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What to Consider When Selecting An RCM Company For Your Practice

June 8th, 2017 - By Matt Garnese

RCM Solutions Are you considering outsourcing to a third-party medical billing service for your practice? There are many factors to consider when comparing your options. It’s also important to understand the distinction between medical billing and revenue cycle management (RCM). A medical billing company will manage the paperwork of filing medical claims for the purposes of medical billing. RCM includes a variety of additional services—reporting and analysis of the financial pipeline and patient financial services—all the necessary tasks required to get the bill through, beyond simply filling out and filing the paperwork.

For example, some RCM companies will proactively phone call patients in order to resolve issues with missing information, such as when the patient moves to a new address and therefore stops receiving medical bills. This is a key difference between companies that are able to accelerate payments and those whose clients have a continually growing account receivable balance.

When compared to in-house billers, third-party medical billing and RCM companies relieve understaffed practices and even perform their services at an overall lower cost to the practice. By having specialists dedicated to the task of RCM services, the efficiency of scale and expertise begin to have a tremendously positive effect when compared to an employee who is distracted by many other front office issues.

Also Read: Utilizing Robotic Process Automation (RPA) for RCM 

If you’re considering an RCM service for your practice, here are some important criteria to look at before making a selection:

  1. Personalized Services Based on Your Current Needs and Future Growth
  2. Track Record of Success in Revenue Cycle Management
  3. Qualifications and Certifications For Billing Service

Personalized Services Based on Your Current Needs and Future Growth

You should seek RCM services that will streamline your medical billing workflow and also provide you with the best customer experience overall.

For that reason, an RCM company’s account managers and billing staff should have a dedicated and focused relationship with you and your practice. That way your practice has the attention of an expert who knows the nuances of your workflow and your practice’s financial goals. A specifically assigned account manager will understand the billing history of your practice in order to aid in maximizing repayment for services.

Track Record of Success in Revenue Cycle Management

The company you select should demonstrate precision and accuracy in claims. They should work with reputable clearinghouses and payment gateway companies, be able to deliver a consistently high acceptance rate (of 98% or better)/ low rejection rate and deliver the shortest possible billing cycles. With PrognoCIS’s RCM services, for example, accounts spend fewer than 45 days in Accounts Receivable (AR), and 85% of AR billing is completed within the first 90 days.

In order to deliver that success, they should provide a wide variety of services including tracking billing revenue in monthly report meetings, including performing regular financial analysis of account balances. Companies that have call centers in the US will be able to assist you and your patients in the event of any billing discrepancies, which also contributes to successful claims.

Qualifications and Certifications For Billing Service

When selecting an RCM company, you want to make sure you’re getting the most qualified medical billers and coders. Billing staff with multiple certifications ensure a high level of achievement that sets them apart from billers at competing companies and ultimately give you confidence that your medical claims are accurate. That accuracy leads to a high approval rating, so having a certified billing staff has a direct impact on how much and how often your practice will be reimbursed.

Certifications to look for include Certified Procedural Coders (CPC), Masters and Bachelors Degrees in Healthcare Administration and management. Electronic Health Records (EHR) companies that offer RCM services should meet all technical certifications and compliance requirements, such as Meaningful Use, ONC-ATCB, and EHNAC Accreditation.

PrognoCIS Medical Billing and Revenue Cycle Management

In addition to PrognoCIS EHR Software, we offer medical billing as our RCM service. If you’re in the process of selecting an RCM company, check out our RCM Solution Brief to see what sets PrognoCIS apart from the competition.

For more tips on medical billing or RCM for your practice, sign up for our EHR newsletter and stay updated.


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