How to Improve Your Practice Performance with Outsourcing

The business of healthcare is a difficult one today. There are many competing demands that practices and health systems must meet. One of the most commonly cited pain points for medical offices is the revenue and billing cycle. Revenue cycle management is a complicated process that demands attention to detail. Oftentimes, it is quite difficult for practices to manage their RCM internally. When they do, it can result in many problems that ultimately end up costing valuable revenue.

As the medical billing landscape in the US continues to evolve, RCM processes are becoming increasingly intricate. Guidelines for Medicare, Medicaid, and the ACA change often, so healthcare providers must employ RCM-centered staff to optimize administrative processes. However, managing revenue internally can cost hundreds of thousands of dollars annually. Furthermore, RCM’s complexities make it particularly vulnerable to human error. This can lead to revenue leakage, data inconsistencies, and poor patient experiences. 

Fortunately, outsourcing RCM can help eliminate this burden. More practices and health systems are opting to work with a full-service RCM partner to manage their billing cycle. By hiring an external company to manage RCM, practitioners can return their full focus to where it’s most needed: helping patients heal so they can lead their lives. Meanwhile, they can expect to see better practice performance and more revenue.

The RCM Challenges for Healthcare Providers

Healthcare RCM poses multifaceted challenges for providers every day. These range from collections to data storage to staffing miscommunication. Lower quality of care, lack of accountability, and unstable cash flow are all symptoms of RCM mismanagement.

Billing Inefficiencies

Inaccurate bills and claims, denials, and delayed A/R follow-up can cause significant revenue leakage. It is estimated that for every dollar spent by a facility, 30 cents is never collected. 20% of uncollected funds are attributed to coding and insurance errors. Billing mishaps are not only stressful for staff at healthcare practices, they can lead to a bad reputation amongst patients.

Data Errors

When data is recorded inaccurately, claims get denied and reimbursements are lost. Human error is often the cause. Oftentimes, a practice is unable to correctly verify insurance in advance of someone’s appointment. This leads to delinquent accounts and lower A/R reconciliation rates. Ineffective charge capture data further expounds the issue.

Staff Miscommunication

Physicians need to direct as much attention to patients as possible. They commonly disconnect from the financial realm of their medical practice, because patient treatment is their priority. Administrative and financial employees are then tasked with cost-cutting and increasing collections, but doctors are out of touch with these background processes.

Clearly, healthcare practices need to find a holistic approach to eliminating these issues. Their resources are already limited, so investment in sensible RCM systems is critical.

The Advantages to Outsourcing RCM

Reduced Billing Errors and Better Data Accuracy

A team of dedicated professionals will be able to focus on RCM. This focus will reduce the potential for human error while minimizing the administrative burden on practice staff. If bills or claims are incomplete, denials are mismanaged, or A/R is not followed up on quickly, the practice could experience significant revenue leakage. Inaccurate data can result in denied claims and lost reimbursement, often a result of human error. RCM professionals will perform daily activities such as patient registration, insurance eligibility verification, coding and credentialing, claims submission and management, and payment collection and reporting.

Stronger Cash Flow

A dedicated RCM team streamlines record-keeping and administrative tasks. They can ensure timely reimbursements because they do not have to focus on providing medical care at the same time. This allows them to focus on collecting and verifying insurance, proper coding, and charge capture. Most importantly, outsourcing RCM greatly reduces practice overhead and operating costs. RCM companies hire very capable employees who perform regular oversight of critical billing functions at a fraction of the cost of practices hiring them in-house.

Better Patient Care

Outsourcing RCM will better enable practices to serve their patients. Performing RCM in-house is labor-intensive and time-consuming. The overhead practices face by performing RCM in-house can be cost-prohibitive. Oftentimes, providers themselves will be pulled into RCM oversight, which distracts them from providing patient service. Patients benefit from outsourced RCM too. The billing process is simple and straightforward. Many RCM companies have trained staff to interact with patients if they have questions or problems with billing. This goes a long way in improving patient satisfaction and propensity to pay.

RCM outsourcing is the best way for providers to maximize their revenue. It reduces overhead, improves cash flow, and enables a better experience for patients and providers alike. PRL is a full-service RCM partner who can generate tangible results for your practice. If you want to increase your revenue while improving your patients’ experience, then learn how PRL can help you.

Read our other posts in this series: