Healthcare is a challenging and constantly evolving field, and for those who work in upper management — CEOs, CFOs, CIOs, CTOs and others — navigating this complex arena is part and parcel of the job. One of the most challenging aspects of these positions is finding the sweet spot between the quality of care provided to each patient, balancing the cost of delivering that care, and optimizing the organization’s cash flow and revenue.
Managing this is never simple, especially when the cost per patient is continually to soar while more and more hospitals, clinics and practices are forced to cut staff, close services or facilities, merge, or shut their doors entirely. While this is a complex situation exacerbated by serving an aging population and declining reimbursement rates, it can, at least in part, be attributed to inefficiencies across the organization…especially where effective billing and collection operations are concerned.
Sadly, it’s estimated that 30 cents of every dollar spent by a healthcare organization are never actually collected. Also, one fifth of all uncollected funds are attributed to a lack of correct pre-registration processes (including a lack of data integrity) not being met on the front end, and a lack of follow-up often desperately needed on the back end. In other words, it must involve the entire end-to-end revenue cycle process that’s fundamental to ongoing success and which is too often woefully lacking.
In an in-house RCM department, these shortcomings can be caused by retirement of long-time, experienced personnel, burnout and the resultant lag times and costs for recruiting and training. Other factors involve high work volumes; a frustration with work-life imbalance; inadequate processes and IT systems; team members not up-to-date on often hundreds of annual coding changes; and a shrinking staff simply not up to the tasks to reexamine, recode and resubmit claims. This often leads to thousands or even millions of dollars in write-offs, potentially causing the difference between profit or loss…the latter leading to sale or closure.
To help optimize a healthcare organization’s revenue cycle to its fullest potential — especially those opening a new practice or facility — those in senior decision-making positions are increasingly taking a hard look at outsourcing their revenue cycle management operations. By partnering with a proven, trusted third-party expert for part or all of their mission-critical RCM services, provider organizations can focus on spending more time on the foundational aspects of the job: treating patients, optimizing health and, hopefully, saving lives. (Read about the success of just one of the hundreds of Advantum clients.)
What does it mean to outsource RCM?
Outsourcing your healthcare provider’s revenue cycle management operations means bringing in an outside team of experts to handle part or all of your administrative work where billing, coding and other non-clinical functions are concerned. This helps enable your entire team to focus more on directly serving patients instead of worrying about how to you — and they — are going to cover the costs of their services.
It’s important to thoroughly vet any potential RCM companies before retaining their services, as the nature of this work is highly sensitive and requires a great deal of skill and partnership. You want to ensure the team you are considering hiring is credentialed and experienced in dealing with the needs of small-, specialized and even large-scale organizations.
A qualified revenue cycle management partner such as Advantum Health has a deep bench of highly skilled professionals who can support you with comprehensive services such as:
Each one of these RCM processes is a complex task unto itself and, as such, it should only be undertaken by highly qualified, dedicated and experienced professionals. A high-quality RCM company will be certain that all of their staffers are up to date in terms of best practices for medical coding, billing and related processes.
The value proposition for RCM outsourcing
As previously stated, by outsourcing their revenue cycle management operations, healthcare organizations are able to focus more on patient care and other human resource issues that can affect their ability to operate at maximum efficiency and clinical effectiveness. Simply put, many healthcare providers are already operationally strapped and overworked…particularly in what are considered “healthcare deserts” where mission-critical resources are difficult to find and keep. If billing doesn’t absolutely need to be performed in-house, why place that additional burden on your team?
Further, outsourcing your RCM operations typically decreases errors related to medical billing and coding, as well as streamlines and speeds the collections process from patients and their insurance providers. This will help ensure that these funds, a large percentage of which were not being previously collected, will be paid to the maximum degree possible.
In short, outsourcing revenue cycle management is about improving the efficiency of your organization’s operational capacity, but also critical to ultimately improve the lives of patients in your care. Ultimately, the true job of those who work in healthcare is to provide quality care to people and to restore them to optimum health so they can best continue to productively lead their lives. By outsourcing your revenue cycle management, your clinical team can truly focus on the issue that matters the most — patient care and fulfilling your mission to helping deliver the best-possible outcomes.
Want to discuss outsourcing with a proven revenue cycle management partner? Contact us today.