End-to-End RCM Partnership Archives – Spark Health Partners

An End-to-End RCM Partner Is Not a Traditional Vendor

Amy Summers, SVP, Marketing + Commercial Operations — Thu, 29 Aug 2024 14:33:29 +0000

What you need to know

While many health systems work with RCM vendors to handle financial transactions at a task level, the true benefits to the revenue cycle lie in forming one strategic, end-to-end RCM partnership. With careful management at every stage of the revenue cycle, this type of partnership can drive sustainable growth, improve patient satisfaction and help to ensure the long-term success of an organization.

Healthcare CFOs must ensure the financial health of a health system, not only through meticulous oversight but through strategic foresight. The choices they make around revenue cycle management (RCM) can have a significant impact on the current and future health of their organization.

The first and most major question many face is how to properly implement RCM processes. Management options have traditionally included:

Keeping management in house, driven by staff who are primarily focused on care
Contracting out with RCM vendors, ensuring revenue-related tasks are completed
Establishing a strategic RCM partnership to drive tech and talent in service of long-term goals

Each of these options can address revenue cycle needs, but only one helps focus and shape the efforts and outcomes that matter the most to a particular health system. Let’s take a closer look.

An RCM partner frees up in-house resources

Effective revenue cycle management ensures that healthcare providers are paid for their services in a timely and accurate manner, critical for maintaining financial stability and supporting care initiatives. However, hospitals and health systems already have a primary mission in place that does not address revenue cycle needs. That mission: providing the best care for patients.

As payers increase their expenditures around artificial intelligence technology meant to assist in denying claims, health systems struggle to keep up with these focused investments, given limited funds and staff available in-house to put toward the latest revenue cycle advancements.

For many, outsourcing revenue cycle management emerges as the best answer — but how a system goes about implementing this process can drastically shift the outcome. There are critical differences between simply signing with third-party RCM vendors versus crafting a robust relationship with an end-to-end RCM partner.

The best revenue cycle management companies are those that understand how to balance proactive management of all aspects of staff and systems with long-term strategic planning to ensure providers continue to be supported at every stage of the revenue cycle.

Traditional outsourced revenue cycle management has limitations

Hiring RCM vendors to handle tasks might seem like a straightforward solution to manage the revenue cycle. After all, most health systems already contract with vendors for a variety of services, including food, janitorial and even pharmaceutical offerings.

It’s critical to note, however, that the aforementioned services don’t require regular interfacing at the executive level, nor are they intertwined with long-term strategies that can make or break a health system’s stability.

Without the integration of a strategic revenue cycle partnership, simply outsourcing on a task level in RCM can fall short in several key areas:

Transactional relationship: Vendors typically operate on a transactional basis, focusing on the completion of specific tasks rather than the overall financial health of the organization. An efficient and effective RCM partnership will ensure that operators are always marching toward the most critical KPIs in line with an agreed-upon strategy.
Limited customization: One-size-fits-all vendors may offer standardized solutions that do not fully align with the unique needs and goals of a particular health system. A true RCM partner will customize scope and carefully consider what success looks like on a system-wide basis, ensuring that each organization measures the outcomes that matter to them.
Minimal executive involvement: Traditional RCM vendors often lack the high-level executive engagement necessary to drive strategic improvements and align RCM processes with broader organizational objectives. An RCM partner should be a partner in more than just name; make sure there’s someone to reach out to when challenges arise.

A true RCM partnership brings numerous benefits

In contrast to the traditional vendor outsourcing dynamic, an end-to-end RCM partnership offers a collaborative approach that extends throughout the revenue cycle. Since a strategic partner plays a role at every stage, it can readily manage any interdependencies that arise, in a way that a vendor operating on a task-by-task basis simply cannot.

This holistic approach unlocks numerous areas of value, including:

Strategic alignment

An RCM partner works closely with the health system to understand its strategic goals and align RCM processes accordingly. This ensures that every aspect of the revenue cycle supports the organization’s broader objectives, from improving patient satisfaction to optimizing financial performance.

Customized solutions

Unlike task-oriented vendors, the right RCM partner will provide tailored solutions that address the specific challenges and opportunities of a particular health system. This customization leads to more effective and efficient RCM processes, ultimately resulting in better financial outcomes.

Regular executive involvement

One standout feature of an RCM partnership is the regular involvement of senior executives. This high-level engagement ensures that strategic decisions are informed by deep industry expertise and a comprehensive understanding of the health system’s needs. Executive involvement also facilitates continuous improvement and innovation in RCM processes.

Enhanced data analytics

An innovative RCM partner can leverage advanced data analytics to provide actionable insights into the health system’s financial performance. These insights enable CFOs to make informed decisions, identify areas for improvement and implement strategies that drive revenue growth and operational efficiency.

Improved compliance and risk management

Navigating the complex regulatory landscape of healthcare requires a proactive approach to compliance and risk management. Because of its strategic orientation, an RCM partner brings specialized knowledge and expertise to help a health system remain compliant with relevant regulations.

Scalability and flexibility

As health systems grow and evolve, their RCM needs may change. An RCM partner offers the scalability and flexibility to adapt to these changes, ensuring that the health system’s revenue cycle processes remain effective and efficient over time.

Each of these factors can significantly enhance the financial performance and operational efficiency of a health system.

The right RCM partner offers a measurable impact

A robust RCM partnership can also provide a significant competitive advantage. By leveraging the expertise and resources of an RCM partner, health systems can differentiate themselves through superior financial performance and patient care. In fact, the benefits of a true RCM partnership often extend beyond financial performance. These include:

Enhanced patient experience: Efficient RCM processes lead to faster and more accurate billing, reducing patient frustration and improving overall satisfaction. A positive patient experience is crucial for building trust and loyalty, which can drive patient retention and referrals.
Financial stability: By optimizing revenue cycle processes, an RCM partnership helps health systems achieve greater financial stability. This stability enables the organization to invest in new technologies, expand services and improve facilities, all of which contribute to better patient care.
Operational efficiency: Streamlined RCM processes reduce administrative burdens and free up staff to focus on more strategic initiatives. This operational efficiency leads to cost savings and improved productivity across the organization.
Data-driven decision-making: Access to advanced analytics and insights empowers CFOs to make data-driven decisions that enhance financial performance and operational efficiency. This strategic approach ensures that the health system is well-positioned to navigate industry challenges and capitalize on opportunities.

The bottom line

For health system CFOs, the choice between simply hiring RCM vendors and forming an actual RCM partnership is clear. An RCM partnership offers a strategic, collaborative and customized approach that delivers superior results.

Moreover, by partnering with an RCM expert, health systems can focus on their own core competencies — delivering high-quality patient care. This allows healthcare providers to allocate more resources and attention to clinical operations, ultimately enhancing patient outcomes and satisfaction.

With benefits like regular executive involvement and enhanced data analytics, the right RCM partnership can transform the financial and operational performance of a health system. By embracing this partnership model, a health system can drive sustainable growth, improve patient satisfaction and help to ensure the long-term success of their organization.

Your revenue cycle is too important to be left to chance.

Contact Spark Health Partners to find out how an end-to-end partner with proven results can help secure your organization’s financial future.

The post An End-to-End RCM Partner Is Not a Traditional Vendor appeared first on Spark Health Partners.

The Ultimate Guide to Revenue Cycle Assessments

Ryan Goodin — Mon, 08 Jul 2024 20:50:00 +0000

How to determine if an RCM assessment is right for you and how to select the right partner. … Read More

The post The Ultimate Guide to Revenue Cycle Assessments appeared first on Spark Health Partners.

Examining the Decision to Outsource

Ryan Goodin — Tue, 18 Jun 2024 13:05:52 +0000

See why future-focused healthcare leaders view the revenue cycle as a value driver, not a cost center. … Read More

The post Examining the Decision to Outsource appeared first on Spark Health Partners.

RCM Outsourcing Guide: Choosing the Right Partner Is Vital to Your Bottom Line

Andrew Bess, Chief Client Officer — Wed, 14 Jun 2023 16:36:29 +0000

When it comes to revenue cycle management (RCM) outsourcing, the process of selecting the right partner for your organization’s financial success is crucial. In the ever-evolving healthcare landscape, managing revenue cycles efficiently has become more challenging than ever. Thanks to increasing complexities, stringent regulations and mounting administrative burdens, many healthcare providers are turning to outsourcing as a strategic solution. However, the key to reaping the benefits of RCM outsourcing lies in selecting the right partner. In this revenue cycle outsourcing guide, we’ll delve into the significance of choosing the right RCM outsourcing partner and how it can significantly impact your bottom line, ensuring optimized revenue streams and streamlined operations for your healthcare organization.

What is Revenue Cycle Management Outsourcing?

RCM outsourcing is the practice of entrusting the management of revenue cycles to external service providers. It involves delegating critical financial tasks and responsibilities to specialized professionals who possess expertise in handling billing, coding, claims processing and other revenue-related functions. RCM outsourcing holds particular significance in the healthcare industry as dedicated firms or vendors can help handle tasks such as patient registration, insurance verification, coding, billing, collections and payment posting. By leveraging the knowledge and resources of an outsourced partner, healthcare organizations can streamline their revenue cycles, enhance financial performance, reduce operational costs and ensure compliance with complex billing and regulatory requirements.

RCM outsourcing enables healthcare providers to focus on delivering quality care while entrusting the intricate financial aspects to experienced professionals, ultimately leading to improved efficiency, increased revenue and enhanced patient satisfaction.

What Are the Benefits of Outsourcing Your RCM?

Outsourcing RCM offers numerous advantages that significantly benefit healthcare organizations.

Ensuring the accurate transmission of data across disparate systems and different departments, without losing anything in translation, is crucial for precise reimbursement and a positive patient experience. RCM leaders must adapt to constant changes and nuanced requirements for how data should be shared, through which systems, and at what time to comply with thousands of intricate rules that vary between payors and service types.

Bringing in individual vendors and systems to manage different aspects of the RCM process demands meticulous orchestration and oversight to prevent gaps between steps or vendors. This task becomes particularly challenging due to the multitude of ways information and performance are captured and shared. Each vendor introduces their own reporting variation, calculating metrics differently or utilizing specific subsets of data. This leads to discrepancies between vendor reports and the provider’s host system, making it exceedingly difficult to obtain a comprehensive overview of RCM performance and verify it through transparent access to the data and calculations.

“Revenue cycle has its own black box,” explains Marty Bonick, president and CEO of Ardent Health Services, a 30-hospital system in the southeast. “There wasn’t visibility at an executive level to see underlying subcategories within the revenue cycle where we were leaving dollars on the table or what was really happening with denials or underpayments or recoveries. I would ask our vendors to provide an overview of our performance I would get spreadsheets with a bunch of data but no insights.”

RCM outsourcing is a holistic solution that offers a comprehensive approach to revenue management, eliminating the challenges associated with coordinating multiple vendors and ensuring a unified, streamlined process.

Through RCM outsourcing, you can unlock benefits including improving your revenue cycle performance, reducing the burden on administration, cost-effectiveness, enhancing the patient experience and achieving better financial forecasting and management.

Improved Revenue Cycle Performance

By partnering with experienced outsourcing providers, healthcare providers can tap into a wealth of industry knowledge, specialized expertise and advanced technological resources. These partners can implement accurate coding practices, effective claims management strategies and efficient billing processes to optimize revenue streams. By conducting thorough audits, they can identify areas for improvement and implement revenue-enhancing initiatives. Outsourcing partners will also stay up to date with evolving regulations, compliance requirements and industry trends to ensure adherence to billing guidelines, mitigate the risk of penalties and reduce rejections and denials.

With streamlined revenue cycles, healthcare organizations can maximize revenue collection, minimize revenue leakage and ultimately improve financial performance. Outsourcing revenue cycle management empowers healthcare providers to focus on core competencies so experts can handle the intricate aspects of revenue management, resulting in improved revenue cycle performance.

Reduced Administrative Burden + Costs

Trying to manage revenue cycle management in-house can be resource-intensive and result in a financial burden. With RCM outsourcing, you eliminate the need for extensive infrastructure, technology investments and dedicated staff, resulting in significant cost savings. Outsourcing partners operate at scale, spreading costs across multiple clients, enabling them to offer services at a lower cost than if you were to maintain an in-house revenue cycle management team.

Outsourcing can alleviate the stress and administrative burden of keeping up with ever-changing regulations, compliance requirements and industry trends. Through a managed services partnership, you can benefit from the expertise of specialized professionals who are well-equipped to adapt to the dynamic nature of these rules. This ensures your RCM processes remain accurate, efficient and compliant, allowing your internal teams to focus on other critical tasks.

Enhanced Patient Experience

Entrusting revenue cycle management tasks to a dedicated outsourcing partner ensures healthcare providers can allocate more time and resources to patient care. Streamlined revenue cycles allow providers and healthcare professionals to focus on delivering quality treatments, enhancing patient satisfaction and improving overall healthcare outcomes.

An inefficient or poorly run revenue cycle can negatively impact patient satisfaction in several ways. Delays and errors in billing and insurance processing can result in confusion and frustration for patients, whether due to receiving unexpected bills or difficulties understanding financial obligations. This stress can ultimately erode their trust in the healthcare provider.

A disorganized revenue cycle can also lead to longer wait times for appointments or procedures. The scheduling and pre-authorization process needs to be optimized to prevent these unnecessary delays before receiving care to prevent dissatisfaction and the perception the patient’s time and needs are not being prioritized.

Optimizing the revenue cycle through a dedicated outsourcing partner can elevate the patient experience. By leveraging the expertise and technology of a specialized partner, healthcare providers can streamline billing, coding and claims management processes, resulting in faster and more accurate billing, reduced billing errors and enhanced transparency in financial transactions.

When processes related to financial obligations are smooth and efficient, the patient can focus more on their healthcare journey for a more positive perception of the provider. Reducing the administrative burden on healthcare professionals will also allow them to dedicate more time and attention to patient care, fostering better communication, empathy and personalized treatment plans.

Better Financial Forecasting + Management

Through the expertise of outsourcing partners, healthcare providers and organizations gain access to comprehensive financial reporting and analysis. A good outsourcing partner will generate detailed reports on key performance indicators, revenue trends and financial metrics, providing valuable insights into your organization’s financial health.

This accurate, timely financial data helps healthcare providers make informed decisions, identify potential bottlenecks and implement proactive measures to optimize revenue streams. Revenue cycle management outsourcing also offers robust revenue cycle analytics and predictive modeling capabilities to enable organizations to forecast revenue, identify revenue leakage points and strategize for future growth. Outsourcing partners will utilize advanced technologies and industry best practices to improve revenue capture, reduce bad debt and enhance cash flow management.

Relying on the expertise of an outsourcing partner helps your organization achieve better financial forecasting and management, leading to increased revenue, improved financial stability and long-term sustainability.

What To Look for in an RCM Outsourcing Partner

Choosing the right RCM outsourcing partner is crucial for the success of your healthcare organization. It’s important to apply careful evaluation and consideration of various factors. Your ultimate goal is to select a reliable, capable RCM outsourcing partner with a track record of delivering consistent results for organizations like yours.

Below are the top considerations when looking for an RCM outsourcing partner.

Understanding Your Organization’s Needs

Every healthcare organization has unique requirements, challenges and goals within its revenue cycle operations. By thoroughly understanding your organization’s needs, you can find an outsourcing partner that aligns with your specific objectives and can effectively address your pain points.

Comprehending your organization’s needs can help a partner tailor their services and solutions accordingly. They’ll take the time to analyze your existing revenue cycle processes, identify areas for improvement and customize their approach to meet your specific requirements. A higher level of understanding ensures a more seamless integration of their services with your existing systems and workflows to minimize disruptions and maximize efficiency.

In addition, working with a partner who understands your organization’s needs can provide proactive solutions, offer valuable insights and adapt their services as your needs evolve.

Experience + Expertise

Having a revenue cycle management outsourcing partner with extensive experience means you immediately get industry-specific knowledge and insights brought to the table. They already understand the complexities of healthcare reimbursement, coding standards, billing regulations and payor requirements.

Their experience and expertise can help you navigate the intricacies of revenue cycle processes, identify potential challenges and implement best practices to optimize reimbursement. Additionally, an experienced outsourcing partner has likely encountered a wide range of revenue cycle scenarios and has developed effective strategies to overcome them. Their track record should demonstrate their ability to deliver results and meet or exceed expectations. You want to ensure your revenue cycle operations are placed in capable hands to stay ahead in the ever-evolving healthcare landscape.

Technology + Infrastructure

Working with a technologically advanced outsource partner means you can leverage state-of-the-art software solutions, automation tools and electronic health record (EHR) systems. These solutions will help streamline billing, coding, claims processing and other revenue-related tasks. A competent partner should have the capability to integrate seamlessly with your existing systems for smooth data exchange and to minimize disruptions.

Having a robust infrastructure is essential for handling the volume and complexity of your organization’s revenue cycle, so working with a partner that has strong infrastructure ensures you’re able to handle high transaction volumes, maintain data security and privacy and ensure business continuity. Technological proficiency contributes to efficient revenue cycle management, enhanced data security and scalability.

Reputation + References

The reputation of a potential outsourcing partner reflects their reliability, trustworthiness and the quality of services they provide. A reputable partner will have a positive track record, demonstrated by satisfied clients and successful partnerships. When evaluating the credentials of a potential partner, it’s beneficial to consider rankings and recognition from esteemed industry organizations. For example, HFMA recognizes healthcare organizations that meet industry standard revenue cycle benchmarks each year. Ask your potential partner how many of their clients have received this designation.

Check references and seek feedback from current or past clients to gain insights into the potential partner’s performance, responsiveness and ability to meet expectations.

It’s also important to inquire about their level of customer support, deadline adherence, billing and coding accuracy and overall client satisfaction. Having a revenue cycle management partner with a strong reputation and positive references instills confidence in their ability to deliver results and establishes a foundation for a reliable long-term partnership.

Additionally, third-party organizations like KLAS Research and Black Book Research release annual rankings of firms across a variety of categories, including RCM outsourcing. It’s essential to gain a clear understanding of the criteria employed by these organizations in formulating their rankings, including how client feedback is obtained and how performance is evaluated.

Communication + Transparency

A revenue cycle management outsourcing partner that provides clear and open communication channels ensures there’s a seamless flow of information between your organization and the partner. Regular, timely communication allows for addressing concerns, providing feedback and sharing updates. It fosters a collaborative relationship where both parties are on the same page regarding expectations, goals and project timelines.

The number one thing is communication. Not everything is going to go perfectly, and the key is how the customer and vendor react.

– Health System CFO

Transparency is equally as important as it promotes trust and accountability. An outsourcing partner who values transparency will provide clear visibility into their processes, performance metrics and financial reporting. They should be open about their pricing structure, contractual terms and any potential risks or challenges. Transparent communication helps build a strong working relationship based on trust and enables you to make informed decisions and monitor the progress of your revenue cycle management effectively.

Potential Risks + Challenges of RCM Outsourcing

Revenue cycle management outsourcing can undoubtedly bring several benefits, but it does come with potential risks and challenges to be aware of. One of the main risks is the potential loss of control and oversight over revenue cycle operations. Depending on a partner for performance can raise concerns about their ability to deliver and prevent financial disruption, ensuring they adhere to agreed-upon service levels. There may also be concerns surrounding data security and privacy as sensitive patient information is shared.

Additionally, there’s a risk of communication gaps or misalignment of goals between your organization and the outsourcing partner. A lack of clear communication and collaboration can result in misunderstandings and potential errors in revenue cycle management processes, which can negatively impact revenue. It’s also crucial to consider the financial implications as outsourcing does come with associated costs. Evaluate financial feasibility and be sure the potential benefits outweigh the expenses.

Lastly, the transition phase from in-house to outsourced RCM can present challenges like staff training, data migration and adjusting to new processes. Your organization will need to have a well-defined transition plan and effective change management strategies to address these challenges.

While these are very real risks to consider, considering what to look for in a revenue cycle management outsourcing partner upfront can help mitigate these risks to ensure you have a positive experience.

Ensure Less Worry About Your Outsourced RCM With the Right Partner

Partnering with an experienced revenue cycle management outsourcing partner is of the utmost importance for healthcare organizations seeking to optimize revenue cycle processes. At Spark, we offer a wealth of healthcare industry-specific knowledge, expertise and a proven track record to ensure a successful partnership. Through this experience, we can help your organization navigate the complexities of patient engagement, coding, billing regulations and payor requirements to ensure accurate and efficient revenue cycle management. With Spark’s outsourcing solution, we can help you streamline operations, enhance data security and achieve scalability. If you’re ready to improve financial forecasting, achieve better revenue cycle performance, and allow your team to focus on core competencies, contact us today.

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The post RCM Outsourcing Guide: Choosing the Right Partner Is Vital to Your Bottom Line appeared first on Spark Health Partners.