Revenue Cycle Management: Is Outsourcing the Answer?

Health care facilities don’t always have the resources to cover their priority — patient care — and all their internal operating costs. Outsourcing offers one way to manage the business of health care.

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Health care revenue cycle management (RCM) is how health facilities track revenue from a patient’s first appointment to their final payment. That may sound simple, but an efficient and effective RCM process is both complex and vital to a health facility’s survival. Providers prefer to focus on caring for patients, leading some health care systems to outsource RCM to an experienced third-party vendor.

Benefits of outsourcing RCM

RCM determines a facility’s cash flow and bottom line, but in-house billing and coding are time- and labor-intensive. Outsourcing RCM goes beyond saving on staff; other benefits include:

  • Efficiency, accuracy, and consistency. Professional, well-trained billers and coders with experience processing RCM data.
  • Increase collection rates. Accuracy and efficiency mean fewer mistakes and faster processing, allowing for higher collection and reimbursement rates.
  • Ensure compliance with current laws and regulations. Up-to-date familiarity with local, state, and federal regulations regarding patient data and information access.
  • Focus on patient care and improve their billing experience. Providers focus on health care and leave RCM activity to the RCM experts.

How does RCM outsourcing work?

Outsourcing RCM to a third-party service provider relieves a significant portion of a facility’s administrative burden and increases its overall efficiency. Third-party RCM vendors collect and process patient data, verify insurance, and validate a planned course of treatment. Available services include:

  • Claim submission. Processing claims, billing patients for out-of-pocket expenses, generating and distributing patients’ explanation of benefits (EOBs).
  • Correction and resubmission of denied claims. Investigating denied claims, correcting mistakes or errors in coding, resubmitting claims, and tracking progress.
  • Service standard and specialized claims. Medicare, Medicaid, third-party insurance claims, and worker’s compensation claims.
  • Manage accounts receivable (AR). Issuing statements and invoices, collecting payments, managing payment arrangements, and tracking payer reimbursements.
  • Reduce processing timeframe. Increasing efficiency and accuracy for faster processing and reimbursement times.
  • Provide regular data analyses and key performance indicators (KPIs). Providing data for performance insights and potential growth opportunities.

RCM outsourcing lowers operating costs, saves time, improves accuracy, increases efficiency, and provides data to help providers plan for future growth.

Finding an outsourcing partner

Outsourcing RCM can make all the difference in the financial success or failure of a healthcare facility, but it’s important to find the right third-party vendor. Evaluate your facility’s specific RCM requirements, and consider the following questions when choosing a partner:

  • Is the vendor capable of meeting your specific needs?
  • Do they provide regular updates, meetings, and/or reports?
  • Are there policies and procedures in place for ensuring the vendor’s accountability?
  • Is the vendor a good fit for your facilities’ service offering?

For most health care organizations, outsourcing their RCM activity is the obvious choice. Instead of managing in-house staff and navigating insurance claim minefields, providers leave RCM to the experts and shift their focus back to where it belongs — on patient care.  

Contact TruBridge to learn more about the benefits and drawbacks of outsourcing RCM activity.

Written by Jason Coffin
TruBridge Vice President, Professional Services