What to look for in a RCM Revenue Cycle Management partner or provider?

RCM, or Revenue Cycle Management, is a process used in healthcare facilities. It involves many sub-processes, such as:

• Handling check-in for new patients
• Conducting background checks of patients
• Checking for the insurance coverage of patients
• Investigating the reasons behind insurance claim rejection
• Suggesting ways to work around claim rejection
• Scheduling appointments
• Monitoring the progress of patients
• Collecting payments from patients

The process tends to be very extensive for medical organizations. Therefore, most organizations hire external RCM partners. These partners are given the responsibility of handling one or more of the above tasks. The main aim and focus of RCM outsourcing is to help the facility achieve a break-even point between cost and quality. On one hand, the focus needs to be leaving customers satisfied with the services provided to them. On the other hand, this is a business which means you have to cover your hard costs internally and maintain an overall profit margin.

Therefore, having an RCM partner allows to you have peace of mind knowing that the business aspect of the healthcare provision is covered.

When looking for a potential RCM partner, evaluate the cost to collect, which determines your return on that investment. Since the RCM partner is assigned the duty of managing finances, they need to be good at their job. They must be able to get high collection rates. Only by doing that will they be able to maximize the net revenue for the medical facility.

The second factor is the pricing policy of the potential partner. Many companies charge their clients per claim. Therefore, these might prove to be quite expensive. Also, the charges of multiple potential RCM providers should be compared. The prices of these companies may vary greatly. This may be due to the scope of the services provided by the partner. Therefore, your available budget may play a critical role in the selection of a partner. The terms of the contract between the facility and the partner must be decided accordingly as well before engaging.

The degree to which a partner is ready to be involved in the entire process also matters. It has been observed that most medical companies only require RCM partners for managerial purposes. They need some external party to manage the process and give suitable, relevant advice. An RCM partner needs to be aware of each patient’s records. They should be able to decide what action to take in each specific patient’s case. In case of denied insurance claims, the partner should be able to provide the appropriate solutions. This can only be done if the firm in charge analyses the reasons behind claim rejection in depth. The partner must also be able to carry out comparisons between current and past data. This could reveal critical information about the trends in those rejection cases.

An RCM partner is also responsible for providing dynamic reports based on real-time data. Static reports are based on historical data which may or may not be relevant. Dynamic reports allow firms to take immediate action as needed. The RCM partner should also be able to provide insight into the maximum number of key performance indicators (KPIs). These are factors which determine whether a healthcare organization is meeting business goals or not.

Other factors in the process of recruiting an RCM provider include:

• Efficiency
• Ability to deliver
• Use of RCM management software
• Quality of service
• Compatibility with the facility’s current system

In order to pick the best partner, a combination of these factors must be considered. You should then choose the company which seems to be closest to your companies requirements.

For a consultation regarding the RCM of your organization contact MC AnalyTXs today!