How To Select The Right Revenue Cycle Management Partner?

Choosing the Right Revenue Cycle Management? RCM. Revenue Cycle Management. RCM Healthcare is vital for all healthcare providers, from the most prominent hospitals to the minor private practice. It's also critical to Medical Billing Companies. RCM Healthcare Services makes the coding and billing happen, the Claims Processing wheel turning, giving Healthcare Providers, large and small, the funds to operate.

Revenue Cycle Management is crucial. So how does it happen? Or, more precisely, how does it not happen? The opportunities for errors are many and easy to find-the hard way. The goal is to document each patient visit flawlessly, submit the claims form correctly coded in a timely fashion, have it processed by the correct Healthcare Insurance Company quickly, then receive the payment and get the correct patient account credited. Easy, right? But a misstep during any one of these actions can mean delay. So, it's to everyone's advantage to make this workflow happen.

Steps In The Revenue Cycle Management Process

As mentioned earlier, the RCM has several discrete parts.

Step 1:

The patient gets an appointment with the health care provider and ensures that their medical insurance can be applied to cover the appointment.

Step 2:

The healthcare provider verifies the patient's insurance plan and confirms which services will be covered.

Step 3:

The patient gets treatment at the provider's office or hospital. After this, the medical biller will send a detailed report of the patient and the treatment.

Step 4:

The medical biller codes the treatment in the claim and checks compliance. Billers will make sure claims submitted follow the standards of billing compliance.

Step 5:

According to the Health Insurance Portability and Accountability Act of 1996(HIPAA), all medical claims must be submitted electronically.

Step 6:

Next is adjudication. Now the claimant will know how much can be claimed. In some cases, the claim also gets rejected partially or fully.

Step 7:

Now the biller will prepare a statement for the patient with details of the insurance amount paid and what the patient is responsible for.

Step 8:

The final stage in RCM is the balance remaining, which is now collected from the patient.

A recent survey indicates that 50% of patients have either partially or wholly unpaid bills. Much of the time, this is because of a breakdown in the RCM! This is essentially "money left on the table." Having a Revenue Cycle Management Partner, usually a Business Process Outsource partner, is a way to capture this otherwise lost money. The Return on Investment can be huge when you engage a BPO for RCM.

Challenges Of Selecting the Perfect RCM Partner

Let's say you want to hire an outsourced RCM expert to increase your revenue. What do you look for? What do you need?

Pick an effective, affordable partner.

Choose a Revenue Cycle Management partner you can afford. Don't go for the biggest and best if you're a smaller company with limited funding. There will be some BPOs out there that can do the job, but their fees may not fit your budget. Don't spend more than you'll recover.

Can they work quickly?

Increasing the pace of your financial workflow is vital for the value-based care model that the healthcare industry is shifting to. Heavy attrition, inefficient processes, and billing challenges have pushed healthcare practices to outsource RCM to enhance productivity.

Revenue loss is affecting most of the players, both large and small. Increasing overhead, shifting reimbursement procedures, increasing regulatory policies, and staffing issues put pressure on in-house RCM entities.

What about denial?

An experienced RCM partner who can decrease the percentage of denials of payments is a valuable asset. A partner that has experience in this shifting landscape because they have the experience and are affordable. But how do you acquire one? One good metric might be their record with denial management. How successful are they in going to the next step to recover your revenue?

Turnaround time.

Don't underestimate the value of knowing how to make the wheels of the RCM turn faster. Make sure your prospective partner has that ability. Left to the natural pace of things, recovering your money can be achingly slow. Find a BPO that can speed things up.

Reporting.

It's also essential that your new partner will be a good communicator. They may be on the other side of the globe, but that's no longer a viable excuse for lack of communication. They need to not only be available during your workday, but they also need to be able to tell you what's going on with their efforts.

Background checks.

Do your usual due diligence before choosing. As you would with any new vendor, check out their references and find satisfied current customers who can vouch for their performance.

Error proofing.

Protect yourself. They're operating under your business's banner. The people and companies they're working with don't know that it's not you; they can't tell the difference. So make sure that you're protected from mistakes.

The tech.

The tech is high on your list of positive reasons for partnering in the first place. Since RCM is your new prospective partner's sole job, their tech should be superior to what you can afford in-house. Far superior. Beware of prospects that can't provide state-of-the-art.

The deal.

Like any prospective partner, make sure you read the fine print. Just because you think they're the best fit for your budget and your needs, go through the contract and know that what you're getting is what you expected.

Checklist For Selecting An RCM Partner

Here's a checklist of good questions when interviewing someone to handle your Revenue Cycle Management. Do they:

1. Offer automated insurance eligibility verification?
2. Have an automated claims scrubber and eCW rules engine that is payer-specific?
3. Monitor payer contracts for underpayments and assist with appeals?
4. Explain the process for following up on denied claims?
5. Reveal the percentage of claims denied in the initial submission?
6. Know the percentage of denials that are successfully appealed?
7. Follow-up on existing claims?
8. provide a comprehensive summary of your Accounts Receivable?
9. follow up on every claim, or will small dollar claims be left behind?
10. Are Certified Professional Coders available to communicate with providers?
11. Offer specialty-specific coders?
12. Conduct a regular code analysis to improve compliance and prevent under coding?
13. Have tools available to assist with patient pay?
14. send patient statements? If yes, how many?
15. offer credentialing services?
16. offer contract negotiation services?
17. Have experience with RCM? Are they relatively new to the space or have a track record of success?
18. Have experience with your current EHR? If not, how will they manage the billing? Will their system interface with your EHR?
19. Have a designated point of contact available across multiple channels like email and phone?
20. Meet with your account manager/RCM team on a regular basis?
21. Have KPIs and data to review with your account manager/RCM team?
22. allow access to the work being done on claims?
23. offer a report? Are reports an additional cost?
24. Will they offer benchmarking services to track provider productivity levels compared to other providers at the state and national levels?
25. manage patient phone calls/questions about statements?
26. disclose what their HIPAA program looks like? Are they HIPAA compliant?
27. offer training during the onboarding process?
28. include any other services or products with your RCM service?
29. Consider a performance-based fee structure?

Your Next Move.

Here's the bottom line: a Revenue Cycle Management Program is only as good as the execution of that program. When looking for a partner, a BPO partner, make sure that you've checked and double-checked the things we've mentioned here. A good starting point would be to get in touch with the pros at Rely Services. They've been doing business for over two decades, know the field better than anyone, and can make the transition painless.