How To Choose the Right RCM Company

Blog
Jul 30, 2024
Article Background

Revenue cycle management (RCM) is the backbone of a healthcare organization’s financial health. From capturing charges for services rendered to ensuring proper coding and collecting reimbursements, a well-managed revenue cycle is crucial. Often, the best way to reap the benefits that come with it is to partner with the right RCM company.

Why revenue cycle management is important

Efficient RCM translates directly to an organization’s bottom line, leading to a higher clean claim rate and collection rate. Through accurate and timely claim submissions, healthcare providers experience faster reimbursements and improved cash flow. Beyond the bottom line, a strong RCM assessment and implementation reduces administrative burden and allows for more time spent focused on patient care activities.

Revenue cycle management challenges

Navigating the complexities of medical coding and billing regulations is a significant challenge. Adding to this complexity are the nuances of dealing with different health insurance companies and plans, verifying patient eligibility, obtaining prior authorizations, and handling denials and appeals. Managing the revenue cycle requires full-time diligence. Instead of hiring in-house staff, many organizations are choosing to delegate to an RCM company capable of overseeing every critical variable.

How to evaluate an RCM Company

Finding the right RCM partner to manage your revenue cycle is imperative. Here are some key factors to evaluate:

Industry expertise and experience: Look for an RCM company with a proven track record in your healthcare specialty. Their staff should have an understanding of the coding and billing nuances specific to your practice area.
Qualifications and certifications: Inquire about their team’s certifications, such as whether they are certified professional coders or certified billing and coding specialists.
HFMA Peer Reviewed: Check for this designation by the Healthcare Financial Management Association (HFMA), which identifies products and services that have met rigorous standards and been endorsed by industry experts.
Technology and software capabilities: A modern RCM partner should leverage technology to streamline processes and integrate seamlessly with your existing electronic health record (EHR) system. Automation tools for tasks like coding and claim scrubbing can also improve efficiency.
Data security and compliance: Ensure the RCM company adheres to strict HIPAA regulations and has security measures in place to protect patient data.
Troubleshooting and customer support: Your RCM partner should offer troubleshooting and customer support with weekly or biweekly meetings to ensure your revenue cycle is moving smoothly. Customer support should also be readily available to address any questions or concerns while providing ongoing communication and clear explanations of processes.
Pricing structure and contract terms: Evaluate the fee structure and ensure it aligns with your budget and services required. The contract terms should be clear, outlining service level agreements, termination clauses, and performance guarantees.

Choosing the best RCM company

When selecting an RCM company, don’t neglect the intangibles. Consider the cultural fit, current/past customer references, and core values. By carefully evaluating potential partners based on the criteria outlined above, you can ensure a successful partnership that delivers improved financial performance, streamlined workflows, and better patient experiences.