Key Financial Enablers that Improve ROI in Healthcare: Outsourcing Revenue Cycle Management
- SolvEdge
- Nov 19, 2020
- 4 mins read
Healthcare Revenue Cycle Management (RCM) is undergoing constant change. Every time you develop a revenue cycle strategy, a new reimbursement challenge appears. Recruiting qualified professionals to manage medical billing and coding have become complex and expensive.
Healthcare organizations including hospitals and practices are increasingly turning to outsourced medical billing services to eliminate the administrative burdens and drive up revenues. What’s more, Practices that outsource medical billing services are reported to witness a 5-10% increase in net collections, along with improved operational efficiencies that help practices focus on higher priority tasks like patient care!
Consider asking these questions when you are looking at outsourcing your revenue cycle management.
1. How long have you been in the industry and what is your experience in billing for Medical offices?
2. Are you a HIPAA-compliant company?
3. What are the types of reports that I will receive?
4. How willing are you to adjust to my processes?
5. Will your operation alert me about contract issues?
6. What services do I get for my billing costs?
7. What happens when the people on my account go on vacation or get sick?
8. Who can I call for references?
The actual cost of in-house Healthcare Revenue Cycle Management
When considering whether outsourcing revenue cycle management services makes complete financial sense, you might want to evaluate the costs involved in in-house medical billing. Most often hospitals and practices take into account only the medical billing staff expenses and tend to overlook the tangible and the intangible costs involved in the process.
What Type of Medical Billing Outsourcing Company do you need
Not all healthcare revenue cycle management companies are alike. The array of services is most likely to vary. Discovering the right RCM company depends on your specific business needs, pertaining to your unique care pathway management strategies.
Customized Services to Look for in a Medical Billing Outsourcing Company
1. Eligibility Verification
2. Charge entry
3. Create, scrub and submit claims
4. Medical Coding services
5. Charge submission
6. Credentialing
7. Work denials
8. A/R follow up
9. Denial management
10. Insurance verification
11. Practice management consulting
12. Payment posting
13. Patient collection
How to evaluate your Returns?
It is critical that healthcare organizations base their decision to outsource medical billing services—on real metrics. But how do you gauge this? These KPIs we discuss below help you evaluate the revenue cycle returns on RCM outsourcing.
The first two metrics are
First Pass Acceptance Rate (FPAR)
First Pass Resolution Rate (FPRR)
The second set of metrics are
Days in Accounts Receivable (Days in AR)
Net collections
Having and in-depth understanding of your KPIs help you understand if the desired or promised financial goals by the medical billing outsourcing partner were realized. This also gives insights into your in-house billing process and its efficiencies. To learn more on revenue cycle outsourcing services or to get you free and customized ROI evaluation report, give us a shout!
