What is RCM Outsourcing?
Healthcare revenue cycle management outsourcing (RCM) encompasses the processes behavioral health systems use to bill for services and generate revenue. It captures all time and services provided to each patient, establishing workflows for each step, and the payor’s acceptance of the final payment.
Outsourcing RCM is contracting with a specialized service to handle all aspects of accounts receivable completely – a streamlined process covering therapy and medical billing, coding, and other non-provider-related tasks. This strategy helps ensure accurate coding, prompt revenue collection, improved cash flow, and financial viability for the organization. It allows for more focus on patient care and practice growth.
RCM Elements
RCM services should include a high-touch, advanced-accountability approach. It’s vital to have an outsourcing organization that’s all-in with commitment. Ultimately, creating a practice’s comprehensive billing service.
These are full-service elements to look for:
Dedicated Account Management – The value of this is in the insight and financial backstop the RCM service provides. They review a practice’s medical revenue with weekly calls to discuss status, concerns, and ambitions. The Account Manager reviews the RCM processes to reduce claim denials (target: sub-2%) and collect payments efficiently. They’re on top of changes from the Centers for Medicare & Medicaid Services (CMS), supplying strategic advisory services. They compile complete, continuous revenue activity reporting.
Claim Denials Reduction – This encompasses having the option of RCM specialists managing the entire claim denial process or providing recommendations to fix individual denied claims submissions. With both, there’s help to create overall fiscal improvements increase revenue, improve cash flow and impact growth decisions.
Patient Services – Eligibility checks through the clearinghouse based on demographic information, authorizations run for multiple visits for treatment planning, and statement delivery on behalf of the practice.
RCM Considerations
These considerations are factors indicating when practices should evaluate outsourcing RCM:
- High Staff Turnover in a Tight Labor Market
In most practices, staff members are tasked with multiple responsibilities throughout the organization. With billing and RCM, knowledge and experience are necessary for the business to operate appropriately. If a practice is experiencing frequent staff turnover, there’s a good chance RCM is taking a significant hit – given the steep learning curve associated with medical billing and coding.
By outsourcing RCM services to a third-party company, the practice’s staff transition won’t jeopardize payment collections and overall revenue integrity. Instead of constantly teaching staff the ins and outs of how the organization handles medical billing and coding, management can be assured knowing the RCM tasks are being addressed by experts who focus on these financial aspects of the business.
- Regulatory Challenges Becoming an Increasing Struggle
Regulatory changes, including both state mandates and federal edicts, have significantly affected the day-to-day tasks of behavioral healthcare. With the myriad of compliance issues to monitor, a lack of understanding of these challenges will likely result in regulatory complications and fines, negatively impacting revenue.
Third-party RCM services feature teams of medical coding and billing experts, to mitigate risk and protect practices from suffering losses in revenue due to compliance challenges.
- High Payroll Creates Need to Reduce Costs Without Compromising Care
A common myth about any outsourced service of a mental health or medical practice is that it’s more expensive than employing an organization’s own people to shoulder the load. That’s rarely true. With RCM, on-staff experts are expensive and increasingly difficult to find.
If the financial burden of a practice’s overall staffing has grown uncomfortably high, outsourcing RCM duties is a step in reducing costs while gaining expertise. This optimized billing approach achieves a revenue increase as a welcomed byproduct.
- More Patient Time – Less Administrative Burden for a Growing Practice
As mentioned above with the influx of regulatory challenges, more time is being spent on various RCM aspects than ever, taking away valuable patient interactions. The shift toward value-based reimbursement models has made quality patient relationships the foundation of a successful and profitable practice.
Outsourcing RCM services will help a practice focus on its priorities – helping those who need behavioral health services. While revenue is required to fulfill that mission, seeking assistance from those who specialize in that field is a fiscally healthy way to go.
How to Outsource RCM
Having a company steeped in behavioral health operations knowledge is the goal when selecting an RCM partner. Understanding the particulars of this healthcare industry specialty makes the difference – mapping and streamlining workflows that reflect a practice’s particular processes is key to efficient and accurate receipt of revenue. Qualifacts’ InSync Healthcare Solutions, an EHR systems provider, built its RCM service with direct input from behavioral health professionals, understanding their business and care models. See their RCM services capabilities here.
