The Ultimate Checklist for Picking the Right Revenue Cycle Management Partner

Revenue Cycle Management

An excellent Revenue Cycle Management (RCM) system enables a healthcare organization to manage finances effectively. But, for it to work, you need the perfect implementation strategy that will produce desired results at the most cost-effective rates. Most healthcare businesses outsource revenue cycle management services to reduce implementation and administrative charges. 

Offshoring RCM services come with a ton of benefits. It enables healthcare service providers to focus on value-based care initiatives while cutting costs. To obtain the desired outcomes, you need to pick an RCM partner best-suited to your business needs. 

Here is a comprehensive checklist that you should abide by before offshoring healthcare BPO services:

  • Industry Experience

Before outsourcing revenue cycle management services to a partner, do thorough research on their services and their industry performance. It is best to opt for a healthcare BPO service provider with 5-10 years of experience in all aspects of medical billing and transcription services. 

  • Customized Fee Structure

RCM vendors offer a range of pricing options. Choose a partner that allows flexible pricing modules. The safest bet is to opt for a service provider with a performance-based fee structure. Such vendors are more likely to deliver on their commitment.      

  • Days in A/R

It is an important parameter to consider before you offshore revenue cycle management services. Days in account receivable the time taken for claims to be paid. Long wait periods are detrimental to your business cash flow. Opt for an RCM service provider that sticks to the industry benchmark of 33 days. 

  • CCR Ratio

The Clean Claims Ratio (CCR) indicates the percentage of claims paid at first submission. The higher this ratio, the faster you get paid. Also, a high CCR ratio reduced the time spent analyzing and re-working on denied claims. Before outsourcing revenue cycle management services, make sure your service provider offers a CCR ratio of 75-80%. If the ratio shoots above 90%, you may rest assured that your RCM partner has a robust strategy in place. 

  • Denial rate

It is yet another crucial KPI to look at before selecting a healthcare BPO service provider. This ratio will give you an idea of the percentage of claims denied. The higher the CCR ratio, the lower will be the denial rate. These two numbers work in tandem to give you the clarity you need before hiring a vendor. 

  • Net-collection Ratio 

This figure is the best indicator of collection successes. The net collection ratio highlights the actual efficacy of a revenue cycle management system or the lack thereof. It reflects on the number of claims denied or unreimbursed and other factors affecting the revenue. Take this crucial parameter into consideration before deciding on an RCM partner. 

  • Automated Verification

Verifying insurance for every application is an important part of revenue cycle management services. Before farming out revenue management cycle services, ensure that your service provider is technically sound. Ideally, they should have RCM software that allows for automated insurance verification. It will save time and reduce the chances of human errors. 

  • 72-hour Pre-authorization

Ensure that your RCM service provider obtains 100% pre-authorizations. The general practice is to confirm pre-authorizations at least 72 hours before upcoming appointments. Keeping this time buffer will ensure that glitches if any, get resolved before time. If not, you’ll have the window to reschedule the appointment while scheduling a new patient in the now available slot. This way, you can maximize revenue for your healthcare center.

  • Reliable Co-payment collection

Ask a potential RCM service provider about their co-payment collection procedure. Your RCM partner should use appropriate technology to facilitate payments via various payment options. 

  • Accurate Clinical Documentation

Does your RCM partner provide medical transcribing services? They must do. Clinical notes form a crucial part of the billing process. And accurate medical transcribing services enable physicians to cater to more patients. It does not only save time but also increases revenue. It allows you to focus on the more important aspects of running a healthcare center. 

The Conclusion

Outsourcing healthcare BPO services is the best bet for healthcare service providers to keep up with medical billing and revenue cycle management procedures. By offshoring denial management strategies, medical coding compliance, and other responsibilities; healthcare centers can finally focus on the core services and customer satisfaction. They can also cater to a greater number of patients. 

However, choosing the wrong RCM partner will only lead to more issues and heartburns. It will do more harm than good. Selecting the right service provider is an important decision to make. Refer to the above checklist for a comprehensive guide on how to select the right outsourcing partner for medical billing and transcribing services.

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