The definition of Electronic Health Records (EHR) is a digital version of a patient’s health record. EHR technology allows for the secure exchange of patient information between healthcare providers and patients themselves. The benefits of using EHR technology include improved quality care, increased efficiency, and enhanced security measures.

Technology has been a key factor in the revenue cycle management industry as well. In recent years, this particular field of healthcare has seen a shift from its standard paper-based practices to those involving more computerized methodologies. By using technology, practices can efficiently process payments and provide higher quality care for patients – all while saving money at the same time.

Believe it or not, the field of revenue cycle management has become so popular that companies are beginning to offer revenue cycle management outsourcing services. This is great news for facilities that would perform if they handled RCM in-house.

Having said this, there are some risks involved with outsourcing revenue cycle management services. Therefore, it is important that any facility considering outsourcing their RCM be aware of these risks before making a decision. By understanding what to expect from an outsourced firm, hospitals can easily determine whether they need help with their daily operations but do not have the staff or expertise needed to provide a high level of service. Essentially, these firms take up much of the work previously performed by the hospital’s own staff.

This article will go in-depth as to what facilities can expect from such practices.

What Is Revenue Cycle Management (RCM)?

Revenue Cycle Management is a system that helps hospitals manage the money they make and spend. This is important because it helps the hospital stay organized and make money. Sometimes, hospitals need help to do this, so they outsource part of their RCM work to companies who know how to do it well.

The revenue cycle can be divided into three main steps: revenue intake, revenue management, and revenue realization.

  • The first step, revenue intake, is when the hospital collects payments from patients. This can be done in a variety of ways, such as through insurance or by directly billing the patient.
  • The second step, revenue management, is when the hospital organizes and processes payments. This includes tasks such as verifying that payments were received, posting payments to the correct account, and reconciling accounts.
  • The third and final step, revenue realization, is when the hospital actually sees the money from payments. This happens when funds are transferred to the hospital’s account or when the hospital spends money on supplies or services.
  • Check our article here to learn more in-depth about how RCM works.

What Is Revenue Cycle Management Outsourcing?

  • Revenue cycle management (RCM) outsourcing is the contracting of a third-party firm to manage a healthcare center's revenue intake, management, and realization. By doing so, the center can expect to experience increased efficiency and quality care, all while saving money.
  • There are some risks associated with outsourcing RCM services, but these can be mitigated by understanding what to expect from an outsourced provider. RCM outsourcing is becoming increasingly popular due to the advancements in technology and the benefits it offers.
  • Any hospital or medical center that is looking to outsource part or all of their RCM operations should do their research first in order to find the best provider for their needs.

How To Be Successful With Outsourcing Your RCM?

In order to be successful with outsourcing your RCM, there are a few things that must be done. First of all, you need to know exactly what it is that you want from the provider. You should determine which areas you would like for them to take care of and then find an outsource service that specializes in this type of work. Also important is to select a reputable service. This will ensure that your provider is capable of handling these types of services and can meet the standards you are expecting.

Besides knowing what to look for in an outsourcing company, it is important to know the risks involved with RCM outsourcing. There are several factors that could impact the success or failure of this type of relationship. These factors include:

Provide Digital Touchpoints

A good RCM platform should make it easier for hospitals to obtain patient information, not more difficult. This is important because it can help the hospital stay organized and make money. By making it easier to obtain patient information, the RCM platform can help the hospital improve their revenue intake, management, and realization.

Extensive Pre-Registration

Before the appointment, make contact with each patient via phone or email. This will help you gather important information about their visit, such as insurance and expected payment. It will also help you to confirm the appointment.

Prepare A Registration Checklist

On appointment day, give the patient another opportunity to make changes to the information your office has on file. This will help to ensure that all of the information is correct and up-to-date.

This checklist should also help eliminate errors related to wrong dates, times, and patients. The checklist should include the following information:

· Patient's full name

· Insurance carrier name

· Insurance ID number

· Statement dates

Take Immediate Payment During Appointment

When the appointment is over, make sure you ask for payment right away. This will reinforce to the patient that you are expecting payment and can help you make money.

Make sure to meet with each patient and family member before making any billing decisions. Ask them about their financial situation and work out a payment plan that will allow your office to see some form of income for all of the services provided.

Do Not Be Afraid To Ask For Help

If you need help with handling patient accounts, make sure to ask the RCM service for assistance. They should be able to provide your office with assistance in dealing with uncollected payments and other services related to billing.

For more information on outsourcing your RCM operations, please contact Outsource Strategists today.

Establish A Claims Policy

The article you have written is on the whole quite helpful. However, there are a few points that need to be clarified. Denied claims can have a significant impact on your revenue stream, as each one halts payments for an indefinite period of time while it is re-submitted, appealed, and finally paid. In order to reduce the number of denied claims and keep your revenue stream flowing smoothly, make sure you have a well-defined claims policy in place. This will help ensure that all submissions are accurate and meet the necessary requirements for reimbursement.

Address Denied Claims Immediately

If a claim is denied, you should address it immediately. This will help to ensure that the denial does not have a significant impact on your revenue stream. You should also have a defined claims policy in place to help reduce the number of denials.

Utilize Electronic Payment

In the digital age, organizations that are unable to remit and accept electronic payments are well behind the curve. This is due to the fact that a majority of people now use electronic means to make and receive payments. Organizations that cannot keep up with this trend will find it difficult to remain competitive in their industry.

Here's a great article that can explain more about the RCM process

Reasons To Outsource

Healthcare providers can save on costs by outsourcing their coding and billing processes to a revenue cycle management firm.

Here are some reasons why you should opt-in:

Focus On Patient Care

  • The focus of the healthcare industry should be on the patient and not on the revenue cycle. Constant monitoring of the revenue cycle only distracts the high-quality care and attention that healthcare consumers expect. Hospitals and other providers should outsource their billing and coding processes to a reliable third party in order to ensure that they are able to provide quality care to their patients.
  • Outsourcing revenue cycle solutions will help providers to focus on patient care and attention, reducing costs and increasing quality healthcare.
  • Competition For Talent
  • There is a severe lack of billing and coding professionals in the market today. According to The Center for Studying Health System Change, more than half of all states report having an insufficient number of qualified individuals in this industry.
  • If your business is unable to compete for talent with other companies in your area, outsourcing revenue cycle management can help you find the necessary expertise without breaking the bank.
  • Reduce Costs And Increase Profits
  • All organizations are facing increased pressures from all fronts - competition, low reimbursement rates, and others.

Reduce Man-hours

By outsourcing your revenue cycle management operations, you will not need to hire more employees. In fact, you can better manage your existing staff by delegating the billing and coding processes to a third party. This will help to improve efficiency within your organization and reduce the amount of time spent on administrative tasks.

Timely Reimbursements

One of the many benefits of outsourcing your revenue cycle management to a professional firm is that you can be assured of timely reimbursements. By entrusting the billing and coding processes to experts, you can focus on providing high-quality care to your patients without having to worry about the financial aspect of running your business.

Uninterrupted Cash Flow

  • Medical billing outsourcing services use the latest software and hardware to manage your medical bills for you. Cash flow is the lifeblood of any business but it is especially vital for healthcare providers. By outsourcing, you will ensure that your revenue cycle process never has an impact on your cash flow
  • Enhance Your Bottom Line
  • Medical billing outsourcing services can help organizations to enhance their bottom line by providing them with the necessary expertise without requiring long-term financial commitments.

Error-Free Billing

  • Billing and coding errors can occur in any healthcare organization, regardless of size. The main reason for this is the fact that most healthcare providers do not have the necessary resources to properly manage their revenue cycle. This is where outsourced healthcare revenue cycle management companies come in. These companies are experts in the billing and coding process and are far less prone to common billing errors.

Maintaining Regulatory Compliance

  • A healthcare revenue cycle outsourcing company can help your organization to maintain compliance with all applicable regulations. By implementing a compliant billing and coding process, you can avoid any penalties or fines that may be imposed by regulatory agencies.
  • Revenue cycle management outsourcing firms have experience with all aspects of compliance, including HIPAA, ICD-10, and others. They can help you to develop a workflow that is both compliant and efficient.
  • In addition, these companies use the latest software and hardware to ensure error-free billing. This will help to improve your organization's bottom line by reducing the amount of money that is wasted on billing errors.

Optimize Reimbursements

  • Outsourced medical billing and coding services can help healthcare providers to optimize their reimbursements. By entrusting the billing and coding processes to experts, providers can focus on providing high-quality care to their patients.

Better Cash Flow

  • Healthcare providers are feeling the impact of reimbursement cuts and the increasing cost of healthcare. This can have a negative impact on the bottom line. An outsourced revenue cycle partner can mitigate this impact by streamlining reimbursements and cash flow.

Improving Efficiency

  • An outsourced revenue cycle partner can mitigate this impact by streamlining reimbursements and cash flow. By entrusting the billing and coding processes to a third party, you can improve your organization's bottom line by reducing the amount of money that is wasted on billing errors. Additionally, an outsourced partner can help you to maintain compliance with all applicable regulations, which can help to avoid any penalties or fines that may be imposed by regulatory agencies.

Transparent Models

  • One of the benefits of partnering with a medical billing service company is that you have utmost control and transparency into the billing and coding processes. By working with an experienced and reliable company, you can be assured that your bills will be processed accurately and efficiently. In addition, you will have access to real-time reporting that allows you to track the progress of your bills and ensure that they are being processed in a timely manner.


If that wasn't enough then be sure to check out this article on reasons to outsource.

Pros and Cons of Outsourcing Your RCM

  • There are a number of reasons why outsourcing your revenue cycle management (RCM) can be beneficial for your healthcare practice. Here are some of the advantages:
  • Error-free billing: By outsourcing your RCM to an experienced provider, you can minimize the risk of billing errors. These errors can be costly and time-consuming to correct.
  • Maintaining regulatory compliance: Outsourcing your RCM can help you to maintain compliance with all applicable regulations, including HIPAA, ICD-10, and others.
  • optimize reimbursements: Outsourced medical billing and coding services can help healthcare providers to optimize their reimbursements. By entrusting the billing and coding processes to experts, providers can focus on providing high-quality care to their

Pros

Cost-Effectiveness

  • One of the primary benefits of outsourcing your revenue cycle management (RCM) is that it can be a more cost-effective solution than maintaining an in-house billing and coding staff. By partnering with an experienced outsourced provider, you can minimize the risk of billing errors, which can be costly and time-consuming to correct. Additionally, outsourcing your RCM can help you to maintain compliance with all applicable regulations, including HIPAA, ICD-10, and others. This can help to avoid any penalties or fines that may be imposed by regulatory agencies.
  • Outsourcing your RCM can also help you to optimize your reimbursements. By entrusting the billing and coding processes to experts, you can focus on providing high-quality care to your patients while minimizing the amount of money that is wasted on billing errors. 

Expert Attention To Detail

  • Outsourcing physician billing and coding to well-trained professionals can minimize the chance of errors, denials, or even HIPAA violations due to inadequately trained staff. By entrusting the billing and coding processes to a third party, you can focus on providing high-quality care to your patients while minimizing the amount of money that is wasted on billing errors. Additionally, outsourcing your RCM can help you to maintain compliance with all applicable regulations, including HIPAA, ICD-10, and others.

Better Patient Experiences

  • Focusing on your patients and providing them with the best care possible is every provider’s ultimate goal. By outsourcing your revenue cycle management (RCM) to an experienced and reliable provider, you can minimize the risk of billing errors and ensure that your patients receive the highest quality of care. Additionally, outsourcing your RCM can help you to maintain compliance with all applicable regulations, including HIPAA, ICD-10, and others.

Management Can pay More Attention To Patients

  • One of the advantages of outsourcing your revenue cycle management (RCM) is that it can allow healthcare professionals to focus more on providing care to their patients. By entrusting the billing and coding processes to experts, providers can minimize the risk of billing errors and ensure that their patients receive the highest quality of care. Additionally, outsourcing your RCM can help you to maintain compliance with all applicable regulations, including HIPAA, ICD-10, and others. This can help to avoid any penalties or fines that may be imposed by regulatory agencies. Focusing on your patients and providing them with the best care possible is every provider’s ultimate goal.

Increase In Revenue

By outsourcing their RCM to an experienced provider, healthcare providers can minimize the risk of billing errors while still maintaining compliance with all applicable regulations. Additionally, outsourced medical billing and coding services can help providers to optimize their reimbursements.

Cons

It Can Be Considered An Extra Expense

  • One of the potential disadvantages of outsourcing your revenue cycle management (RCM) is that it can be considered an extra expense. However, when weighed against the benefits of outsourcing, this cost is often seen as minimal. In addition, many outsourced providers offer financing options to help make the transition to outsourced billing and coding services easier for healthcare providers.
  • Lack Of Control
  • When you outsource your RCM, you are handing over control of these critical processes to a third party. While the provider you choose will likely be experienced and reliable, there is always the potential for errors or delays. Additionally, if you decide to terminate your contract with the outsourced provider, it can be a lengthy and complicated process to bring billing and coding

Potential Extra Fees

  • It’s essential to read the fine print of a contract to look for hidden costs. For example, some outsourcing providers may charge an initial setup fee or a monthly maintenance fee. In addition, you should be aware of any penalties that may be assessed for late payments or for services that are not rendered. By understanding all of the costs associated with outsourcing your RCM, you can make an informed decision about whether this is the right solution for your organization.

Outsourcing Means Giving Control Of Revenue

  • Another potential drawback of outsourcing RCM is that you’ll lose control over this process. This means that you’ll have to rely on the provider you select to be experienced and reliable, as you will no longer be in charge of billing and coding. In addition, if you decide to terminate your contract with the outsourced provider, it can be a lengthy and complicated process to bring billing and coding in-house. It’s essential to read the fine print of a contract to look for hidden costs. For example, some outsourcing providers may charge an initial setup fee or a monthly maintenance fee. In addition, you should be aware of any penalties that may be assessed for late payments or for services that are not rendered.
  • Click here to understand more about the cons.

Certain Collections Can Take Time

  • While outsourced RCM services tend to be more successful in collecting patient balance payments, reports suggest that some accounts may take longer to close. This may be due, in part, to the fact that outsourced providers have a broader reach and are better able to identify and pursue outstanding balances. However, it’s important to work with an outsourced provider who has a proven track record of success in order to minimize the risk of lost revenue.

Conclusion

Every healthcare provider faces the challenge of ensuring compliance with all applicable regulations, while still providing the best care possible to their patients. One way to minimize the risk of billing errors and optimize reimbursements is to outsource your RCM processes to an experienced provider. By doing so, you can focus on providing quality care while leaving the billing and coding to the experts. However, it's important to weigh the pros and cons of outsourcing before making a decision, as there are both benefits and potential drawbacks to consider.

In conclusion, with so many options for medical billing companies, it is important to carefully select the right one. A great place to start is with your peers, who have worked with several different billers in the past. Peer-to-peer discussions are an opportunity to learn about billing experiences and what they've learned throughout their journeys. There are also multiple online forums through which multiple business owners are discussing their medical billing service providers. The more information you have about the process, the better you'll be able to identify which billers are best-suited for your practice.

One of the best ways to ensure that your RCM is running efficiently and effectively while freeing up time for you to focus on other aspects of your business, is by outsourcing it. The decision has its pros and cons so be sure to read our article before deciding what's right for you. If you're looking for a partner who can help streamline your RCM process through their expertise in revenue cycle management, check out Enter Health Solutions today!



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