You can’t undermine the importance of an effective revenue cycle strategy, as that could be the key differentiator between a financially successful practice generating regular and timely reimbursements – adding money to your business account versus everything else you don’t like in your reimbursement cycle such as claim rejections, poor denial management, coding discrepancies, increasing average AR days, etc. leading to poor financial performance.
Outsourcing your RCM could be the best strategic decision, and like all big decisions, this also requires critical thinking. Teaming up with someone for the better part of our practice requires a good amount of discussion; here are nine key questions to help you get closer to the partner of your choice.
- What is your denial management strategy?
Denial management – it’s daunting, devours time, and is usually the primary reason you seek professional help. You don’t want to leave this money on the table and thus you need to know what different strategies the RCM vendor is able to implement to ensure that this obvious pitfall can be prevented.
- Do you offer training during the onboarding process?
The onboarding process involves lots of coordination and demands a great deal of knowledge sharing between the two teams; after all, “sharing is caring”. Your billing vendor should be open to educating and training you and your staff to optimize your existing workflow for improved efficiency instead of imposing their set processes which may not even be in sync with your existing billing practices.
- What KPIs do you measure to ensure performance improvement?
Your RCM vendor must-have criteria to measure its performance, and that’s where Key Performance Indicators are crucial and play a vital role. You must ask for specifics in the KPI as it could range from keeping a tab on Clean Claim Rate and Average AR to Net Collection Percentage and Resolution Rate.
Most of the modern billing software are capable of creating customized reporting to pull this type of data. Still, you should also inquire if they use additional resources and proprietary technology to analyze and create actionable insights.
- Do you provide dedicated account management?
You don’t want to deal with multiple representatives when seeking answers to your billing queries. Instead, a dedicated account manager would be your single point of contact, able to answer any questions related to your billing account – this adds a lot of conveniences and puts confidence in the system.
- How do you keep up with changing trends in reimbursement scenarios?
“Change is the only constant” modern RCM vendors are going global to leverage the economy of scale. Try to identify how they keep up with industry changes, new regulations, and guidelines with their local and global teams and what affiliations they have with industry experts.
- How do you control underpayments?
It’s a no-brainer to identify a rejected, denied, or non-paid claim; however, insurance companies also underpay claims which may appear just fine to untrained eyes. Try to identify the billing vendor’s measures to identify such underpayments. For example, do they have a proprietary billing system that identifies them, or do they review the payor contracts? This could add significant value to your bottom line.
- How do you ensure total transparency and control to your clients?
Transparency is the ability to see through, and often providers find themselves unable to see through patient claims after they’ve outsourced their billing. Even if you choose to outsource your billing to your EMR vendor, you don’t get the same level of transparency and control you had when you were doing it in-house on the same platform.
Medical billing companies who often work as an extension of your in-house teams would allow you to keep total control and won’t migrate PHI to different systems where you don’t have much control over things.
- What are the additional services you offer around RCM?
RCM vendors may offer different bundled packages covering a list of services in their pay for performance model, the percentage they quote may vary significantly, so please pay close attention as added services could relieve your staff from additional work and justify the additional cost added by the vendor.
- What’s your performance review process with clients?
Performance review meetings are there to justify the service viability. This could be a quarterly, monthly, or bi-weekly exercise where your vendor creates specific reports and dashboards representing meaningful data with actionable insights shared with management, allowing them to view the ROI and make strategic changes in navigating their service portfolio.