5 Signs You Need to Outsource Your Revenue Cycle Management

Nov 27, 2018

Should you outsource your revenue cycle management operations? Here are five signs that you may benefit from doing so. 

Last year, Black Book discovered that the revenue cycle management outsourcing market is growing 42 percent annually

Should you follow the path of other hospitals and work with an RCM partner? It depends on what your current RCM process looks like. Here are five symptoms that indicate you should outsource: 

1. You Can't Get Costs Under Control 
If you consistently struggle to reduce your hospital's RCM costs, seek partners capable of identifying processes that stress your budget, such as:
  • EHR redaction: Removing sensitive information from patient health records before sending them to payers.
  • Utilization review: Reviewing the services the patient received and assessing which payers should reimburse the hospital for those treatments. 
  • Point-of-service registration: Gathering information from the patient regarding how he or she sustained an injury as well as confirming coverage.
Inefficiencies and redundancies may exist across these and other RCM steps, but your in-house staff likely neither has the time nor perspective to clarify and rectify such issues. 

2. RCM Technology Can Do More Harm Than Good 
Some RCM applications do introduce recognizable improvements, but there are also many that exacerbate hospital revenue cycle challenges.

For example, after you buy a license to use an RCM application, it may be up to you to train people how to use the software. In addition, the system itself may force your department into a workflow which does not complement existing operations. 

The point isn't to avoid RCM technology altogether. Instead, you simply need to carefully assess which technologies are the best fit for your business. Here are a few questions to ask:
  • Does the provider offer consultation in addition to RCM technology? 
  • Is on-site training a part of the agreement?
  • Can the provider assist you with installing the software?
"For every complex denial, the average institution spends $5,427."

3. Workers' Comp Frequently Deny Claims 
The tricky thing about managing workers' compensation claims is that each state has different fee schedules. On top of that, in-house A/R departments have to navigate jurisdictional payment problems and the manner in which workers' comp providers (WCs) structure policies.

As a result, many in-house teams don't know what sort of information WCs need to deliver reimbursement. Denials can add up quickly, too.

A survey from the American Hospital Association analyzed the average costs hospitals typically encountered when handling recovery audit contractor denials. The research found that for every complex denial, the average institution spent $5,427. That's more than twice of what it costs to treat a broken leg without insurance, according to Cost Helper. 

4. Your Time-to-Collect Rate is Long 
If it takes a long time for you to receive reimbursement from payers, you're not alone. Black Book found 96 percent of RCM leaders working in hospitals experienced inefficient billing processes. All of the survey participants maintained that they chose to outsource their RCM processes due to excessive time-to-collect rates and dropped collections. 

RCM partners reduce time to collect by:
  • Understanding payers' legal obligations under statewide regulations. 
  • Validating patient information post-registration and pre-billing.
  • Tracking claims metrics and spotting inefficiencies. 
  • Leveraging existing relationships with payers. 
  • Repricing claims based on fee schedules or contracts. 

5. You're Launching a New Practice 
Are you a physician opening up your own practice? All of the physicians who participated in the Black Book study said they were seeking to outsource their billing and claims management operations. 

Why not manage it yourself? Treating patients is what you know best. As you probably know, receiving reimbursement isn't as simple as sending a bill to a payer.

This is especially the case in circumstances where a resident from another state gets into a car accident. Determining which auto carrier to bill isn't something you have the time to deal with, especially on top of all of the other demands associated with your business. 

Outsourcing is usually a solid option, but be critical of the RCM partners you vet. Make sure the individuals behind their operations know how to handle the nuances you can't afford to tackle on your own. 
By doug 22 Jul, 2020
In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike. Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online. Direct accessibility With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities. "Data analytics harvests insight from seemingly unrelated details." Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly. Shorter cycles Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital. "From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible." The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices. PROMEDICAL's benefits With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features: Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster. Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis. Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board. Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics. Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.
By doug 02 Mar, 2020
According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue. For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance. How do Lyft and Uber insure drivers? Lyft has three types of coverage within its insurance policies: Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury. Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle. Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible. For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger. What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills. Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.
By doug 28 Jan, 2020
With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete. "Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it's mostly about bad debt avoidance. With that in mind, there are a few specific points." Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes: The benefits of an optimized approach By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach: Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance. Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time. I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review. Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.
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