Looking to outsource your RCM to a revenue cycle consulting firm? Look for these four qualities in a potential partner
There are many reasons an ASC may struggle with its revenue cycle. Maybe changing payer policies and regulations are causing denials and slow reimbursements? Maybe your patients are not properly educated about their financial responsibility? Maybe you are falling behind on your claims follow-up? The list of contributing factors can go on.
While one or more of these reasons might be a challenge, my experience has shown me that the real cause of most ASC revenue cycle management (RCM) problems is resources. Many of the ASCs I work with simply lack the resources necessary to give their revenue cycle the full attention it needs. This is a challenge that has increased over the past several years as healthcare organizations, including ASCs, have struggled with staff turnover. Unfortunately, there is no indication that staff recruitment and retention challenges are going away any time soon, as one recent study revealed that 60% of all healthcare support workers are expected to leave their job in the next few years.
If your ASC falls into the category of lacking or struggling with maintaining the resources necessary to achieve successful RCM, consider outsourcing to a revenue cycle consulting firm. By using ASC RCM consulting, you can turn your revenue cycle into a fine-tuned machine that brings in timely, appropriate reimbursements, increases clean claim rate and reduces denials, and improves the overall efficiency of your business office team.
But what should you look for in an ASC revenue cycle consulting firm? In this post, I identify four qualities to put on your checklist to help ensure that you select the right firm for your ASC.
A revenue cycle consulting firm should always start an engagement with an assessment of your ASC's current RCM processes and come up with a plan for improvement and further optimization of areas performing well. Your consultant should analyze every aspect of your revenue cycle by meeting with the experts who work the processes every day, establish a baseline, discover the root cause of poor performance, prioritize issues, and develop a detailed strategy to achieve these improvements and optimizations. The strategy should include a strategic roadmap with targeted milestones and identification of stakeholders and their responsibilities.
Once your revenue cycle is optimized, you need to keep it that way. Entropy will always prevail without constant attention, and the time spent to get your revenue cycle in order will be wasted. The ASC revenue cycle consulting firm you select should use a business intelligence tool and analytics to monitor the performance of scheduling, admissions, verification, charge capture, billing, follow-up/collections, payment posting, and other key financial metrics to keep you on track.
Additionally, the firm should monitor external factors that may affect your revenue cycle and adjust your processes accordingly. Coding changes, payer rule revisions, insurance premium changes, and healthcare legislation are just a few of the areas any good consultant should be on top of and be able to discuss with you when those areas can or will affect your revenue cycle performance.
While certifications are by no means a guarantee of a successful relationship with a revenue cycle consulting firm, they represent that the firm and members of its team have received the necessary training that should enable them to effectively manage your ASC's revenue cycle. Some certifications to look for are:
When considering whether to make a substantial investment in a service or product, nothing is usually more valuable than references. Outsourcing to a revenue cycle consulting firm should be considered such an investment. You should never take a firm's word that it can do what it says it can do – and do that work well.
Ask the firm to provide contact information for several clients, particularly ASCs like yours (e.g., state, specialty(s)). Then, take the time to contact these clients and ask about their experience working with the firm. These conversations should help solidify that you are considering a good ASC RCM partner or raise red flags that motivate you to look elsewhere.
By putting the four items identified in this piece on your revenue cycle consulting firm due diligence checklist, you'll put your ASC in a better position to identify and select the firm that's the best choice for your center — one that will help stabilize your cash flow, better ensure you collect all that you are owed, and enable your center to grow and achieve long-term success.
Looking for a revenue cycle consulting firm? Download a summary of these tips to help you assess potential revenue cycle partners!