcare experts is unsettled financial transactions due to a disorganized revenue cycle. Together both factors create a malicious loop that healthcare stakeholders are unable to resolve. To handle the revenue cycle and make it cost-effective, it is essential that you as a healthcare services provider must select a Revenue Cycle Management (RCM) partner who recognizes your needs and addresses the challenges appropriately.

Some factors that will help to choose the right RCM partner are:

  • Will this RCM partner help enhance cash flow to your practice?
  • Will this RCM partner make your operations seamless and keep them structured?
  • Will this RCM partner help your practice focus more on patient care?
  • Will this RCM partner take care of training needs?

Enhancing financial workflows is most important for the success of the value-based care model that healthcare is shifting to. Heavy attrition, unproductive processes, and billing challenges have pushed healthcare practices to outsource RCM and secure financial success.

As healthcare overheads, variations in reimbursement procedures, regulatory imperatives, and administrative overload exert pressure on healthcare establishments, revenue loss is affecting most players. So the decision to outsource and the choice of the RCM partner takes on additional significance.

Factors of right RCM Partner

Why is Choosing the RCM Partner Crucial?

With a quick and efficient RCM process in place, healthcare establishments can decrease write-offs and enhance bottom lines. It is but natural for some providers to try and make in-house improvements to tackle problems like a new untrained workforce, lack of communication, and inappropriate workflow. However, it may be prudent to hand over complete responsibility of the RCM if you are fortunate enough to find a competent partner.

Without a thorough understanding of what RCM entails, it is not possible to spot the best RCM vendor for your healthcare facility. Here is a checklist you could use:

1. Select an RCM Partner Who Provides the Best Return on Investments(ROI)

Selecting a sensibly-priced RCM vendor is vital, particularly for smaller establishments that have constricted budgets. Investing in a third-party RCM Management Services is not a wise judgement if you are only trying to rationalize financial workflows. When considering a potential RCM partner, assess the cost to collect, which regulates your return on that investment. The best collection rate is 100 per cent. Nevertheless, on condition that the vendor can augment collections and improve revenue, the ROI must be more than the budget allocated to the vendor.

2. Expertise is Everything

Outsourcing non-core activities is one thing. When a crucial function like RCM is outsourced, it is equally important to find a partner who is well-versed in handling issues as diverse as billing and compliance. To avoid errors, the outsourcing agency should also have a thorough knowledge of healthcare services. So if you are an expert in medical services –say the treatment of cancer -- make sure you find an expert in RCM who knows a lot about oncology.

Medical Billing and Coding Outsourcing Services

3. Denial Handling and Effective Claims Processing

A partner who can dynamically manage denials to payments – a vital part of the RCM, can enhance revenue. The RCM partner should not only be able to support, recognize, and oversee trends in payments and collections but also understand the root causes of denials by comparing previous data with existing data. Look for effective denial management skills in your outsourcing partner if your main motive in hiring him is to enhance revenue and speed-up payments.

4. Turn-Around Time is Crucial for RCM Processes

Billing and payments involve multiple parties. Your RCM partner should be able to demonstrate his superior skills in these functions by ensuring a fast turnaround time. Timely collections, filing of claims, denial management, and processing of appeals will reduce the turnaround time and make profits for the organization.

5. Reporting is Vital for An RCM System

Your outsourcing partner should communicate regularly with you and provide reports on every aspect of the outsourced business. This will not only improve financial matters but also make the partner accountable for the work undertaken.

6. Customer Experience is Vital

Before you hire an RCM outsourcing partner, make sure you check his credentials. Research online and read up testimonials to see if his customers are satisfied. Regular training of staff should be a feature of the outsourcing partner’s business operations. Without evidence of customer satisfaction, there is no point in outsourcing RCM activities.

7. Operational Excellence

Think of a situation in which the RCM provider you are working with commits an error. Do you have any agreement in place to protect yourself against damages? Check the Service Level Agreement proposed by your partner and make sure you add your own clauses as well.

Revenue Cycle Management Process

8. Technology and Support

Technology is another motivating factor when you are choosing an outsourcing vendor. Does the firm you are considering, have systems and solutions that synchronize with yours? Crosscheck in terms of features and functionalities as well.

Beware, many RCM service providers only use software for selected functions. Look for a fully-automated RCM partner. Make sure there is a robust Practice Management System listed in the services package.

Does your partner have billing applications that will support you through the ICD-10 transition? That is, can it be integrated into your current patient management system, and will the transition be smooth? Also, consider how these systems will be acquired -- for a one-time fee or as an ongoing service?

9. Agreement Resilience

Do not be carried away by the service brochures; go through the service agreement diligently to ensure there is an exit clause. Even the best-sounding agreement can backfire, if it costs an arm and a leg to back out of. Flexible end clauses and interim commitments will keep you from being “married” to an RCM firm you do not want to work with.

Critical Questions to Ask a Potential RCM Partner

To help you evaluate better which vendor is a perfect fit to handle your RCM, go through the checklist below:

  1. Do they have the required abilities to interface with your EMR, labs, hospital systems,  etc.?
  2. Do they provide training through the on-boarding process?
  3. What is their denial management approach?
  4. What percentage of their denied claims is appealed?
  5. What is their pricing model?
  6. How do they cope with patient calls or respond to questions from you?
  7. Does their RCM solution come with access to patient portals, appointment reminders,      and reports?
  8. Do they charge additional fees for tasks such as insurance authentication and electronic  claims submissions?
  9. Do they have dedicated account managers who are accessible and able to resolve your    issues rapidly?
  10. Will you still have access to patient accounts, record reports, claims, and other revenue cycle tasks even after they adopt a different RCM software, such as Practice Management Software?

Related Service: Medical Coding Services

The Road Forward

Once you have these queries answered and your potential partners are narrowed down, you can select the partner who is ideal for your practice and patients. The agreement you execute with the RCM firm should clearly indicate the services that will be delivered by your partner and also identify key RCM service staff who will interface with you.

You should also make your expectations apparent. If done well, you will have a seamless transition from in-house RCM to an outsourced one.

Article by
Aaron Garcia

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