Considering revenue cycle outsourcing? Begin with the middle in mind

Chris Martin, Senior Vice President, Market Solutions, Optum360 -

The financial challenges facing the revenue cycle are well documented.

WF4606706 URGENT Image needed for call out in Becker s v1 02 02 1Margins are razor thin and the COVID-19 pandemic has had a significant negative economic impact on health care organizations nationwide. Among the side effects of the financial squeeze is a lack of capital for needed innovation.  Within the revenue cycle, the area that wrestles with some of the most difficult challenges is the middle revenue cycle, particularly health information management (HIM). These challenges are often in response to constant change, whether new or altered regulatory requirements, or continued demands from the transition to value-based care. Furthermore, market unpredictability and fluctuating patient volumes have made it more difficult to optimize and balance coding and other HIM staffing requirements. 

Addressing the middle revenue cycle first can pay big dividends. A great way to start is by considering a new, more far-reaching form of middle revenue cycle outsourcing. 

Staff augmentation is no longer enough 

Outsourcing is not new to the middle revenue cycle. Traditionally, health systems have outsourced coding on a selective basis. Designed to cut costs and solve short-term needs, this one-dimensional approach leaves hospitals with the unenviable task of managing multiple vendors that do not align with the organization's overall goals. We're now at the point where coding and HIM staff augmentation is just not enough to meet today's and tomorrow's challenges. What's needed is an outsourcing approach broad enough to connect across the revenue cycle and deliver a greater return.   

A new mindset and model

It's time to think outside the box and consider new alternatives. Strategic outsourcing is not just about staffing and cost cutting, but also about achieving your key performance indicators (KPIs), mitigating risk and elevating performance. To do so, you need to outsource an area broad enough to realize efficiencies of scale and drive better overall outcomes. 

A strategic partner overseeing your entire HIM operation can look at your needs holistically and drive a greater return on investment. It can deliver a scaled mechanism to help you optimize staffing models across functions and align the people, processes and smart automation technologies needed to lower costs and improve performance. In short, you need to team with a partner that not only addresses costs but also is willing to invest in your long-term success.

A new path to resiliency

By optimizing people and processes and reducing costs in a synchronized way, the right strategic partner and outsourcing approach can dramatically improve value and increase financial resiliency. You should expect:

Transformative technology without capital investment. Select a partner with proven technological capabilities — including artificial intelligence, natural language processing and smart automation — that are delivered as part of the service without separate capital investment. This saves licensing and administrative costs and lets you gain efficiencies by consolidating vendors.

Innovation through process and workforce optimization. Proven best-practice methodologies can align purpose and people with value stream improvements to drive cost savings and facilitate continuous enhancements. Furthermore, Lean-based process methodologies can create optimal workflows and strategic staffing can add flexibility.

The agility to adapt quickly to changing requirements. With an outsourcing partner that assumes full responsibility for the middle revenue cycle, you are better positioned to reduce risk and meet your financial and operational objectives. Additionally, by leveraging specialized expertise and economies of scale, your strategic outsourcing partner can help you rapidly react to changing needs with new technologies, optimized staffing and dynamic process management.

Better performance across the revenue cycle 

Outsourcing HIM improves performance across the entire middle revenue cycle. It can deliver significant and immediate operating cost reductions, improve KPIs, drive better financial outcomes, and increase efficiencies by standardizing operations and procedures.

But that's only part of the story. Strategic HIM outsourcing not only elevates the performance of the middle revenue cycle, it positively impacts the entire revenue cycle. The ripple effects improve results across the areas you continue to manage on your own.  

Selecting the ideal partner

How do you select the right middle revenue cycle outsourcing partner? Ask prospective partners the following:

  • Does their expertise include both HIM and processes throughout the entire revenue cycle?
  • Do they offer comprehensive HIM services, best-practice methodologies and the latest innovative technologies?
  • Do they provide a modern outsourcing framework where the strategic partner shares performance risk?
  • Do they offer outsourcing solutions across the revenue cycle? 

Selecting the right partner and approach to HIM can positively affect performance and revenue, provide savings that can be reinvested in areas important to your organization, and let you focus on your core mission of providing care. 

Everest Group Research. Exploring Technology Frontiers to Unlock Superior Value from Operations: Revenue Cycle Management (RCM) Solutions State of the Market Report. December 2020. 

Learn more on at Health Information Management Performance Outsourcing 

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