How do you choose the best revenue cycle outsourcing partner for your healthcare organization?

Be wary of RCM vendors that promise or highly showcase their "average" increase in revenue for clients. The revenue cycle is unique to a practice or facility, and no two results will the same. The risk of shady RCM practices will only harm the practice or facility.

Revenue cycle operations should not be unique to a practice or organization. There are standard processes involved in running a highly effective and efficient revenue cycle operation.

Start by clearly defining your organization's specific needs and objectives. Consider what aspects of the revenue cycle you need assistance with, such as billing, coding, or collections. Identify any pain points in your current process and determine the desired outcomes you want from outsourcing. This will help you find a partner that aligns with your goals and can address your unique challenges effectively.

Once you have a clear understanding of your needs, evaluate potential partners based on their capabilities. Look for a partner with a proven track record in the healthcare industry and expertise in revenue cycle management. Assess their technology stack, data security measures, compliance with healthcare regulations, and ability to integrate with your existing systems. Ensure they have the necessary resources and experience to handle your specific requirements.

If a RCM is owned or invested by shareholders and traded on the stock market in the U.S. or another country, think twice before you buy. Their loyalties are to the shareholders, and they will work very hard for their owners at the cost of their clients. RCM that have every technology solution under the sun, a big area of physicians handling appeals aggressively pushing to justify every inpatient admission, polished off by the "best in class" compliance program, are often tell tail signs that vendor is motivated by showing strong key performance indicators to trigger some bonus by the client. Worse yet, inflate numbers to meet the shareholders' numbers. Read very closely all public documents of a publically traded RCM.

Ask for references and case studies from potential partners to get a sense of their past performance. Reach out to their current or previous clients to learn about their experiences and satisfaction with the service. Pay attention to feedback regarding their responsiveness, problem-solving abilities, and overall impact on the revenue cycle. Positive references can provide valuable insights into the partner’s reliability and effectiveness.

Avoid bonus payments. Bonus payments foster edgy billing practices that can be very harmful to the practice or facility. Under a bonus structure, there is motivation to "hit the numbers," but numbers can be manipulated to ensure those numbers are hit to trigger the bonus. With any vendor, always conduct periodic audits which you control and not the vendor. This can help ensure compliance with contractor requirements along with regulatory compliance.

Once you have narrowed down your options, negotiate the contract terms to ensure they align with your organization's needs and expectations. Discuss key performance indicators (KPIs), service level agreements (SLAs), and reporting requirements to establish clear benchmarks for success. Make sure the contract includes provisions for scalability, flexibility, and periodic performance reviews. Negotiating a well-defined contract can help set the foundation for a successful and collaborative partnership.

A modern RCM partner brings streamlined medical billing processes, reducing billing errors and accelerating revenue cycles. Healthcare regulations and codes are constantly changing. Your RCM partner should be agile and quick to adapt to these shifts. Leveraging advanced analytics for actionable insights, empowering your organization with informed decision-making. Outsourcing RCM can be more cost-effective than managing an in-house team, freeing up resources for strategic initiatives.

Carefully look at the billing and coding operation. Find out if there are quotas imposed by the RCM and whether those are reasonable. Also, ask for a list of coders and billers, and you select whom to contact. If they offer up someone to contact, chances are very high that you will not receive an honest answer. Ask to see the CV of all the coding and billing leadership. This can very very revealing that those overseeing coding and billing may not have any experience within that space. Lack of experience can foster an environment ripe for problems. It is not uncommon for coding and billing managers, directors, vice presidents, and senior vice presidents to have zero experience in revenue cycle or coding and billing.