Practice Management Alert

Question: My practice is feeling a little overwhelmed by the scale of our revenue cycle management, and we’re considering outsourcing it to an outside vendor. Should we go ahead with outsourcing, and how do we find the right vendor?

Washington subscriber

Answer: Your patients shoulder a greater cost burden for medical care than ever before, and payers continue to dream up creative ways to deny or delay your claims. As a result, your current revenue cycle operation probably isn’t equipped to handle today’s unprecedented pressures.

John G. Wiik, member of the HIMSS Revenue Cycle Improvement Task Force and presenter at the 2016 North Carolina HIMSS Annual Conference, advises that to keep revenue cycles healthy, physician practices need to fundamentally change the way they think and operate. For some providers, that means outsourcing all or part of their revenue cycle management and collections process. And make no mistake, there are hordes of vendors out there that want your business, and they want it badly.

So how do you choose the best vendor for your health care organization? Ask these questions when you are thinking about how to outsource all or part of your RCM and private pay collections:

1. What’s your vendor’s experience working in this health care arena? The more experience the vendor has with businesses like yours, the more you will benefit.

2. Does the RCM vendor do background checks on employees so that you can trust them with your practice’s PHI and billing data?

3. What reporting is provided and how often?

Tip: Ask the vendor to show you a sample report. It should be simple and clear enough to read quickly.

4. What kind of days in A/R metric can you expect to see once the RCM vendor is working with your practice?

5. How can the RCM vendor help you collect the out-of-pocket costs that make up a greater share of your practice’s revenue? As deductibles rise and more and more patients sign up for HSAs, working insurance claims is only one piece of the RCM puzzle. Does the prospective RCM vendor help your front desk staff verify insurance and co-pay amounts?

6. Where to and how often is your money transferred from the RCM company to you? This seemingly simple logistic can really impact cash flow for your practice.

7. What is the price structure and what does my health care organization get for that price?