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6 Signs It’s Time to Outsource Your Healthcare RCM Services

Healthcare organizations and professionals have come to anticipate rejections & errors in reimbursement all throughout the healthcare revenue & medical billing cycle.

Errors and bottlenecks are more likely to arise during periods of transition, such as the shift towards value-based healthcare.

Several hospitals have recognized that completely or partially outsourcing the healthcare RCM services is a really cost-effective strategy to simplify the shift towards value-based healthcare. Partnering with a third-party healthcare RCM service provider can also provide additional customer relations benefits.

How can you determine if outsourcing your healthcare RCM services is a good idea? Acknowledging the difficulties is the very first step.

6 Signs: How to Decide If You Need to Outsource Your Revenue Cycle Management Healthcare

1. Poor registration & collection worklists: When worklist pieces are missed or incomplete such as precluding eligibility signatures, never seeking funds upfront, not getting authorizations for treatments, not obtaining patient insurance details, or following up on claims, the healthcare revenue cycle can crash before the procedure even begins.

2. Revenue dwindles: There are multiple factors that influence the practice revenue outflow such as new employees, extra training, new procedures, and declining net income revenue.  Holding a large credit amount in accounts receivable could also lead to sustained declining revenue. Another red flag is repeated underpayments by insurance companies.

3. Inability to establish price transparency: Patients are customers and like any average consumer, they prefer to know their out-of-pocket expenses upfront. Any patient who is shocked by charges is inclined to turn into a patient who is sluggish to pay.

4. Failure to collect patient/insurance costs electronically: Inside a technologically advanced, consumer-driven economy, paper-based money transfer not only fosters inefficiency but also carries all the cons of such method such as the possibility of paperwork being misplaced or stolen, and the process could be slowed by missing paperwork.

5. Frequent coding errors: With codes updating quarterly and getting more detailed, an overburdened medical billing team combined with an antiquated charging master/code system is a formula for devastation at all stages of the healthcare revenue cycle.

6. Claim payment delays: Claim delays and reluctant payers hinder you from receiving payment. When claims are frequently not paid during the first pass and major gaps occur between treatment completion, invoicing, or payment, you require assistance.

Outsourcing Healthcare RCM Services Can Help in 3 Ways:

1. Access to skilled and knowledgeable RCM experts: A dedicated healthcare RCM service provider has one task and one purpose only – to ensure that everything is in line and precisely documented (service delivery, eligibility, patient data, etc.) with the goal of ensuring that you receive all payments due.

Most of these frequent difficulties develop solely because the provider’s in-house billing team lacks the time to focus on all the daily aspects of healthcare revenue cycle duties. For smaller facilities, attention lapses become particularly challenging. You could eliminate a lot of the minor mistakes that can result in larger issues by simply outsourcing the more minutely detailed work.

2. Enhancing the RCM process transparency:  A reliable revenue cycle management healthcare partner will work inside the facility’s system. All of this visibility enables the providers to observe everything that happens with each profile, claim, and payment. Along with continuous reporting, the implementation of outsourced healthcare RCM services gives further assurance. Your partner could concentrate on doing thorough research required for you to be paid and remain compliant.

3. Strengthen the healthcare revenue cycle process: The success of the healthcare revenue cycle involves equal parts of human resources and technological resources. Clinics can minimize medical coding/billing and charge entry mistakes that result in rejections by calling in a healthcare RCM services professional to assist in verifying that systems are correctly set up and users are utilizing them in the manner they should be thereby linking humans and technology.

There are several indicators for a practice that their medical billing and coding may require the assistance of a dedicated revenue cycle management healthcare provider. The ones discussed above are only a handful of the most popular or easily identifiable.

Finding the root of RCM issues might be difficult at times or necessitate a lot of time away from other important RCM activities. If you recognize you have difficulties but don’t know what’s causing them, hiring a third party to perform an RCM assessment is a good first step.

Picking the Best Revenue Cycle Management Healthcare Partner

A practice should search for one thing in particular: “Partnership”. The advantage of outsourcing healthcare RCM services in terms of commitment, transparency, & streamlining will be evident if your provider of choice addresses the problem as more than just a committed specialist but instead as a member of your workforce.

Speak with our professionals at Practolytics by emailing us at [email protected] or calling (803) 932-9624 (or) (678) 940-8115 to discover that standard of partnership and also get your RCM on track to all-time high claim clearance. Utilize our healthcare revenue cycle solutions for your, the practice’s, as well as the patient’s benefit.

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