Things to Look for When Choosing a Revenue Cycle Management Vendor or Partner

Revenue cycle management for any business can be complicated. Throw in the extra challenges that come from insurance providers, billing and coding processes, and uninsured care recipients—as well as a focus on health outcomes that is not always cost efficient—and managing your revenue cycle process can become a wholly tangled mess—one that you might not be able to manage on your own.

In these cases, many practices have considered outsourcing some of their revenue cycle management processes in order to increase efficiency and improve their bottom line. However, that path can be very risky if practices make the wrong decision about who to trust with their revenue stream.

“Outsourcing aspects of the RCM cycle, or the entire process, could have a tremendous impact on a practice’s finances,” stated a recent article in Medical Economics. “On the other hand, if the wrong vendor is chosen or if the relationship is not properly managed, outsourcing RCM services could have a devastating impact.”

Below are five major areas of concern for any practice considering a relationship with a revenue cycle management vendor/partner. While a mutually beneficial relationship to help you better manage the financial side of your practice can be genuinely rewarding, you have to make sure that you’re considering the decision from various angles before making a choice about what vendors or potential partners you can truly trust.

Data transparency

Not all revenue cycle management vendors offer real transparency of your revenue data. This data can be invaluable to understanding your financial trends, policy deficiencies, and procedural issues. Make sure you understand exactly what information will be available to you before you sign on with a vendor. You will want full access to the financial data so you can perform your own benchmarking analysis and track your own performance in comparison to your peers.

Comprehensive analytics and comparative data options

A good revenue cycle management partner does more than manage some of the paperwork and behind-the-scene element of your practice for you. They conduct real, comprehensive data analysis and provide detailed information. While data transparency is important, delivering that information in a usable format is just as vital. You want a vendor who can help you see how your practice’s financial trend compare to its peers and how your numbers rank within the industry. Otherwise, it’s just a bunch of numbers with little context.

Compatibility with existing systems

Another important consideration that some businesses may not consider initially is system compatibility. Your vendor or partner will need access to your information and may utilize systems that don’t interact well with yours. Confirm this ahead of time to avoid time-consuming technical issues.

Denials resolution capabilities

Most practices finds their biggest challenges in revenue cycle management come from managing claims submissions and denials management. A truly useful partner for a practice is one that will assist in managing and resubmitting claims that have been denied, helping to bring in further revenue that could be lost if claims are not resubmitted in a timely manner.

Performance guarantees and good contract terms

Read the fine print and take the time to understand exactly what your vendor is offering and at what rates. Know what you’re getting and exactly how you’re paying for it. A partner that can guarantee certain performance capabilities as well as assist your practice in setting a plan for long and short-term goals to improve performance is one to consider.

Partnering with outside vendors may not be for every practice. The ability to manage revenue stream internally is often preferred, but it’s not always the best choice when building and managing a skilled team of billing, medical coding, and analytics professionals, which can often be costly and time-consuming.

Sometimes, outsourcing is a more efficient option, but take the time to make sure you’re getting the right partner or vendor for your practice by carefully reviewing the terms, checking references, and considering your practice’s goals for long-term success. The right partner will be involved and active in helping you achieve those goals by providing the support and data you need to manage your revenue effectively.