Revenue Cycle Management Blog | GroupOne Health Source

How to Evaluate Revenue Cycle Management Companies

Written by Arun Murali | September 3, 2013

Are you thinking about outsourcing your revenue cycle management (RCM) services to a third party vendor? Welcome to the party!  Increasing pressures on physician groups to lower operating costs is forcing them to look at outsourcing options.  Well, outsourcing is nothing new and companies on-shore and off are saturating the market with thousands of options - one of which could be right for you.  

Making the correct decision is imperative or else you might go through several billing vendors before you find the right one for your unique billing situation. Comparing vendors based on price is easy, but are you equipped to evaluate other factors in the billing agreement that makes the overall cost to your group effective?
 
There are many options and paths, but before you make a decision you should determine your values, your practice objectives, and how involved you want your vendor to be in both.  Here are a few things to consider when deciding which path is right for you:
 

1) Practice Advisors or Practice "Participants"?

The term partner is overused, but the basic notion behind the word is a vested interest in what the other partner is hoping to achieve.  

It is easy to be vested as an RCM company. Since most companies charge a percentage of collections, the more you make in your business the better for the vendor. However, what are the goals for the practice?

Companies in the market today can range from the small community shops to the large publicly traded multi-national companies. Pricing doesn't vary too much in most cases - after all, billing has long been a commodity.

However, the recent trend in healthcare has led to a more focused sense of outsourcing. While there are companies out there that will simply provide services, (doers) there are others who have billing experts serving as the de-facto billing manager for your practice.

Keeping costs down means trimming the fat off your operation, and office administrators and billing office managers are a luxury that are simply difficult to afford in today's environment.  

Consider whether you are going to manage your RCM process and stay tuned into your practice performance.  You set the goals - will you be tracking how you are doing?

2) Can you get in touch?

If you have or have had the luxury of your own billing office, especially one in your physical location, then whenever there was a concern, you could run down the hall and talk to the billing team about it.

You might have weekly or monthly meetings with your billing team where you could discuss results, trends, and indicators that help keep your goals on track.

How important is being able to stay on top of the business performance of your practice? If you want to stay in the loop and have control then it is vital that you have that same relationship, those same meetings, with your service provider.

Your billing company should have clear contacts that will go over performance and key indicators with you on a regular basis so that your practice performance never stutters.

If things are trending the wrong way, you should be able to make the call that will turn things around. If you don’t have clear representatives that will go through that information with you, how will your problems be resolved?

If you have that clear contact for the regular discussions, that might still not be enough. What about the daily questions you have? We can never be sure of when an issue comes up and in urgent cases will there be someone on the other line that can help?  

When you are evaluating billing service providers, be sure of what you want to do when those urgent situations take place. Will you have people "in-house" to troubleshoot issues, or will you need that assistance from your billing vendor?

3) Domestic vs. Off-Shore Operations

There is a trend in the industry today where off-shore companies are acquiring US billing companies at a fast pace.  This is a trend that is likely here to stay.  

The opportunity for growth in the outsourcing market is improving drastically, but US vendors no longer have the human resources to scale to the needs of clients.  

Off-shore companies become vital contributors to the RCM process because of this issue.  The most important thing when dealing with the on-shore versus off-shore debate is to determine whether your values are compromised by going overseas.

Stay away if you don't believe in the ethics of the off-shore vendor, or are skeptical. The feeling of knowing you are compromising your ethics, even if the price is right, might be too big to overcome. 

If you are comfortable with an off-shore vendor, and you are considering the option, then make sure you do your due-diligence.  Who will you speak with daily? Who will your escalation point be? Will they be able to answer your questions accurately and in a timely fashion?

There are incredible companies out there with off-shore operations either entirely or partially, and the talent they employ is remarkable. However, there are others who will undercut price simply to win your business, and knowing what matters more to you will help you build a successful practice.

It might also be appropriate for you to find local vendors who have overseas connections or contractors which can allow you to work with your local folks who can absorb your business easily.  

Better yet, there are companies with a combo of both resources giving you the ideal service and price you expect.

4) HIPAA Compliance

What is your vendor's compliance strategy?  With omnibus looming, Billing Companies are liable to HIPAA violations more so than ever.  Business Associates who could hide behind their covered entities now have an obligation to be compliant or face penalties.

That doesn't mean that your covered entity can shift blame, but that risk is something that needs to be weighed heavily.  Ensure that your vendor is aware of the new rules and is ready to protect the privacy and security of your patient records.

5) Complete or Partial Billing Services

There are all sorts of billing service providers in the market, and many of them are experts at individual pieces of the RCM process. Some are better coders. Some are better billers. Some are worthy technically. Some are not. There are many with combos of both and fewer still that have all the necessary components.

Make sure you consider all the parts that need to be done and which parts are left over.  Then decide, for the parts that are left over who will handle them.  For instance, who is responsible for fielding the calls of your patients when they have questions about your bills?  Can your front office staff handle that responsibility?  

Patient balances are a crucial part of the collections that your practice will recognize.  Quickly resolving patient balance issues can determine the degree to which your practice can be successful.  

If your service company can provide this facility, find out what information they track and how the info they gather can help your business.  

Any opportunity that you have to connect to your patients will give you the feedback you need to build a better patient service experience. Where else is this important to you in your RCM process?

6) Resourcefulness

This might be a rather vague topic, but let’s look at it more closely.  

If you are looking to a service provider to help you with your RCM process, then are there other parts of your business process that might need that same type of assistance?  How efficient is your practice? How qualified is your staff at utilizing your technology? Is your technology going to serve as a platform for your success or is it lacking a few features?  Do you have all the tools that will allow you to be a more profitable practice?

If your RCM Company is going to be an advisor, then it should be able to point you in the right direction for other tools and business processes that can help improve your bottom line.  

In the end, you might have all the info and resources you need to expand your practice performance, and for you, a simple RCM company may suffice.  

But if it helps to get connected to others that can help you be more profitable, find a service provider that goes above the average revenue cycle management of your practice to help you succeed daily.

7) Use of an Integrated EHR System (EMR and PM)

If you are already using electronic health record software at your practice then you are aware that it not only takes time to learn how to use it but also how to use it to its full capacity. 

When considering your revenue cycle management, is your team going to have the right experience needed and what you expect in order to get claims out the door? “Right” experience meaning with electronic medical records. Is the billing expertise primarily from the paper days or are they capable of success through the use of EHR software?

It is also important to consider how you are going to manage your workflow if your office staff will be using one system at the practice and the billing company using another software to submit claims. 

How will you access the information on your claims if it is not the same system you have at the practice?  Will the use of another system cause a delay in your practice getting paid? 

An integrated software will keep your practice on task by allowing information to flow seamlessly throughout the system therefore reducing the need for double entry and ultimately saving you time. 

Choosing a billing company that is willing to provide the service on your practice’s EHR will give you the transparency you need to your claims and hold the appropriate teams accountable.

Like airlines, restaurants, and gas stations, there are nearly unlimited choices for you when looking for RCM vendors.  Similarly, there are a variety of flavors that you can choose from that will suit the specific needs of your practice.  

Be clear on those key factors and look for the experts out there who can help you work through concerns.  Awareness of your financial goals makes an enormous difference, and communicating those goals to your billing company can only help. So, be selective and be clear on how to define success, because that could be the difference between success and failure. Your service company should be vested in your success.