As hospitals and health systems transition to alternative payment models, many are seeking outsourced revenue cycle management services.
Numerous provider organizations believe making the change to value-based payments will require a need for tighter clinical and financial integration, which means adding resources dedicated to improving clnical-financial performance, according to a peer60 report.
The report also reveals the amount of potential RCM segments healthcare organizations are seriously considering for outsourcing has grown in the past year. Accounts receivable management and collections, claims and billing, denial management, contract management and eligibility and benefits, coding, audit, transcription and clinical documentation improvement also are now being included in potential RCM segments needing to be outsourced.
Overall, according to Black Book's 2016 RCM survey, the U.S. market for physician and ambulatory revenue cycle management outsourcing and extended business office services is expected to increase by 42 percent from the fourth quarter of 2016 to the first quarter of 2019.
The demand for RCM outsourcing is due in part to an increased need for more reporting and transparency between all organizations. Instead of focusing on getting claims out and collecting money, changes in payment models dictate the need for hospitals and health systems to validate the costs of collecting while keeping their accounts receivable days low, said Chare Franks, senior director of client services at Plano, Texas-based healthcare technology company RemitDATA.
With the revenue cycle in this state of transition, it is imperative that healthcare organizations align themselves with the right RCM partner.
Representatives from RemitDATA recently spoke with Becker's Hospital Review about areas to consider when choosing an RCM partner. Below are eight areas they recommended.
1. Access to comparative data. Hospitals and health systems should consider whether the RCM partner has access to external data in addition to the organization's internal data. This allows the hospital or health system to compare itself to peers, and gain insight on whether an RCM issue is specific to that particular organization, or if their RCM issues are happening across the industry. "That's really important. They need to know how the issue is impacting them and what's going on in the marketplace," says Stacie Bon, vice president of marketing at RemitDATA.
2. Access to real-time data transparency. Ms. Bon also recommends hospitals and health systems seek an RCM partner that can provide a real-time view into its data. "Looking at what's happening now and being able to compare your year-over-year success is important," she says "Is the issue seasonal, or is this an anomaly you haven't had before? Being able to run real-time reports and understand why spikes are occurring and the pattern of these issues allows you to determine whether the issues you're having are happening across the market, or whether it's something specific to your organization. Real-time comparative data can help you overcome these issues more quickly." It is also important to understand how the partner will share this information with the hospital or health system. It's important for the data to be in an easily digestible format that can be shared throughout the organization.
3. Proactive denials management system. The right RCM partner should not only be able to identify RCM problems, but also be able to help resolve them. If the organization does not help resolve the root cause of the issues, manpower will continue to be used to fix every issue individually, according to Ms. Bon. Therefore, she said, hospitals and health systems need to get down to the core of the RCM issue to decrease denials and increase reimbursements by asking the following questions: Why is that issue happening? Should the hospital or health system be coding something else? What in the hospital or health system's process is causing it to have this issue over and over? After the issues are identified, how will the RCM partner help the hospital or health system ensure the same issues do not continue to occur.
4. Ability to set key performance indicators. A good RCM partner should help hospitals and health systems track and monitor their RCM process through KPIs, according to Ms. Bon. With KPIs, organizations are able to identify their top business issues by return on investment. "If you know the top three issues with the greatest ROI, you're not going to worry about the other 20 right now. Resolving those top three will be priority because they're going to have the most immediate impact on your cash flow. And if you're continuously resolving the top three you shouldn't have the same issues over and over," Ms. Bon says.
5. Staff mix. According to Ms. Franks, hospitals and health systems should ensure the staff and team of their RCM partner gels with the organization's case mix. "Make sure the partner has that expertise where they can really help you," she says. For example, if the organization is focused on emergency medicine and surgery, but the RCM partner focuses on internal medicine and pediatrics, they are likely not the ideal RCM partner for the organization.
6. Treatment by the RCM partner. It is important that hospitals and health systems ensure the RCM company will fit in with their way of doing business, according to Helen Bardo-Levins, RemitDATA's vice president of client services. "You have to make sure it's not a cookie-cutter format, meaning everybody's not treated the exact same way," she says. "You have to make sure they're monitoring your billing around what you're looking for and what's important to you."
7. Technology integration. The right RCM partner will have technology that interfaces with the hospital or health system's existing health IT system. Ensuring technology from the RCM partner integrates with the existing system at the hospital or health system will save time and effort during the onboarding process, according to RemitDATA. It will also help the RCM partner to get a more complete view into the organization's data, allowing them to be more successful in helping the organization get the greatest ROI.
8. Agreement on contract terms. Hospitals and health systems should ensure they have agreed with the RCM partner on contract terms and performance goals, including goals for reporting. "From a reporting standpoint, how are we going to keep a successful relationship? It's not just about the RCM company getting you up to speed and then moving on and focusing on other customers. It's crucial to have this partner helping you continuously drive change. And I think that's why setting up mutual goals to hold them accountable to is important for these organizations," Ms. Bon says.
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