We all know that one of the most important things for hospitals, EHR businesses, and medical billing organizations is revenue cycle management. It is also regard as the most difficult task in the field. That’s one of the key reasons they hire specialized businesses to handle this part of their business.
How can you choose the best RCM business, though? Here, this article will walk you through 8 simple steps to picking the top RCM provider. For doctors, hospitals, EHR providers, and others wishing to outsource their medical billing businesses, the next few stages will be very useful. Let’s first define revenue cycle management (RCM) and how it works before we get into further detail.
What exactly is Revenue Cycle Management (RCM)?
The phrase revenue cycle management is most commonly link with medical claims submitted by hospitals and doctors for services rendered to patients. In other terms, Revenue Cycle Management (RCM) is the process through which medical practitioners and hospitals identify, verify, and collect payments from patients’ insurance companies who have used their services.
The presence of a Revenue Cycle Services Companies
The first and most important step in selecting an RCM firm is to learn about its history. Any RCM firm you are searching for should have been in business for at least 5 years. The greater the number of years, the greater the experience and skill.
Consider the following companies: ABC with 8 years of experience and XYZ with 2 years of experience. It is evident that ABC company would have witnessed more incidents than XYZ company. When a company has been there for a long time, they will be familiar with both the old and new practices. As a result, you may choose your RCM firm based on these criteria.
Examine the RCM company’s ISO 9001 certification
Another technique to evaluate the RCM firm is to see if they are ISO 9001 certified. Why should we care about the company’s certification? ISO 9001 accreditation is grant for maintaining quality standards in an organization’s processes.
This is a very important factor to consider. The reason for this is that medical claims include numerous processes and procedures. Because ISO 9001 certified businesses adhere to established protocols in their work processes, we may be confident that they have an organized process in place.
Clients of a revenue cycle management Company
Understanding their client list is the next critical criterion for shortlisting a revenue cycle management firm. You must investigate the quality and quantity of their clients. The number of clients served is refer to as the quantity of clients. The type of clients served is refer to as client quality.
You must comprehend the distribution of clients in terms of client size, client type, and geographical location. For example, if you belong to a group of doctors that practice in the same location, search for an RCM business that has previously served a similar type of setup. This shows that they have greater experience serving clientele like this. As a result, it is easy for them to serve you better.
Examine for the HIPAA standard
The Health Insurance Portability and Accountability Act (HIPAA) governs patient data security standards. Why is it significant? It is critical from the patient’s perspective that their personal medical data is secure. It is the obligation of hospitals and medical practitioners to protect patient data. So, when selecting a sales cycle management business, we must determine whether they adhere to HIPAA regulations.
The RCM company’s claims ratio
It is difficult to identify or obtain data on an RCM company’s number of successful and rejected claims. In general, most corporations will be hesitant to reveal information about their rejected claims. Some businesses may even experience an increase in rejection cases as a result of a patient-side issue. As a result, obtaining this information is challenging. However, we can always ask them about this during the discussion or negotiation stage. You can shortlist them if they are confident and receptive to provide these details.
Team for Revenue Cycle Management
This is another important thing to consider when selecting a revenue cycle management organization. You should always be inform of the company’s team. The term “team” refers to the top-level management as well as the support team.
It is critical that we understand their vision as well as their physical regions. If at all possible, we should be able to learn about the team’s qualifications and expertise in this subject. This will allow us to determine whether they have the right people to serve you.
RCM company fees
Most of us believe that this is the most important factor to consider when selecting an RCM firm. To be honest, if the chosen organization can deliver on its promises and assist you in running your business effectively, pricing should not be a concern.
If we choose a company only based on their pricing, ignoring the other considerations stated above, we may wind up spending a lot of time explaining and following up on things. This defeats the objective of outsourcing your medical claim in the first place. When outsourcing, it is critical to keep your budget in check. At the same time, we must not sacrifice service quality.
Support services provided by RCM
Another critical component to consider is the sales cycle management company’s support system. We must investigate their support system. We must ensure that the company is process-driven rather than person-driven.
The reason for this is that process-driven businesses drive themselves. If the situation is person-driven, the work comes to a standstill if that support person departs the organization. A significant amount of time will be lost while the new employee learns the system and this specific case. As a result, it is critical to select an RCM business with the greatest support system in place.
