It’s not always the best interest of a practice to seek the help of an outsourced revenue cycle management team.  This typically happens for one of two reasons: a practice either does not need to bill a third party payer at all or the practice is small enough where they do not find the need to have other people working their revenue cycle yet.  Below is a list that explores deeper into these two major categories:  

1. Single Provider Practice

Single provider practices are usually capable of handling their own revenue cycle as patient caseload is familiar and issues are both recognizable and consistent. Software solutions, however incomplete, typically can offer enough within this category where the provider can handle it without additional assistance.  Even so, the headaches surrounding payer billing will still be present and only the most dedicated provider will continue doing it themselves.

2. Upfront Cash Patients are the Vast Majority of Revenue

Certain types of medicine lend themselves to a revenue cycle where payment can be collected upfront before treatment is rendered.  The billed amounts are small and manageable for their clients and the services are not emergent or critical. These environments are truly the sweet spot and many practices who are tired of dealing with third party payers or inadequate RCM seek a pivot to this type of model. Many RCM groups will offer a point of sale solution as part of a larger offering for these types of setups.

3. Payers Will Not Cover Most Procedures

Third party payers are not interested in paying for that facelift, Swedish massage, or any procedure consistently deemed not medically necessary.  These types of practices will likely fall into a full cash payment environment that simplifies the revenue collection process dramatically. 

4. No Electronic Medical Record or Practice Management System is Used

Practices who are unwilling to adopt modernized means of organizing rendered care will not have success when passing off information about their practice to an RCM group.  Records must be electronically managed and transmitted in a workflow driven standards-based format.  A good RCM team can assist a practice in getting to this spot but buy-in and value must be recognized by the provider for it to be successful.

5. Customers are Happy with Superbills to Invoice Their Own Insurance

Environments where the total billable amount is both manageable to their clients and lower than most deductibles can support handing off a superbill to their patient and making them bill their insurance. Some practices chose this route only because they haven’t made the leap to billing payers themselves which we have found can dramatically open up new lines of revenue for them. 

As a rule of thumb, if the practice is feeling overwhelmed with their revenue collection cycle or desire to shift their practice into billing third parties and patients, it will more likely than be time to bring in the big guns to assist. Enter is here to help guide practices in making the right decision for their RCM solution.

Revenue Cycle Management

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