What to Look for in an RCM Partner

Thanks to healthcare reform and the resulting shift in payment models, revenue cycle management is in a state of transition. Accordingly, providers need more help than ever before when planning to outsource RCM. According to survey results published in peer60’s “Healthcare Revenue Cycle Management: 2015,” providers’ concerns include adoption of alternative payment models as healthcare moves toward value-based reimbursement, lingering concerns over ICD-10 and reimbursement issues. Providers also pointed out issues they would like to see addressed, including a focus on improving the patient experience, improvements to point-of-service collections, and better coordination among finance, operations, and clinical teams to implement bundled payments.  Many of these areas point to the need for proven data analytics solutions.

When looking for a potential RCM partner, evaluate the cost to collect, which determines your return on that investment. The ideal net collection rate should be as close to 100 percent as possible. According to the report, “MGMA Performances and Practices of Successful Medical Groups: 2013 Report Based on 2012 Data,” the median adjusted collection rate across all multispecialty practices is 96.02 percent. Better-performing practices have a median collection rate of 99.16 percent. RCM partners should be leveraging data with providers to increase net revenue, and help reduce days in accounts receivable.

As providers enter the discovery phase in vetting potential RCM vendors, the following are areas to consider when selecting a partner:

•Ensure the RCM partner has access to internal and external data so they can begin comparing your performance to that of your peers.  Comparative data allows creation of meaningful benchmarks so that you and the prospective partner can more accurately prioritize business initiatives. Prospective RCM partners should provide examples of how they will create benchmarks and compare internal data to external data. Ask the prospective vendor how they will know if data points fall outside of established parameters, how they will measure and trend your client base, can they compare data with state and national data, and how they will monitor initiatives.

• Determine whether a potential RCM partner provides true data transparency. Some RCM partners only provide access to static, monthly reports about key metrics involved in running a practice. It’s best to work with a vendor who can deliver dynamic, real-time access to information about patient accounts, payment collection status, and other important practice information. Determine whether the RCM partner offers comprehensive analytics, whether it allows for easy distribution of vital information to practice partners, and allows for benchmarking clinic performance against peers.

• Look for an RCM partner who can proactively manage denials to resolution – a critical part of your RCM.  An effective RCM partner should be able to help quickly identify and monitor trends and the root causes for denials by comparing historical data with current data. Using this information, the RCM partner can help pinpoint areas to resolve denials and in turn, increase revenue and/or payment velocity.

• A prospective RCM partner should be able to help track and monitor progress. A quality RCM partner will work with clients to set key performance indicators and provide an easy method, such as dashboards, to monitor progress being made against those KPIs. Leveraging this information, the vendor should be able to highlight problem areas that you can resolve, help prioritize areas of top concern, and develop an action plan.

In addition to the data-related inquiries, additional areas in which to vet a potential RCM partner include determining:

1. Contract terms including termination clauses, what the RCM partner will be providing, and whether the partner will charge fixed or percentage pricing in their contracts.

2. Performance guarantees including how the vendor will solve problems identified during the discovery phase and success rate with previous clients.

3. How the RCM partner’s technology will interface with the provider’s existing systems. Reporting requirements and what reports the RCM partner should provide.

And finally: be sure to check references. Interview RCM references to dig into how data analytics helped improve financial performance as well as their bottom lines.

Amber Civitarese has 17+ years of experience in the healthcare industry specializing in revenue cycle and product management. She develops long and short-term product roadmaps that align with market needs and company goals. Focusing on analytic and workflow solutions, Amber works closely with product owners, developers, marketing and end users to ensure product design aligns with market needs.

Prior to RemitDATA, Amber began her healthcare experience working in the Revenue Cycle Management space, before joining GE Healthcare as a program manager in 2003.

In her spare time, Amber enjoys spending time at the lake with her husband, children and 3-year-old granddaughter.