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 Billing & Coding

Dispelling ASC Myths: The Transition from Internal Billing and Collections to Outsourced RCM is Challenging

The Myth: It is challenging for an ambulatory surgery center (ASC) to transition from an internal billing and collections team to an outsourced revenue cycle management (RCM) team.

The Truth: ASCs can actually increase the productivity of a center quickly and efficiently if they select to partner with an outsourced RCM team that is proactive and has an orchestrated transition process in place.

The Evidence: Dispelling this ASC myth comes down to the ASC selecting the right outsourced RCM provider. When going through the selection process, ASCs should consider three key qualities to ensure a smooth, efficient transition process:

  1. ASC Policies and Procedures:
    A proactive RCM providers will spend one to three weeks on-site with a transition team to understand the center’s current RCM policies and procedures. Common questions asked at this stage may include: “How does the center handle patients who pay at the time of service?” “How are insurance payments received (via lockbox or sent directly to the facility)?” and “What daily, weekly and month-end reports are necessary to operate your business?” When developing the transition strategy, certain changes to current policies may be recommended to increase efficiency. Since there isn’t a cookie-cutter approach to transitioning to an outsourced RCM provider, this is an essential step that must occur prior to conversion to ensure there is minimal business disruption.
  1. IT Systems:
    The preconceived notion that RCM partners require centers to switch to a specific IT system often fuels this myth. This is not the case with all RCM providers. A good RCM provider will be able to work with any management information system (MIS) in use, while potentially offering recommendations that could increase efficiency for the center. Prior to the transition, an IT assessment should be performed to determine how the RCM provider would connect to the center’s existing MIS. Newer systems can be accessed via the cloud, allowing the RCM provider to make adjustments as quickly as if they were physically in the center. VPN tunnels can be used to access older systems. It’s important that HIPPA/HIGHTECH compliant software should be utilized to always keep data secure.
  1. Contracts:
    Becoming intimate with a center’s contracts prior to transitioning is also essential for a smooth transition. The RCM provider should request updated copies of each contract for extensive review and loading into the system well before conversion. While the transition team is still on-site, a good RCM provider will meet with the managed care team to fully understand the content and avoid any hidden language that could affect bundling, payment methods, or limit the increase of charges. Contracts are an essential part of the billing and collections process and as a result, oversights could cause a center to be operating at only 60 to 80 percent.