Finding the right fit: How to choose a healthcare revenue cycle outsourcing partner
As a healthcare provider, outsourcing your revenue cycle management (RCM) process is one of the most important decisions you’ll ever make. Why outsource healthcare revenue cycle management services? When done carefully, it’s a partnership that ultimately helps you address RCM staffing shortages, decrease claims denials, enhance cashflow, improve your ability to provide high-quality patient care, and much more.
However, it’s critical to find an RCM partner you trust—one that can serve as an extension of your practice and deliver the stellar healthcare revenue cycle outsourcing experience you deserve.
As part of your due diligence, ask these 10 questions to understand what each revenue cycle management outsourcing partner has to offer:
1. How long has the healthcare revenue cycle outsourcing vendor been in business? Does it have a proven process to ensure clean claims and reduce claim denials? Can it provide client testimonials and references to back up its assertions? How does it define overall return on investment? Also ask about the number of providers in the vendor’s network, volume of claims processed annually, and revenue collected annually.
2. What is the outsource RCM vendor’s criteria for coder employment? Are coders U.S. based or offshore? What are their credentials and average years of experience? Are they independent contractors, or are all coders W-2 employees? With what medical specialties do coders have experience? Do they understand state-specific coding and billing nuances? With what specific electronic health records, encoders, and computer-assisted coding software do coders have experience?
3. What does the revenue cycle management outsourcing implementation process look like? Will the outsource RCM partner bring its own technology, or will it work in your existing system? Does the vendor design an implementation plan that fits each practice’s schedule, resources, and needs? Does it handle all program setup, documentation, EDI implementation, process coordination, and training? How will the vendor work with the practice’s internal IT team to address any problems that arise?
4. Can the outsource RCM partner demonstrate HIPAA compliance? Is it willing to sign a Business Associate agreement?
5. What is the outsource RCM vendor’s pricing model? Is the vendor’s reimbursement tied to revenue the vendor collects on behalf of the provider, or is there a flat rate regardless of revenue collected? Does the vendor include software upgrades, or is there a separate charge for that? In addition, does the vendor actually submit the claims? Does it provide additional services such as patient statements and receiving and responding to all patient calls related to billing and invoice inquiries, or are there separate charges for this?
6. How does the outsource RCM partner promote coding quality and accuracy? Does the vendor provide its coding staff with ongoing opportunities for continuing education? Does it audit coders regularly? If so, how? How does it select cases, and what standard does it use to gauge performance? What are the ramifications for coders who don’t meet performance standards?
7. What type of transparency does the outsource RCM vendor provide? Are you able to see what your vendor is doing at all times? Can you access customized reports with real-time data as well as past and present key performance indicators?
8. Does the outsource RCM vendor handle denials? What is their denial management approach? Do they identify and address the root cause of denials? What percentage of their denied claims is appealed?
9. What is the turnaround time for RCM processes? Ask the outsource RCM vendor to provide turnaround times for collections, claim filing, denial management, and processing of appeals. What are the ramifications for not meeting these turnaround times.
10. How does the outsource RCM vendor prioritize partnership? For example, do coders identify opportunities for physician education and clinical documentation improvement? Do they attend meetings with internal staff? Does the vendor analyze key performance indicators and make recommendations to enhance your workflow and optimize revenue cycle processes? Does it provide a dedicated account manager who can help you interpret and act on your data?
Conclusion
Asking questions at the onset makes sure everyone is on the same page and that you’ll ultimately find a revenue cycle management outsource vendor that meets your unique needs—one that’s ideal for your practice and patients. Learn how edgeMED can help by visiting https://www.edgemed.com.
