The fast-changing healthcare environment puts increasing pressure on internal Revenue Cycle Management (RCM) teams.
Partnering with an experienced RCM vendor can boost efficiency and financial stability while easing the workload on your RCM team.
But what to consider when selecting an RCM partner?
We will provide insights to help you choose the right vendor for your organization and explain the benefits of this kind of partnership.
What Is RCM Outsourcing?
RCM outsourcing is the practice of hiring an external vendor to manage a part or all parts of your organization’s RCM processes.
This can include tasks such as patient registration, medical coding, claims submission, payment posting, accounts receivable follow-up, and denials management.
You should consider partnering with an RCM vendor if:
- Your organization is growing and requires scalable solutions to manage the increased demand on your internal team
- Your organization’s current metrics are falling under best practice KPI measures
- You experience a shortage of skilled staff to handle the complexities of today’s challenging RCM marketplace
- You work with outdated or insufficient technology that is compressing your RCM success
- You experience cash shortfalls month after month
- You want to focus on patient care and safety while reducing administrative tasks
The Benefits of Partnering With an RCM Vendor
Partnering with an RCM vendor offers your organization the opportunity to leverage specialized expertise and advanced technology solutions to manage the complexities of revenue cycle management.
What can you expect?
Improved Financial Results
RCM vendors bring expertise that significantly increases cash collections.
Minimizing claim denials, optimizing charge capture, and ensuring accurate billing, RCM vendors help your organizations collect a higher percentage of billed amounts and expedite payment recovery.
The increase in cash collections directly affects your organization’s revenue stream. The expedited turnaround is particularly beneficial for higher impact accounts, where timely reimbursement can significantly affect cash flow and financial stability.
Reduced Operational and Leadership Burden on Managing Staff
Outsourcing RCM functions to a dedicated vendor allows you to give someone else the responsibility to handle the complex and time-consuming aspects of the revenue cycle.
With experts managing RCM, your internal teams are freed from administrative burdens to focus on higher value work tasks for internal staff.
Additionally, leadership can concentrate on strategic initiatives and organizational growth without being distracted by daily revenue cycle issues.
Enhanced Patient Satisfaction
Partnering with an RCM vendor ensures transparent and accurate billing processes.
Patients receive timely and detailed information about their financial responsibilities while billing inquiries are resolved promptly — this reduces patient frustration and builds trust in your organization.
Many RCM vendors offer financial counseling services to help patients understand their bills and explore various payment options.
This additional support can reduce financial stress for patients, contributing to higher satisfaction and a more positive perception.
The Challenges of Outsourcing RCM Services
Although partnering with an external RCM vendor offers many advantages, it also comes with its own set of challenges. Make sure to weigh these factors to achieve a successful collaboration.
Data Security Concerns
Partnering with an external RCM vendor may present data security challenges, including the risk of data breaches as sensitive patient information is shared with a third party, potentially exposing it to unauthorized access or cyberattacks.
Integration Issues
Integrating the vendor’s systems with your existing IT infrastructure can be complex and may require significant time and resources.
Hidden Costs
While outsourcing can save costs, there may be hidden fees or unexpected expenses that arise during the partnership.
What to Consider When Selecting an RCM Services Company?
If you are considering outsourcing your RCM services, focus on these key factors to ensure effective revenue cycle management.
Industry Expertise
Selecting a vendor with deep industry expertise and knowledge of the complex healthcare regulations, such as payor compliance, surprise billing, and price transparency requirements will ensure your RCM processes are proficient and compliant.
Look for a vendor with a history of success in the healthcare industry. Their experience should be broad in nature but also include a depth of experience in operational processes and success metrics in the RCM space.
Vendors should have a bench of referrals and testimonials to provide prospective clients to showcase their results. Validate the measurements being showcased and ask questions to drill into the data!
Technology & Integration Capabilities
Using advanced technology and seamless integration by the vendor can help streamline your RCM cycle, improve accuracy, and maintain data integrity.
Ask questions about the technology stack the company uses, including their billing and coding software, claims management systems, and data analytics tools.
Check if the vendor’s systems can integrate seamlessly with your Electronic Health Records (EHR) and other systems to optimize workflows and improve your operations.
Verify that the vendor uses strong security measures to protect patient information and comply with data protection regulations.
Services
A comprehensive range of services ensures end-to-end management of the revenue cycle.
Make sure your RCM potential partner offers various services, from patient registration and eligibility verification to claims submission, payment posting, and denial management.
Ask if they can customize their services to meet your organization’s specific needs and scale operations as your organization grows.
This customization may include adapting billing workflows, implementing specialized reporting functionalities, integrating with existing IT systems, and aligning with the unique compliance requirements of your organization
Personalized RCM solutions can enhance efficiency, accuracy, and overall performance in managing revenue cycles for your healthcare clients.
Results-Driven Staff
Knowledgeable vendor staff can help maximize your RCM process efficiency.
Ensure the vendor’s team includes industry-leading RCM experts with a proven track record in managing healthcare revenue cycles. Read more about why a remote RCM workforce makes sense.
Cost
Understanding the cost structure and potential ROI will help you determine if investing in an RCM vendor is financially beneficial.
Look for a vendor that offers a clear and transparent pricing model to avoid hidden fees that could lead to unexpected increase in cost. Request a detailed pricing structure upfront and thoroughly review the contract to understand all potential costs and billing terms.
Compare the potential benefits — such as increased collections, reduced denial rates, and improved cash flow — with the costs to determine if outsourcing your RCM processes will lead to financial gains.
Look for specific outcomes like expedited payment recovery timelines, increased cash collections, and enhanced operational efficiency.
One critical aspect to consider when selecting an RCM partner is your internal “cost to collect.” This metric reflects the expenses associated with your revenue cycle processes, including labor, technology, and administrative costs.
By examining this internal cost, you can create a benchmark to compare against potential vendors’ pricing.
The goal is to ensure that the RCM partner not only offers competitive rates but also demonstrates an ability to reduce your cost to collect, thereby demonstrating ROI.
Why You Should Choose Healthrise for Your RCM
Healthrise is a trusted RCM services provider with over a decade of experience in RCM. Our company has overseen over $35 billion in revenue and helped over 100 hospitals to pursue their operational and financial goals.
Working with us, you will have access to:
Efficient Operating Systems
Our operating systems are designed to streamline and optimize every aspect of your revenue cycle.
Unlike legacy systems that lack integration capabilities and advanced features, our modern systems offer technological solutions to improve your financial performance.
These systems ensure accuracy, reduce processing times, minimize errors across billing and coding, freeing up your internal resources to focus on other important activities for your organization.
Tailored Front-End, Mid-Cycle and Back-End Solutions
We offer end-to-end solutions that guarantee comprehensive and efficient management across all revenue cycle processes. Using our services, you can expect:
- Front-end solutions, such as registration, scheduling, and financial counseling
- Mid-cycle solutions, such as coding, charge capture, clinical documentation, and case management
- Back-end solutions, such as cash posting, AR management, claims submission, and denials management
Performance
Our partnerships have a transformative impact on our clients’ revenue cycle management.
One of our success stories includes a national hospital with 3,500 beds.
By outsourcing various services from Healthrise — including AR Management, Interim Leadership, Staffing, Process Improvement, and EHR Optimization — they achieved significant results: $20 million revenue improvement in the first year, $17 million cost reduction in two years, and $95.6 million revenue increase in four years.
Revenue Cycle Solutions Services Provided by Healthrise
Still uncertain how Healthrise can help you optimize your revenue cycle and enhance operational efficiency?
Discover some of the services we offer below.
Payment Posting
As an RCM provider, we offer precise and efficient payment posting services, ensuring that every transaction is recorded and updated, reducing errors, and enhancing overall financial transparency.
Benefits:
- Improved cash flow
- Custom solutions that provide a clear financial picture with enhanced accuracy
Hospital and Physician Billing
We specialize in hospital and physician billing services, offering you precise coding, efficient claim processing, and detailed follow-up to maximize reimbursement for the services rendered by your healthcare practice.
Benefits:
- Accurate submission reducing denials and rejections through automated data capture and validation
- Streamlined revenue collection
- Compliance with regulatory standards
- Improved cash flow facilitating quicker reimbursement cycles
Accounts Receivable (AR) Follow-up
Our dedicated AR follow-up services include identifying and prioritizing overdue accounts, speeding up payment recovery from insurance companies and patients, resolving disputes, and maintaining the financial health of your organization.
Benefits:
- Improved cash flow by boosting collections by 10% within one year
- Reduced risk of bad debt
Denials Management
Our comprehensive denials management services cover analyzing the reasons for denials, resubmission of corrected claims, and implementing corrective actions to prevent future denials.
Benefits:
- Increased efficiency
- Reduced revenue loss
- Improved cash flow
Post-Pay Audits
We offer comprehensive post-pay audit services that feature reviewing and verifying claims after payment has been made to ensure accuracy, detect discrepancies and billing errors, recover lost revenue, and implement measures to enhance future billing accuracy.
Benefits:
- Protection against revenue loss and compliance issues
- Improved financial performance
- Dedicated teams with deep revenue cycle expertise
Healthrise has extensive industry experience and a proven track record of delivering impressive results and driving operational excellence.
Based on a deep understanding of the regulatory landscape and of your specific needs, we create personalized RCM solutions that drive innovation and shape the future of healthcare revenue cycle management.
FAQs About Working With an RCM Services Provider
For more insights on partnering with an RCM vendor, explore our frequently asked questions section.
How long does it take to see results from partnering with an RCM vendor?
The timeline for seeing results can vary depending on the complexity of your organization’s revenue cycle, the effectiveness of the chosen RCM provider, and the implementation of recommended improvements.
Make sure you establish Key Performance Indicators (KPIs) and Service Level Agreements (SLAS) to ensure guardrails of success in place before work has been done.
Typically, you will be able to see improvements within a few months after you have started working with the RCM provider.
With Healthrise, you’ll see improvements in your cash flow and boost collections by 10% within the first year.
What questions should I ask RCM providers during the selection process?
When choosing an RCM provider, ask questions about their experience, client references, technology capabilities, services, and pricing structure. Their answers will help you evaluate if the vendors align with your organization’s needs and objectives.
How can RCM providers help optimize revenue capture?
To maximize revenue capture, RCM providers provide accurate coding, thorough claims review, proactive denial management, and effective reimbursement negotiations.
