According to a recent report by MicroMarket Monitor, the market for third-party revenue cycle management (RCM) providers has been exploding lately. With the consolidation of health providers and the emerging reductions in compensation rates, health care organizations (HCOs) are discovering that unless they possess a superior billing staff, they can easily fall behind in their revenue cycles. Too much drift from tight reimbursement schedules can spell financial malaise in your practice. For the very smallest clinic up to the massive hospital networks, outsourcing RCM seems to solve a host of growing problems. Should your medical enterprise consider this as a solution? Below, we describe some of the benefits of outsourcing your medical billing and RCM.
RCM Vendors Know What’s What
Vendors are in the business of staying current and ahead of what payers require for claims, government regulatory changes and plan benefits. They know the codes and quickly adapt to any alterations in them. Because they employ IT that automates processes and updates databases, third party RCM vendors have all the resources to streamline the billing and collections tasks and even integrate their applications with those of client HCOs to save time on information transfers from one to the other.
Because vendors specialize in coding requirements and contractual obligations per payer, they tend to avoid the common coding errors and oversights that often occur with an overwhelmed back office staff. Therefore, more claims meet with success on the first pass. Faster and more frequent approvals plus fewer re-files mean revenue expectations are met or exceeded.
They Have the Talent
Not all areas enjoy a large pool of medical service professionals (MSPs) from which to build a dedicated, loyal billing department. If in-house billing suffers from personnel churn, revenue management will surely remain in a state of disarray. As payment sources become more stringent, can your medical business afford any failures to submit claims in a timely manner or not realize when some are denied? Vendors pay close attention to these matters, as well as dealing with slow pay patient accounts. A vendor can quickly track down denials, determine if a payer shows a pattern of capricious denials and also contact patients in arrears with a firm but compassionate demeanor.
Feature Flexibility and Scalability
Most RCM firms offer scalable plans that fit organizations of any size. Acting as your partner, they may offer cloud-based software as a service (SaaS) by which you can integrate front office, clinical, and back office workflows into one unified space for greater efficiency and accuracy. Or, you can hand off files for billing and collections or choose any configuration of services customized to your unique business plan. So, whether you are a sole practitioner, a small physicians group, or a large hospital system, you can outsource some or all of your RCM as you see fit.
By allowing a billing partner to handle your revenue cycle, you save on your staffing expenses. Because vendors have an efficient, productive system in place, they spend fewer man hours processing claims and collections. Many companies will have a flat rate for their services. This means instead of paying an hourly wage or having your salaried workers spending countless hours on these tasks, you can utilize their skills elsewhere.
As a wise business manager, you’ll want to monitor your RCM vendor, not simply hand off the processes and forget about them. Still, it’s well worth investigating how outsourcing your RCM can benefit your HCO. You gain the peace of mind knowing they will maintain awareness on all the moving parts in payer reimbursements, government regulations and contractual obligations. You can reduce your administrative staff and focus on doing the important clinical work at hand. You can pare your budgets and thrive financially with timely reimbursements and far fewer denials. It may be just what your business needs for the new year.