Revenue cycle management (RCM) services aren’t just for primary care clinical practices, ambulatory clinics or even hospitals. Specialty organizations including oncology, cardiology, gastroenterology and others have unique operational and clinical needs. But specialty providers share one universal need: accurate billing and timely reimbursement.
For specialty practices in particular, third-party billing and follow-up, coding, credentialing, authorization, denial prevention and management, and CMS-compliant auditing are often intricate, time-consuming and essential. Managing these aspects efficiently enables teams to stay focused on delivering effective, efficient revenue-enhancing medical services.
If you’re evaluating an RCM solution, you’re in good company. Advantum Health and its diverse client base have repeatedly demonstrated how strategic RCM partnerships streamline this critical part of the healthcare equation while allowing providers to devote more time to patient care.
According to a survey report co-sponsored by the Healthcare Financial Management Association (HFMA) and Eliciting Insights, 95% of health systems plan to purchase RCM or finance technology. This is a clear indicator that organizations recognize the need for more sophisticated, integrated, and scalable revenue cycle support.
While coding and billing practices are generally consistent across modalities, each specialty can have unique requirements and documentation. RCM solutions must accommodate these various requirements to be effective. In addition, the financial and opportunity costs inherent in an RCM partnership need to help you achieve your short- and long-term financial goals.
5 Questions to Ask When Deciding to Engage RCM Services
1. How do you plan to grow your organization in the next 5 to 10 years?
When developing long-term growth strategies, it’s essential to consider if, when and how you will efficiently expand your business. Key considerations include:
Ownership
For private practices or freestanding ambulatory care systems (ACS), a cost-effective RCM solution can provide billing support that enables physicians and other affiliated clinicians to maintain autonomy.
Over the past decade, practice ownership has drastically shifted from wholly owned practices to those now owned by or otherwise aligned with larger hospital- or health system-based provider organizations. The 2024 Physician Practice Benchmark Survey, released in 2025, by the American Medical Association, show that private physician practices now account for less than half of U.S. physicians in most specialties.
This shift is often driven by:
- Inadequate payment rates
- Increasing practice operating costs, including RCM operations
- Burdensome regulatory requirements
The most-cited reasons for this change revolve around payers. In short: physicians are selling their practices due to the increasing number of cumbersome hoops required to get paid accurately and on time.
Partnering with an RCM services company that understands a private practice’s specific billing challenges, regardless of specialty, can help physicians and their clinicians maintain their independence. Access to revenue cycle tools, technology and knowledge can help insulate practices from administrative burdens that can otherwise erode revenue and increase costs.
‘We’re in an era where we’re being paid under contracts that require extremely specific information on what costs and outcomes we’ve provided. Every month during our financial review with Advantum, I can see that our AR numbers keep going down. It’s exciting.’
– Sharon, RN, SVP
Kidney specialist organization
Louisville, KY
Patient Volume
What are the estimates for patient volume within your specialty? Will your target market grow or contract over the next five to 10 years?
For example, with an aging population, if you specialize in geriatric rehabilitation therapy, your potential patient mix may skyrocket over the next decade. In addition, several areas of cross-service utilization in older populations can impact the services you offer and their associated costs.
Payer Mix
As health plans, regulations and payer rules continue to complicate the market, practices must keep up with the changes and update their processes and technology to maintain steady cash flow. With a continuing shortage of skilled RCM staff, a complex payer mix creates a compelling case for a skilled RCM partner to oversee the payer relationship.
Market Expansion
Multiple facility sites may require you to recruit physicians, other clinical staff and both financial and administrative support across different geographic locations. These locations may have different rules and regulations for credentialing and billing.
As your practice expands into more markets, a scalable staffing model becomes critical to managing your administrative costs in the revenue cycle.
Service Expansion
Similar to market expansion, new services can require certifications, prior authorizations and new billing codes. The right RCM partner can help boost growth for private practices.
2. Do You Have Chronic Staff Shortages?
Researchers forecast nationwide labor shortages across most healthcare occupations over the next 15 or more years. These employment gaps are especially troublesome for specialty providers, who often operate with smaller teams and fewer locations to attract and retain skilled staff than their larger health system counterparts.
Augmenting your administrative staff with an experienced RCM billing and coding team can fill these gaps while minimally disrupting operations.
3. Are Claim Denials and Write-offs Eroding Your Profit Margins?
According to a KFF consumer survey, insurers did not reimburse 17% of insured adults for healthcare services believed were covered. This can often be traced to poor preauthorization requirements or coding and documentation errors.
Not only does this cause frustration and stress for patients, but it also wastes time and resources as providers follow up with payers to obtain proper reimbursement.
An RCM partner such as Advantum Health can make a meaningful difference as specialty providers see declines in payer payments. With deep specialty billing and coding expertise, Advantum can take on the complex, time-consuming work allowing you to focus on patient care.
4. Are You Using Outdated (or NO) Technology Systems to Code,Bill and Follow Up on Your Claims?
‘In 2024, we sought a partner well versed in the latest RCM best practices for billing, coding and documentation, all of which impact payment delays or denials and which are constantly changing. We found that with Advantum.’
– Former CEO
Growing Midwest
The high cost of replacing technology— particularly an agingpractice management system (PMS) that may or may not be integrated with other clinical and administrative software applications— can be a significant financial burden for healthcare practices. But with the rise in cyberattacks and the growing complexity of payer rules and regulations, maintaining updated, integrated technology is no longer optional.
Advantum uses a software-overlay technology (Advantum One) to seamlessly integrate with clients’ existing and future PMS platforms. Advantum One leverages a machine learning model with predictive analytics to provide real-time feedback to coders about a claim’s likelihood of being paid or denied. This feedback can help coders improve their coding accuracy, leading to expedited and maximized reimbursements.
Choosing an RCM solution provider with extensive revenue cycle expertise and easily implemented technology and policies such as Advantum can make a substantial difference in optimizing your practice’s financial performance.
5. Do You Have a Method for Reporting RCM Metrics and Monitoring Auditing Processes?
Without accurate data, it is impossible to target and implement operational changes that will strategically increase revenue capture.
A comprehensive, accurate and user-friendly data analytics solution enables healthcare providers to quickly assess their revenue cycle performance.
Advantum’s real-time, comprehensive AR work queue and dashboard provide clients with visibility into claim denial data. This data enables Advantum’s RCM team to collaborate with client organizations to prioritize their daily work, reducing denials and appeal turnaround times.
Not All RCM Solutions Are Created Equal
Simply put, Advantum Health has demonstrated that when it comes to billing and coding multiple specialties, not all RCM service providers are equal.
If partnering with an RCM partner aligns with your specialty practice’s strategy, invest time in evaluating several options to understand each provider’s expertise and documented outcomes within your specialty.
When selecting an RCM partner, Advantum and its clients — across a wide range of specialties — recommend working with a trusted company with knowledge, technology and experience in your specialty. After identifying a few potential RCM service providers, ask for client referrals and meet with the operations teams who will directly support your practice.
Benefits of RCM Services
RCM services can be a powerful tool for medical practices looking to improve their financial performance. Key benfits include:
- Streamlined billing and coding practices
- Improved efficiency
- Increased revenue
- Ability to focus on patient care
- Reduced administrative burdens
- Access to revenue cycle tools, technology and expertise
However, it’s essential to carefully consider your practice’s needs and requirements before deciding.
RCM services are often the strongest option for many specialties, especially markets facing persistent staffing shortages. Advantum Health has a proven track record of optimizing revenue cycle operations for specialty practices, ASCs, hospitals and health systems.
Click here to find out more about Advantum’s approach and the outcomes we help clients achieve.