revenue cycle review

The Benefits of Outsourcing RCM: Leveraging Expertise in Billing and Collections

Last week, we explored the overall benefits for ASCs to outsource their revenue cycle management, identifying four key benefits. Over the course of March, we will dive deeper into each of these outsourcing benefits. This week, we take a closer look at the importance of leveraging expertise in billing and collections, especially with coding changes being brought on by ICD-10.  

With the Affordable Care Act, Medicare and Medicaid payment bundling, and the specter of ICD-10 looming over every health system in America, the revenue cycle management landscape is changing quickly. Most ASCs have struggled to keep up. A lack of time, funding and resources has made it nearly impossible for ASCs to train their limited staff at the level necessary for in-house RCM to be cost effective.

In addition, ASCs often have a single administrator managing not only billing and collections, but also a multitude of other center priorities that takes away focus from effective RCM.

Revenue cycle management outsourcers, however, specialize exclusively in developing, executing and refining billing and collection strategies, and are therefore able to invest in enabling their staff with the most up to date tools and technologies. Doug Brown, managing partner of Black Book Market Research, which has undertaken a massive study on the RCM outsourcing trend, said, “”RCM outsourcers…have the staff and technology expertise to integrate patient billing, collections, accounts receivables, and grievances as ICD-10, and value-based payment models present even more potential for internal inefficiencies …”.

ICD-10 will require training that goes above and beyond the typical professional development provided by ASCs. It requires staff that is immersed in the world of coding, and ideally, certified specifically in ICD-10. With an RCM outsourcing company, every coder you interact with will be well-versed in not just ICD-10, but all the latest terminologies and coding requirements. In addition to excellent training, RCM outsourcers are equipped with the most advanced facilities, systems, and processes.

Other regulatory changes over the years have made billing and collections a more complex process. Billers now must have a wide range of competencies, including medical expertise and the ability to manage denials. Most ASC billing staff are ill-equipped for the challenges they are faced with today, and ongoing training would require significant time and financial commitments.

Perhaps most importantly, RCM outsourcers have experience. They’ve encountered almost everything that could go wrong, and they’ve learned how to handle virtually anything that might come up. They are experts in the intricacies of billing, denials, and coding; everything an ASC needs to receive payment for their services fully and promptly.