Efficient revenue cycle management (RCM) is crucial for a practice that wants to remain financially successful. As practices are facing heavier workloads and increased requirements, many providers are considering outsourcing their RCM services, including the management of claims processing, payments, and the generation of revenue.
Practices are choosing to embrace new team-based approaches as physician compensation moves away from fee-for-service and toward shared savings and outcomes-based models. Unfortunately, many doctors are discovering that the skills and technology needed to do the job correctly are beyond their means and capabilities.
Outsourcing some or all of the revenue cycle management services can have a remarkable influence on a practice’s finances. However, if the wrong vendor is chosen or the relationship is poorly handled, outsourcing RCM services could have unfortunate consequences. The RCM cycle can only be as successful as those who manage it.
Before hiring an RCM vendor, practices should calculate their baseline performance for all RCM cycle metrics and identify any flaws or possible challenges. Physicians should then create a list of what they want the practice to achieve.
When evaluating an RCM service, key metrics to consider are the return on investment and the costs to collect. It is important to note that the cost to collect will vary by practice. Practices need to continually search for new ways to reduce this cost to collect while moving toward the ultimate goal of a net collection rate of 100%.
A recent article from Medical Economics provides a list of questions to ask possible RCM vendors:
- What is the cost and what is included in the price?
- What are the performance guarantees?
- What technology will the vendor provide and how will it interface with the existing system?
- Where are the call center employees located?
- How long is the contract for?
- What are the termination clauses?
- Are employees certified and familiar with the industry’s best practices?
- What security mechanisms are in place to deal with sensitive protected electronic health records?
- What reporting is provided?
- Where to and how often is money transferred?
Once these questions are answered and the potential vendors are narrowed down to a few candidates, providers can choose the vendor that is right for both the practice and their patients. The contract should clearly indicate the services provided by the vendor and detail who is responsible for what. The practice should also make clear how it expects the RCM vendor to conduct itself with patients. If done correctly, this should be a seamless transition.
Author: Lauren Daniels