Like most big decisions, it depends. Here are 5 questions to help determine whether third-party billing and coding align with your practice’s short and long-term strategies.
If you are considering a revenue cycle management (RCM) solution for your medical practice, you’re not alone. RCM solutions help medical practices streamline billing and coding, improve efficiency, and increase revenue.
According to a recent survey report co-sponsored by HFMA and Eliciting Insights, 95% of health systems plan to purchase RCM or finance technology this year.
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 to an RCM partnership need to help you achieve your short and long-term financial goals.
5 Questions to Ask When Deciding to Use RCM Services
1. How will you expand your practice in the next 5-10 years?
When developing long-term growth strategies for your physician practice, it’s essential to consider if, when, and how you will grow your business over the next five to ten years.
Key considerations include:
Ownership
For private practices, a cost-effective Revenue Cycle Management (RCM) solution can provide billing support that enables physicians to maintain autonomy.
For the past decade, physician practice ownership has drastically shifted from wholly-owned private practices to larger hospital practices.
The most cited reasons for this change revolve around payers. From negotiating better reimbursement rates to helping manage regulatory and administrative requirements, physicians sold their practices due to the cumbersome hoops they needed to jump through to get paid for their rendered services.
Partnering with an RCM services company that understands a private practice’s specific billing challenges within its specialty can help the physician maintain independence. Access to revenue cycle tools, technology, and knowledge can help insulate physician practices from administrative burdens that can erode revenue and increase costs.
Patient Volume
What are the estimates for patient volume within your specialty? Will your target market(s) grow or contract over the next five to ten 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 may impact the services you offer.
Payer Mix
As more health plans, regulations, and payer rules flood the market, physician practices must keep up with the changes and update their processes and technology to maintain steady cash flow.
Usually, a complex payer mix creates a compelling case for an RCM partner to oversee the payer relationship.
Market Expansion
Multiple facility sites can require you to recruit physicians, clinical staff, and administrative support for 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, authorizations, and new billing codes. The right RCM partner can help boost growth for your private practice.
2. Do you have chronic staff shortages?
Researchers forecast nationwide labor shortages across most healthcare occupations for the next 15 years. These employment gaps are especially troublesome for specialty providers, who often operate with smaller staff and fewer locations to pull resources than their large health system counterparts.
Augmenting your practice’s administrative staff with an RCM billing and coding 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, insurance providers did not reimburse 17% of insured adults for healthcare services thought to be covered by their insurance provider.
Not only does this cause frustration and stress for patients, but it results in wasted time and resources for providers to follow up with payers and get properly paid for the services they rendered.
An RCM partner, like Advantum Health, can make a huge difference for specialty providers experiencing dips in payer payments. With deep specialty billing and coding expertise, Advantum can take on the grunt work while their physician clients can focus on their patient’s care plans.
4. Are you using outdated technology systems to code, bill, and follow up on your claims?
The high cost of replacing technology, particularly a Practice Management System (PMS) integrated with other clinical and administrative software applications, can be a significant financial burden for healthcare practices. However, given the increasing frequency of cyberattacks and the growing complexity of payer rules and regulations, practices must maintain updated technology.
At Advantum, we use a software overlay technology (Advantum Ai) to seamlessly integrate with our clients’ existing and future Patient Management Systems (PMS). Advantum Ai leverages a machine learning model with predictive analytics to provide real-time feedback to coders about a claim’s likelihood of getting paid or denied. This feedback can help coders improve their coding accuracy, leading to increased reimbursements for clients.
Choosing an RCM solution provider with extensive revenue cycle expertise and minimally disruptive technology, like Advantum, can make a substantial difference in optimizing a practice’s financial performance.
5. Do you have a method for reporting RCM metrics and auditing processes?
Without accurate data, it is impossible to target operational changes that will strategically increase revenue capture.
A comprehensive, accurate, and user-friendly data analytics solution enables healthcare providers to assess their revenue cycle performance quickly.
Advantum’s real-time, comprehensive A/R work queue and dashboard give clients visibility into claim denial data. This data enables Advantum’s RCM team to collaborate with clients to prioritize their daily work, reducing denials and appeal turnaround times.
When it comes to billing and coding multiple specialties, not all RCM service providers are equal.
If partnering with an RCM service provider aligns with your specialty practice’s strategy, take the time to research several RCM solutions to understand all of the third parties’ depth of knowledge within your specialty.
When choosing an RCM partner, working with a trusted company with knowledge, technology, and experience in your specialty is important. After identifying a few potential vendors, ask them for client referrals and meet with the operations teams that will support your practice daily.
Conclusion
RCM services can be a valuable tool for medical practices looking to improve their financial performance. Benefits of using RCM services 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 knowledge
However, it is critical to carefully consider your practice’s needs and requirements before deciding.
Specialty providers considering revenue cycle management (RCM) solutions should ask themselves five questions:
- How will you expand your practice in the next 5-10 years?
- Do you have chronic staff shortages?
- Are claim denials and write-offs eroding your profit margins?
- Are you using outdated technology systems to code, bill, and follow up on your claims?
- Do you have a method for reporting RCM metrics and auditing processes?
RCM services may be better choices for some specialties. Practices should consider their particular needs and requirements when making a decision.
If you decide to partner with an RCM provider, choose a company that is experienced in your specialty and has a proven track record of success.
At Advantum Health, we take great pride in our specialty provider billing knowledge and strong reputation in revenue cycle management. Click here to find out more about our approach.