Does your medical practice allocate more time to medical billing and collections than actual patient care? It's a likely scenario as health plan rules are always changing, claims are denied for a myriad of reasons, and patients may be responsible for larger portions of their bills as employers seek to cut costs. Even with automation, the growing complexity of the coding and invoicing process makes it increasingly difficult and labor intensive.
To control costs and improve results, many medical groups are evaluating a new generation of practice management and revenue cycle management (RCM) solutions to streamline work flow, raise clean claim percentages, and speed payments. The promise of these solutions is to reset the balance between payers and providers while improving overall financial performance.
But, wading through the various solution options for RCM can be confusing. One obvious measure is the price of the solution, but that doesn't account for the total revenue cycle management expenses when working with an outside partner. It's important to evaluate the total cost of ownership of the solution to make sure the practice is making the right decision to ease the workload on staff to better focus on patient care.
Selecting the right RCM solution
The main benefits of selecting the right RCM solution are to increase reimbursement, lower accounts receivables, and lower expenses by eliminating or repurposing full-time equivalents (FTEs) of office staff. Often, a practice may use the percentage of net collections in the RCM partner's contract as the main decision factor. But that assumes all RCM providers are equal. It's important to calculate the annual total cost when outsourcing RCM in terms of both actual fees and the remaining workload delegated to practice staff, as well as ease of use.
Let's say you are buying a car and comparing prices on what looks like similar vehicles. Car A lists for $10,000 while Car B sets you back $12,000. Car A looks like the better deal — until you dig a little deeper.
A closer look at Car A's sticker reveals you'll need to pay extra for the engine, tires, doors, and service, while Car B includes all features and services. Now you have a clear picture of the total cost of each car and can make a better decision. In the same way, it's important to look under the hood when selecting an RCM provider.
There are five main issues you should consider to make sure you're getting the solution that best meets the needs of your practice.
1. Strength of the technology solution. The core of any outsourced RCM solution is the technology that drives all of the business functions of the practice. At first blush, most RCM solutions meet the basic requirements. But make sure you take a close look at the software to ensure it includes rich features that easily adapt as the billing and collection environment changes or your practice grows.
• Is the practice management software easy to learn and navigate for your staff?
• Does the solution help you reduce FTEs by automating time-consuming tasks like claims submission, appointment reminder calls, eligibility verification, and referral management?
• Does the solution provide robust business analytics so you can proactively manage the revenue cycle, assess provider productivity, and benchmark performance, not just react to issues?
• If you decide to make a change in the future, is the solution portable or will you need to implement a new solution from scratch?