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A Guide to Choosing an Outsourced Healthcare Revenue Cycle Company

doctor reviewing RCM options

Selecting the right healthcare revenue cycle management (RCM) company requires careful consideration and a strategic approach. 

We’ve created this guide to help practice managers navigate this crucial decision-making process based on our decades of experience working with clients in all types of specialties.

Assess The Needs Of Your Specific Practice

Each practice is unique, so the first step in your search for an RCM vendor should be an evaluation, then prioritization, of your own financial goals and needs. This is particularly true if you’re a specialist with complex coding & billing and an ever-changing patient population. Identify pain points, areas for improvement, and the scope of services required within the revenue cycle, including credentialing & enrollment, billing, coding,  A/R follow-up and patient invoicing. Consider in the long term how your service needs may change over time as your practice grows. Be sure to choose a vendor who can scale their offerings appropriately.

Research Several Potential RCM Vendors

There are a few ways to explore reputable healthcare RCM companies. You can utilize online resources, network with industry associations, and connect with your professional contacts to compile a list of potential vendors. Look for companies with a strong track record, positive client testimonials, and expertise in your specific provider niche. When considering a referral from a colleague, ask direct questions about the nature of their relationship with the vendor to determine whether they have a financial interest in getting your business. Referral programs aren’t uncommon but it’s important to clarify their benefit.

Evaluate The Vendor’s Range Of Services

Take the time to really scrutinize the range of services offered by each company and carefully assess how well they align with the specific needs of your organization. Understanding the structure of their service offerings is crucial – inquire whether they provide comprehensive packages, individual service options, or a combination of both. It's not only about the breadth but also the depth of their offerings.

Dig deeper into the details of the services available. For instance, inquire about their typical and advised approach to handling patient balances including small balances and refunds.

Review the RCM’s Technology And Integrations

Assess the technology and software used by the RCM company. Ensure compatibility with your existing EMR systems for seamless integration. Find out whether there will be onboarding costs associated with the initial integration, as well as any ongoing tech-related fees. Ask questions about potential system downtime or disruptions during and after the integration process.

Ask Questions About Compliance And Security

Data security is paramount; ensure they have robust measures in place to protect sensitive patient information. Verify that the RCM company complies with healthcare regulations like HIPAA, don’t just assume that they do. Ask specific questions about their cybersecurity procedures and incident response plans, cyber insurance and errors & omissions coverage limits including how regularly the efficacy of their program is audited.

Analyze Your Financial And Business Development ROI

Compare pricing structures among different vendors. Consider not only the costs but also the potential return on investment relative to the services requested. Your RCM vendor can be a very effective partner in growing your business and improving long-term sustainability through business intelligence analysis. Evaluate how their pricing aligns with your budget while considering the value of their services not just including improved cash flow but also longer-term profitability projections.

Client References And Testimonials

Once you've identified an RCM vendor that aligns with your needs, requesting references and case studies directly from the vendor can provide valuable insights into their past performances and the outcomes they've achieved for similar clients. Taking the extra step of reaching out to their existing clients for firsthand feedback is also a good strategy. This direct interaction allows you to gather authentic and unfiltered information about the vendor's ability to meet expectations, handle challenges, and maintain a positive client relationship over time.

Ask About Customer Support And Communication

Inquire about the RCM’s customer support system. An account manager who is familiar with your practice and a guarantee for responsive customer service are crucial for addressing queries, concerns, and issues promptly. Find out exactly how you can submit your questions and ensure that you’ll be in direct communication with a representative. Ask about real-world scenarios involving proactive communication like the RCM’s approach to keeping clients informed of coming changes,  how they manage ongoing compliance needs, and whether they can identify cash flow issues before they become critical.

Closely Review Contractual Considerations

It's important to evaluate quotes thoroughly and read your contract carefully, without making assumptions about services provided that aren't specifically spelled out in the legal language. Carefully review the contract terms. If this arrangement turns out not to be a great fit, what are the terms for ending the engagement? Pay attention to service level agreements, termination clauses, guarantees, and any potential hidden fees. Understand the terms thoroughly before finalizing an agreement. It’s advisable to seek legal counsel before finally signing off.

Try A Pilot Project Or Trial Period

Consider initiating a pilot project or trial period with the selected RCM provider. This allows firsthand experience of their performance, efficiency, and compatibility with your organization before a long-term commitment. Not all services make sense for a short-term engagement, such as billing or coding which require significant onboarding time. Start with a chart audit or a policy review as a standalone test to help you get a sense of how well your organization and the RCM vendor work together.

Ask A Lot Of Detailed Questions

Throughout the entire process, be forward in asking specific questions about the RCM vendor’s processes, reporting mechanisms, performance metrics, and any other interests or concerns you might have. Clarity is crucial for a successful partnership and a reputable vendor will not shy away from this type of inquiry.

In conclusion, selecting the ideal healthcare revenue cycle management (RCM) company requires a strategic approach. Begin by assessing your practice's unique needs, prioritizing improvement areas, and anticipating growth. Thoroughly research potential RCM vendors, considering track records and tailored expertise. Scrutinize services for alignment, evaluate technology compatibility, and ensure compliance with healthcare regulations. Remember that choosing the right RCM company is a worthwhile investment in the efficiency and sustainability of your practice's financial processes.

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