Revenue cycle management (RCM) is a high-stakes endeavor for healthcare organizations, as regulators have elevated scrutiny of billing practices and cost competition continues to intensify. That's why choosing a RCM partner is important.
During a March webinar hosted by Becker's Hospital Review and sponsored by AGS Health, Keith Cantrell, chief revenue officer at SCP Health, and Debra Stall, senior vice president of accounts receivable management services at AGS Health, discussed successful RCM partnerships. SCP Health creates innovative health solutions for hospital medicine, emergency medicine, urgent health and telehealth at more than 400 healthcare facilities.
Four key takeaways:
1. RCM solutions need to align with organizational goals. The market for RCM solutions is saturated and choosing an optimal vendor can be difficult. Having a clear understanding of organizational goals and challenges can help in making that decision.
SCP Health, which had been working with AGS Health prior to the pandemic, was considering scaling its RCM providers. It had four strategic objectives: 1) growth and scalability; 2) optimization and automation; 3) payer reimbursement and rising costs and 4) dealing with the disruption caused by the COVID-19 pandemic.
In evaluating potential new partners, SCP Health looked at alignment between people, processes and technology. SCP Health ended up continuing its partnership with AGS because AGS was well aligned with SCP Health's goals of ensuring a smooth RCM experience.
2. For best results, involve your RCM vendor in your long-term strategy. This means actively soliciting the vendor's input when problems emerge and being open to implementing a suggested solution. For example, an RCM vendor with global operations might offer cost-effective alternatives when human resources are in short supply, ensuring alignment between people and processes.
"When we had a critical internal resource resign, AGS helped us rethink how we did analytics within the revenue cycle," Mr. Cantrell said, noting that the solution resulted in greater productivity and efficiency. The right RCM provider can also advance integration between technology and processes by enabling computer-assisted coding, robotic process automation (RPA) and cash posting reconciliation.
3. Treat your RCM vendor as a partner. To realize the full potential of the RCM vendor relationship, setting a foundation of communication and trust is a prerequisite for continuous collaboration. Metrics to be monitored and audited jointly include agreed-upon key performance indicators (e.g., workforce productivity), production processes and process improvement opportunities. "That's so important in this type of relationship as it drives the speed to value, where value equals excellence balanced with the velocity," Ms. Stall said.
4. Globalization enhances your state side strategy. AGS has only a tiny portion of its workforce (around 40 people) in the U.S., while the vast majority — over 10,000 — operate out of four locations in India. These locations have a large talent pool of RCM and medical coding professionals, whose retention rates are over 80 percent.
Mr. Cantrell acknowledged differences of opinion regarding offshoring talent but said the COVID-19 pandemic has normalized using a remote workforce. SCP Health utilizes their global partner AGS for job functions such as Prebilling, Coding, Analytics and even Accounts Receivables. The only area they currently have not engaged in is the customer service arena.
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