Managing your practice’s revenue cycle can be one of the most time-consuming and complex parts of running your business. If you are spending more time managing revenue then you are managing your patient’s health, it’s time to engage with a revenue cycle management company. Because RCM companies focus solely on revenue cycle management, they are equipped with the technology necessary to automate processes and increase efficiencies, ensuring coding, billing, and follow-up happen quickly—resulting in faster physician reimbursement and minimizing lost revenue. Many RCM companies also provide value-added services such as contract management, credentialing/provider enrollment, insurance eligibility, and many other key areas that can help your practice gain greater control over the revenue cycle without expending more resources and manpower. The key is finding the right revenue cycle management company for your specific needs.
Before reaching out to potential RCM partners, you will first want to do an internal needs assessment. Look at each of your billing functions and pinpoint the areas where your practice struggles. You’ll want to select an RCM partner that meets all or almost all of the functions you require to seamlessly complete your revenue cycle—taking into account coding and billing, denial management, patient customer service, collections, compliance, and any other key areas affecting your bottom line.
Once you’ve determined your practice’s needs and matched them to a handful of potential RCM partners, you’ll want to evaluate and compare competitors according to your specific criteria. In addition to asking questions that are specific to your practice’s needs, it will be helpful to your decision-making process to have the providers answer the following questions: Scope of Services
- Do they offer automated insurance eligibility verification?
- Do they have an automated claims scrubber and comprehensive rules engine that is payor specific?
- Do they follow up on denied claims?
- Does the firm have a threshold dollar amount for follow up efforts?
- Do they monitor payor contracts for underpayments and assist with the appeals process?
- Do they offer appointment reminder notifications via phone, text, and email?
- Do they offer point-of-care collection tools (check scanning and credit card processing)?
- Do they offer a patient portal (scheduling, record retrieval, electronic statements, and online payment options)?
- Does the firm send patient statements (paper/online)?
- Will the firm manage patient calls/inquiries?
- Are they equipped to interface with your EMR programs after implementation?
- What are their security measures and protocols?
- Is the organization HIPPA compliant?
- How is the system hosted?
- Will your practice have to maintain and update software or is their system cloud-based?
- Will you have visibility into all of your data?
- Does the technology allow for real-time updates/releases?
- What KPIs (key performance indicators) does the firm track to ensure your practice is successful (AR, adjustment yield, charge and bill lag time, first pass rate, CCR, patient AR)?
- Do they offer a dedicated account executive and support team?
- Do they offer performance coaching and reporting?
- Do they offer in-depth training programs?
- What is their pricing model (fee-for-service, percent of collections, or other model)?
- Are there any hidden fees or extra costs?
- Does training cost extra?
- How long have they been in business?
- Do they have a proven track record?
- Are they experienced in your specialty? How many clients?
- How many claims/bills do they process annually?
Ask for References
Once you have narrowed the field to your top 2 choices, it is time to do a reference check. Ask for case studies and a full list of references. Take the time to call and interview as many of the provided references as you can. Past behavior is the best indicator of future performance. Finally, make your selection and start the implementation process!