Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part One

Revenue cycle management (RCM) is one of the functions healthcare providers outsource the most. In fact, the RCM market is projected to experience a 12 percent uptick in growth through 2021, according to a MicroMarket Monitor report.

Outsourcing is projected to expand due to two primary market forces: Value-based care’s emphasis on improving quality while reducing costs, and the increased complexity that comes with a more accountable organization. Ambulatory surgery center (ASC) leaders are recognizing the need to make RCM more transparent and predictable, and outsourcing RCM is the optimal way to increase cash flow, cut costs and stabilize their centers’ revenue cycle.

In a two-part series, Regent RCM’s VP of Revenue Cycle Michael Orseno identifies the top six reasons for outsourcing RCM. The first installment focuses on expertise, technology and staffing.

  1. Expertise. With the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the RCM landscape is changing at a rapid pace. Ensuring optimal results while keeping up with the latest opportunities related to RCM requires specialized expertise. The team at Regent RCM specializes in developing, executing and refining billing and collection strategies, and invests in the most up-to-date tools and technologies. “Revenue cycle management can no longer be an afterthought,” said Orseno. “With the vast overhaul that the healthcare industry continues to undergo, business office managers at surgery centers must employ RCM experts that have seen it all, and can not only roll with the changes, but anticipate what’s around the bend.”
  2. Best-in-class technology. With tighter margins, and priorities favoring patient care over improved billing resources, ASCs are often not equipped to excel at managing the revenue cycle in-house. By outsourcing RCM, centers can take advantage of economies of scale and gain access to best-in-class technology. At Regent RCM, staff use a trio of technologies: ASC Management Information Systems (MIS platform), clearinghouse software, and next generation dashboard and real-time monitoring and management. “RCM providers have a deep knowledge of which tools work well together and which work in silos,” said Orseno. “We have enterprise dictionaries already built for one MIS platform, so that only facility-specific information needs to be inputted. This makes implementing new technology easier, too. At an ASC, implementation typically takes more than three months, but for our partner centers, we can cut that time in half.”
  3. Smart staffing/no succession planning. For ASCs, an experienced billing and coding staff with built in redundancies is now a necessity. Cutting corners by hiring inexperienced staff can cost an ASC hundreds of thousands of dollars per year, not to mention direct impact on workflow and efficiencies. Outsourced RCM providers have the resources to attract experienced staff because they can pay well, provide good benefits, and situate themselves in desirable locations. In addition, because outsourcing RCM is what they do, these specialists know how to find and hire the best of the best, and often have a pipeline of qualified applicants waiting for a spot to open up.

Are you considering outsourcing to optimize your center’s revenue cycle? Ed Tschan and the experienced team at Regent RCM are available to your answer questions and discuss if a revenue cycle evaluation makes sense for you. Please call 312-882-7228.

Click here to continue to Part Two.

ASC revenue cycle benchmarking

Automating RCM with Three Core Technologies

Automating RCM with Three Core Technologies

Regent RCM recently hosted a webinar aimed at helping ambulatory surgery center (ASC) personnel gain more control and efficiency over their revenue cycle. The following post examines the core technology that forms the foundation of billing and collections and how automation contributes to a predictable revenue cycle.

Automating revenue cycle management (RCM) is as much about efficiency as it is analytics. Three core areas of technology that form the foundation of ASC billing and collections include:

  • ASC Management Information System (MIS platform)
  • Clearinghouse
  • Reporting, analytics, and dashboard capabilities

ASC Management Information System (MIS platform)

While Regent RCM can integrate with any Health Level-7 (HL7) compliant MIS platform, in many cases, the team is asked to recommend a software platform. Regent’s primary goal is to identify a platform that fully captures the individual needs of a center; one that can manage billing, scheduling, and inventory management, as well as seamlessly interface with clearinghouse and other software platforms. Bottom line, implementing an MIS that optimizes and automates workflow results in measurable efficiencies, decreased A/R, and improved profitability.

Clearinghouse software

ASC clearinghouse software provides essential process automation including the ability to send claims and receive electronic remittance advice (ERA), provide claims management, eligibility verification, and patient out-of-pocket estimation. ASC staff no longer have to call insurance companies to assess a patient’s eligibility. With the click of a mouse, a user can verify and pull a patient’s eligibility information into the MIS and view it – including deductible, remaining deductible, coinsurance, co-pays, and out-of-pocket maximums. This information may be used to estimate out-of-pocket expenses and establish patient financial responsibility prior to a procedure.

Reporting, analytics, and dashboard capabilities

Reporting and analytics tools offer detailed insights into the way an ASC operates and highlight opportunities to make changes that can improve outcomes. ASCs can access reports and analytics via a real-time dashboard. This dashboard displays both financial and clinical key performance indicators (KPIs) that can be customized with facility-chosen parameters, alerting an ASC about issues in priority areas. Dashboard capabilities are explained in greater detail in a blog post on real time measurement and reporting.

If you would like to learn more about these core technologies that form the foundation of ASC billing and collections, please contact a revenue cycle specialist or click here to learn more.