What a Practice Should Consider When Making a Change in Revenue Cycle Partners

Considering a new RCM partnerSwitching Revenue cycle partners is a big decision for practices. But with many legacy systems limping along with outdated technology and the ICD-10 conversion looming, it is something that many practices will need to actively consider if they would like to remain viable and profitable. When a practice is considering partnering with a new revenue cycle partner, a number of considerations usually come up.

You should understand how long the transition period will be and how long it will take your new partner to begin submitting claims. The answer to this question depends on various factors including whether or not you will be interfacing your new revenue cycle management system with an existing or new EHR. While in most cases it won't make any sense to try and move line item level detail or even insurance plan data (tends to be very messy in most legacy systems), transitioning basic patient demographic data is generally a good idea to reduce the data entry burden. The longest part of the process tends to be enrollment with the payors for electronic submission of claims through your new partner. Although this process has improved in recent years with more electronic submissions permitted, there are still forms to be filled out and - in some cases - "wet" signatures still required. It is important to understand effect what steps you’ll need to take, and steps the billing service will need to take, to complete the process. If you are starting a new practice from scratch, that simplifies the process somewhat. You will also need to allow sufficient time for testing the electronic connections between your service and your payers.

Another consideration is how to handle existing AR so that cash remains strong during the transition. Generally speaking, it’s most efficient to make a plan to manage your existing A/R before switching to a new RCM partner. If you are currently managing your billing in-house, you can do this by maintaining staff and incenting them to collect the receivables (e.g. a bonus tied to amount collected) or by crafting an agreement with your legacy provider that gives them incentive to work all your claims through to close. Although most billing companies commit to doing that, it is important to stay on top of the process to make sure effort doesn't fall off. Your new partner may be able to take on existing A/R under a separate agreement from your main contract, or they may be able to recommend a local contractor who can help your practice work through its current receivables backlog if your current arrangement can't be extended. Starting fresh with new claims that can be managed from start to finish by your new partner will minimize the risk of previously submitted but not paid or completed claims slipping through the cracks. This means you’ll have two different billing processes running in parallel for a period of time.

You should also consider the transfer of your data. If you are working with a reliable vendor, your data will always be your data. You should review your contract with your current software or service provider and ensure that there are adequate provisions for the transfer of data. You should also ask about the process of exporting data, the format(s) it will be available in, and what kind of timetable would be required to receive your data.

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