Managing the complex requirements of revenue cycle is a tall order for most hospitals and practices which is why they choose to outsource either a part or the complete task to third party specialists. However, deciding what to outsource has always been a tough call for most practices. In fact, there is no one-size-fits-all approach to outsourcing and various considerations should go into making these decisions. In this blog we discuss how to outsource revenue cycle management to derive maximum benefit out of it.
When to Give Outsourcing a Serious Thought
If you believe outsourcing healthcare revenue management is just about delegating all your back-office revenue tasks to a competent partner, you cannot be more wrong. In fact outsourcing must be a strategic decision driven by substantive needs to meet some short-term goals, on which you can bet your long-term plans. For instance, the decision to outsource to reduce on the expenses associated with FTE is always a straightforward decision and involves no brain racking whatsoever. Such engagements do not entail any strategic decision making and yield quicker results much along expected lines.
An outsourcing decision driven by strategic needs warrants a closer evaluation of your existing processes. A case in point is looking for revenue streams you haven’t been pursuing to date or have pursued with little success because of want of expertise. In some cases it can be a mix of two.
A Need-Based Call is Always the Best Call
As a part of strategic decision making, one of our clients, decided to outsource only coding and A/R believing that the performance of these two functions can be measured with ease. The client had a robust internal quality control team which is why they could afford to outsource the spade work to an outsourced partner. For A/R follow-up, they looked for an external resource primarily to tackle the low-value accounts in more efficient ways. The client cherry picked us for both A/R follow-up and coding and thereafter focused on educating our employees on their processes.
Yet another client of ours spotted several metrics that needed a change in performance, such as accounts receivable (A/R) days, cash-to-net ratio, denials to net revenue percent and so on. They incorporated those into the SLA with us to make sure we never went sideways. To honor this commitment, we decided to follow the HFMA MAP keys to apply evidence-based revenue cycle improvement strategies and perform to the highest standards.
These two examples underscore that there are several advantages to outsourcing specific revenue cycle requirements. And the decision to choose what to outsource should depend on the pain points. Having said that, some aspects to revenue management outsourcing which can be universally valuable.
Sometimes, it May Not be Need-based….
For instance, outsourcing patient access, helps you to ensure that the process is consistent throughout all touch points resulting in one-of-a-kind experience. Likewise, the most high-value activity that is widely outsourced is coding. And outsourcing this is logical because come what may coding demands a certain degree of expertise and robust workflow and technology to ensure consistency and finding staff with the right talent has been a perennial struggle. A third party that specializes in coding and has years of exposure coding can help a healthcare provider meet the need for accurate coding at less cost.
In some cases, healthcare providers struggle to strike a balance between older and newer accounts receivables. In such cases it makes perfect sense to outsource a portion of your A/R receivables particularly older ones as they need a lot more focused and extra effort to be recovered. Few years back one of our clients was facing considerable challenges in older accounts receivable—payer and patient—and delegated it to us to get a better handle on it. The decision to outsource was also driven by a secondary need for the client. To free themselves up to focus on growth activities, as they were expanding hospital facilities across the country. Therefore outsourcing helped them meet their secondary requirements better, as their in-house staff could focus on the more recent accounts leaving the older ones to us.
How About End-to-End Outsourcing
So what about end-to-end revenue cycle outsourcing? Is it safe or risky? The answer is very safe, all misgivings notwithstanding. Why we say so is because we have in the past and in present helped several of our clients improve their revenue cycle metrics across the board. An experienced vendor like us is always feels comfortable in managing day-to-day challenges than dousing fires every now and then.
When your revenue cycle management is trusted to a single vendor, it becomes easier for you to identify the root cause of a flaw and make changes that matter. Although this can be done with regular meetings, it can slow down the process and at times be quite inefficient. Sometimes, it is easier to spot and correct errors if you have a comprehensive view. We can testify for this because with everyone belonging to one team, it becomes easier to communicate, train, retrain, making change faster, and more efficient.
An end-to-end revenue cycle partnership throws up another benefit i.e., cross-department expertise. You can always take a call to change back-office staff as per your requirements because all those working for you will be banking on few particular tools, which makes role swapping a lot easier.
One thing common with clients who approach us for revenue cycle management for the first time is hesitation about releasing control, which is quite understandable. But we always take it upon ourselves to break the barriers with an open discussion on how critical needs must be covered with the right skill sets, coming clear on responsibility sharing and ways in which accountability will be measured. We create a team of revenue cycle experts who work closely with the client to drive like an internal department of the client’s organization. And the task for this expert team is cut out, to produce myriad reports, most of which are more detailed and granular giving a proper reflection of what is happening on a day-to-day basis. Besides, the team also generates custom reports to help the CFO drill down and look at specific denials, payers, patients, etc.
Whether you outsource a part or full of your revenue cycle requirements, it is important to understand the costs of the association and the returns in exchange. And if there is a scope for strong ROI you can go for a partnership because third party vendors are able to hit the road running, without any negative effects whatsoever.
Who We are and What Makes Us an Expert?
MedBillingExperts is a healthcare BPO service provider with over a decade of experience in providing a range of specialized back-office services to US-based healthcare practices. We specialize in medical coding, billing, and revenue cycle management. Our revenue cycle management process is driven by experts with considerable experience in critical aspects of revenue cycle management which includes verifying and establishing insurance coverage accuracy, charge entry, denial management, follow up on account receivables, and post patient payments and balance daily deposits. Get in touch with us to know more about our services.
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