Practices are choosing to embrace new team-based approaches as physician compensation moves away from fee-for-service and towards new shared savings and outcomes based models such as capitation. Many doctors are discovering that the skills and technology needed to do the job correctly are beyond their means and capabilities, and therefore are looking to third parties to perform services such as revenue cycle management (RCM), which includes the management of claims processing, payments, and the generation of revenue.

Outsourcing Revenue Cycle Management to third party services can have a remarkably positive influence on your practice’s finances. Before hiring an RCM vendor, calculate the baseline performance for all RCM metrics and identify any flaws or possible challenges. Physicians should then create a list of what they want the practice to achieve.

Selecting the Right RCM Vendor for your Practice

When evaluating an RCM service, key metrics to consider include the return on investment, and the costs to collect. It is important to note that the cost to collect will vary from practice to practice. Often, Electronic Health Records (EHR) companies include RCM services along with their software. You should continue to search for new ways to reduce the cost to collect while moving toward the ultimate goal of a 100% net collection rate.

Medical Economics recently published a list of questions which you may find helpful when evaluating 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?

You can also read more about the current state of RCM in a recent eBook provided for free by Healthcare IT News and HIMSS.

Negotiating Your Practice’s RCM Services

Once you have these questions answered and your potential vendors are narrowed down to a few candidates, you can choose the one that is right for your practice and patients. The contract you create with the RCM company should clearly indicate the services provided by the vendor and give you some detail about the people who will be responsible for your RCM service. You should also make your expectations clear about how the RCM vendor should conduct interactions with patients. If done correctly, you will have a seamless transition to outsourced RCM, which will help increase the financial stability and profitability of your practice. For additional information about Revenue Cycle Management with PrognoCIS, we encourage you to read our RCM Solution Brief.

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