Healthcare Revenue Cycle Outsourcing Guide - 6 Things to Look for in a Partner

Incorrect medical billing, underpaid reimbursements, inability to comply with standards, and threats to patients’ personal information are problems that healthcare Revenue Cycle Management (RCM) leaders come across on an almost daily basis. Lack of available resources who possess the expertise to truly address these issues only exacerbates the situation.

Turning to healthcare revenue cycle outsourcing and joining hands with an experienced external partner who can assist with healthcare revenue cycle services could be the magic-wand solution that many RCM leaders didn’t know they were searching for.

This article will help you find the right RCM partner who can assist with navigating through these challenges and allow you to make an informed decision that will help improve your organization’s revenue cycle performance.

What this article covers:

• Why Is Healthcare Revenue Cycle Outsourcing Crucial?
• 6 Things to Look for in a Partner During Healthcare Revenue Cycle Outsourcing
• Questions to Ask a Potential Healthcare Revenue Cycle Partner

Why Is Healthcare Revenue Cycle Outsourcing Crucial?

Healthcare Revenue Cycle Management is a complex and critical process, beginning when a patient seeks care and ending when the healthcare provider receives payment for that care. Numerous opportunities exist for errors, inefficiencies, and delays throughout the process.

With the progressive shift to value-based care, the chances of health systems experiencing bottlenecks in healthcare Revenue Cycle Management have increased almost exponentially.

Growing hospitals and healthcare organizations generally face the following key problems in their healthcare RCM:

Incomplete records - This is probably one of the most common issues when it comes to healthcare medical billing. Most medical charts comprise incomplete entries and ambiguous terminologies, opening doors to all kinds of misinterpretation and thereby increasing difficulties in the healthcare revenue cycle.

Coding errors - When healthcare providers submit insurance claims, they must use specific codes to describe the services that were provided. If these codes are incorrect, the claim may be denied, payments delayed, or payments may be wrong entirely due to under or over-coding.

Billing errors - Healthcare providers may not be able to submit bills in a timely manner, or they may submit them to the incorrect insurance carrier (especially in instances of multiple carriers), both of which result in delays, if not outright denials, and a negative impact to the organization’s revenue.

Compliance problems - Healthcare Revenue Cycle Management requires medical claims to be filed electronically, protecting that individual’s personal information while also complying with established healthcare standards. Experienced resources are required to understand exactly what these standards entail and how the organization can consistently comply with them for each and every claim.

Additionally, health systems also face troubles with technology, provider credentialing, continued claim monitoring, denial management, and many other aspects impacting their revenue cycle.

Choosing healthcare revenue cycle outsourcing can be extremely useful for the following reasons:

Unlike your providers who need to balance patient care, daily administration tasks, and RCM matters, a partner who comes as a part of healthcare revenue cycle outsourcing can focus entirely on where their expertise lies–your revenue. Watch as your organization is granted more time for those important daily tasks while your revenue also increases, which in turn translates to further business growth.

RCM partners utilize efficient software in conjunction with your own systems, making claim handling extremely easy and transparent.

RCM partners bring well-rounded experience to your organization, ensuring continued and future compliance with ever-changing billing and coding requirements.

In short, healthcare revenue cycle outsourcing not only improves your revenue cycle but also helps you achieve an overall better quality of care for your patients and your community.

6 Things to Look for in a Partner During Healthcare Revenue Cycle Outsourcing

1. Cost

As a growing healthcare organization, you are definitely looking to optimize your ROI. An RCM partner sounds great, but really what can you expect out of the relationship? The first consideration is to understand what the overall cost of the partner (including setup costs, any monthly fees, and per-transaction charges. If these items are not mentioned–ask!) truly covers. This is also the time to make sure you fully understand any features or additional functionality that is included in this price. Also, be sure to check how much customization is available on the price (can you expand support in certain areas while curtailing it in others?) in the form of pricing flexibility in key Revenue Cycle Management areas or even discounts for volume or a long-term contract. Be sure to leave no stone unturned in this research phase to ensure you truly receive the best value for your organization’s needs.

2. Relationship type

The type of relationship is yet another factor requiring special attention when it comes to healthcare revenue cycle outsourcing. Some partners may offer a traditional, transaction-based relationship, while others may offer a more consultative, collaborative approach.

Transaction-based relationships are typically less expensive and require less commitment from both the partner and the healthcare organization. However, these relationships can be more difficult to establish and maintain, and they may not provide the same level of support and guidance as a more collaborative relationship.

Collaborative relationships involve a higher level of commitment from both parties and typically cost more. However, these relationships can provide greater peace of mind in knowing you have a partner who is as invested in your success as you are. These relationships can also provide access to a wider range of services and support, making them ideal for organizations that are looking for a comprehensive solution.

While both of these healthcare revenue cycle outsourcing relationships have their own pros and cons, it is crucial to match them to your organization’s needs and choose the best for you.

3. Analytics capabilities

Healthcare revenue cycle outsourcing should open the doors to insights that help measure your revenue cycle performance and also aid in understanding how far you’ve come in your healthcare revenue cycle journey.

Some of the key things to look for in a partner’s analytics capabilities when considering healthcare revenue cycle outsourcing are:

The ability to track Key Performance Indicators (KPIs) such as claim denial rates, days in accounts receivable, and charges per patient visit

The ability to generate detailed reports on your revenue cycle, with a note of bottlenecks and potential areas for improvement

The ability to forecast future revenue and expenses, allowing your organization to budget appropriately and make informed strategic decisions

The ability to integrate with your existing Healthcare Information System (HIS) so you always receive a complete picture of your revenue cycle

With the right analytics opportunities, you’ll be able to optimize your revenue cycle and improve your bottom line.

4. Dedicated hours

The partner’s operating hours are yet another factor to evaluate in your healthcare revenue cycle outsourcing journey. How available will your partner be in the case of off-hour crises, system upgrades, or even just at onboarding? Also, be sure to evaluate the partner’s preferred method of contact and whether their response time matches your comfort level and expectations.

Evaluating these will help you understand if healthcare revenue cycle outsourcing could provide the level of support that your healthcare organization needs.

5. Community perception

The term healthcare revenue cycle outsourcing may initially seem scary; hence it is a good idea to ask the following questions:

• Can the partner fill gaps in your current workforce, or is it an all-or-nothing approach that could result in layoffs?
• Will the partner absorb current staff?
• Will staff need to reapply for positions?

Layoffs, and subsequent uncertainty, are difficult for a community as a whole, so be sure to understand the level of presence the partner requires in your organization.

6. Track record

Evaluating your potential partner’s track record is one of the most important things to consider in healthcare revenue cycle outsourcing. This will give you an idea of their strengths and weaknesses and help you drive these strengths toward your healthcare organization’s best interest. A few metrics that could help with evaluating the revenue cycle partner’s track record are their overall financial health, customer satisfaction scores, and taking a look at references from past clients.

Looking at how the partner helped other clients solve their Revenue Cycle Management problems could be a great way to start this process. For example, our clients normally understand our work better by looking at our promise in action. One way they do this is by understanding how we helped a Nephrology practice based in Texas establish an efficient Revenue Cycle Management (RCM) workflow.

7. Bonus factor

Don’t forget to evaluate the partner’s ability to seamlessly integrate with the healthcare organization’s existing systems. They may be able to integrate, but how smooth that integration will be for your organization is certainly a question to ask during healthcare revenue cycle outsourcing.

Questions to Ask a Potential Healthcare Revenue Cycle Partner

When you are in the process of picking the perfect partner for RCM, simply ask the following questions to the various partners you are evaluating, and their answers will lead you to the most appropriate one.

1. Do you use a subscription model, pay-per-use, or percentage of collections model for pricing? Or is there any other specific pricing model you use?
2. What tools come as a part of your Revenue Cycle Management solution? Do you offer appointment reminder notifications or something similar?
3. Can you integrate with our EHR instance?
4. What denial management strategy do you follow? And how is that tracked?
5. Will we be able to get in touch with a dedicated account manager to resolve queries?

Revenue Cycle Management is a complex process that can be greatly improved by working with the right partner. By considering these factors in healthcare revenue cycle outsourcing, you should be able to find a healthcare revenue cycle partner who will help your organization run smoothly and increase your bottom line.

If you are looking for an efficient Revenue Cycle Management team, be sure to review our offerings. We’d love to partner with you.