Managing your practice’s revenue cycle can be one of the most time-consuming and complex parts of running your business. If you are spending more time managing revenue then you are managing your patient’s health, it’s time to consider a revenue cycle management (RCM) partner. The key is finding the right revenue cycle management partner for your specific needs.
What Do You Need in an RCM Partnership?
Before reaching out to select the best Revenue Cycle Management partner, you will first want to do an internal needs assessment. Look at each of your billing functions and pinpoint the areas where your practice struggles. You’ll want to select a partner that meets all or almost all of the functions you require to seamlessly complete your revenue cycle—taking into account coding and billing, denial management, patient customer service, collections, compliance, and any other key areas affecting your bottom line.
Another step to determine what you’d like to get out of a new RCM service is to figure out what your success metrics will be. For example, say that your current collections rate is 65% and you’d like to see it at 85% to be considered a success. Being able to offer these metrics during the searching process can help establish if the RCM service will be right for you. Maybe you want to shorten your billing cycle from typically 6 weeks to 2 weeks from time of service to being paid. The right service can not only help you reach or exceed your goals, they will be able to explain the process of how they will do that.
If you’re unsure of what you need, or where your practice is struggling the most, RCM partners (such as eMDs Aria RCM) may offer a financial assessment as part of the vetting process to help you pinpoint problem areas.
A comprehensive financial assessment checks your key operating metrics to determine the overall health of your practice including days revenue outstanding, collection rates, charge posting, charge and payment lags, as well as patient receivable levels. This examination helps explain how and why your practice is performing the way that it is. With an eMDs Aria RCM assessment, you receive a detailed report and a 30-minute consultation. The assessment helps you:
- Determine the health of your practice by identifying areas of revenue leakage
- Benchmark your performance against industry standards
- Provide a roadmap and set of best practices to maximize your revenue per encounter
This insight helps you identify what services would have the most impact on your revenue cycle. For example, you may find that a large portion of your Accounts Receivable is over 120 days old. Some RCM partnerships can focus on just this portion of your revenue cycle helping you bring down those numbers and collect outstanding funds.
10 Questions to Ask When Choosing an RCM Partner
Once you’ve narrowed the field of potential RCM partners, the next step is to evaluate and compare competitors according to your specific criteria and needs. In addition to asking questions that are specific to your practice’s needs, it will be helpful to your decision-making process to have the providers answer the following questions:
- Do they offer automated insurance eligibility verification?
- Do they have an automated claims scrubber and comprehensive rules engine that is payor specific?
- Do they follow up on denied claims? And is there a threshold dollar amount for follow up efforts?
- Do they monitor payor contracts for underpayments and assist with the appeals process?
- Do they offer patient engagement tools such as appointment reminder notifications (via phone, text, and email) and a patient portal (scheduling, record retrieval, electronic statements, and online payment options)?
- Do they offer point-of-care collection tools (check scanning and credit card processing)? And do they send patient statements (paper/online)?
- Will they manage patient calls/inquiries?
- Are they equipped to interface with your EMR?
- What is their pricing model (fee-for-service, percent of collections, or other model)? Are there any hidden fees or extra costs?
- What KPIs (key performance indicators) does the firm track to ensure your practice is successful (AR, adjustment yield, charge and bill lag time, first pass rate, CCR, patient AR)?
Dedicated Account Management Key to a Successful RCM Partnership
Finding a service provider that is hands on from start to finish is going to lead to a bigger return on investment for your practice as opposed to a service that only submits bills on your behalf. Pick a provider that views your practice as more than just a transaction, choose one that is looking to partner for the long term. You can determine intentions by asking leading questions like:
- Will I have a dedicated account executive? It’s important that you have a point person that you can reach out to at any time to answer any questions you might have. Your account executive should serve as and advisor providing guidance and support on how to continually improve your revenue cycle.
- How often do I meet with my account executive? Regular check-ins with your RCM partner are a must have. Monthly check-ins will help you examine your performance against key metrics and set goals for improvement.
- What kind of reporting is provided, or metrics are tracked? Look for a partner that has an analytics engine that not only analyses your data but compares it to industry benchmarks and offers insights on how to improve performance.
- Will I be able to monitor progress? The goal of an RCM partner is to offload the operational burden from your team. However, you still want to keep track of what is going on. Understand what type of visibility you will have into your partner’s work. Ideally, you want to choose a partner that works within your current system, so you have 24/7 visibility.
The point of an RCM partner is to make the business side of your practice easier, so it’s important to find a service that provides excellent account management and reporting.
Choose an Experienced RCM Partner
Don’t forget to ask about the companies experience with RCM. Have they been in business and serving physicians for several years, or are they relatively new to the market? Experience matters.
Don’t shy away from requesting a reference check. Ask for case studies and a full list of references. Take the time to call and interview as many of the provided references as you can. Past behavior is the best indicator of future performance.
Now you are ready to make your selection and start the implementation process!