Trust and Accountability Key to Outsourcing RCM

Outsourcing your billing functions can be a cost-effective strategy that enhances revenue while freeing up your staff to focus on clinical improvement, experts say. However, success hinges on finding a partner you can trust and establishing the terms of that relationship upfront.

“I’ve seen some practices outsource their billing and then wash their hands of any ongoing involvement,” said Nancy Enos, a Warwick, R.I.-based independent consultant and coding instructor affiliated with the Medical Group Management Association. “But any business partner knows when you’re not keeping close tabs on them. You need to have a very open dialogue and ongoing communication.”

Your top priority when selecting an outsourcing partner should be achieving a level of confidence and trust, added John Boland, managing director and leader of Physician Business Process Management for Chicago-based Navigant Healthcare Cymetrix. Ask important questions about their operations and pay attention to your gut instinct as you listen to their responses.

Investing time in finding the right company often pays off in significant operational improvements, said Boland. Although outsourcing can feel like relinquishing control, many physicians who try it find they actually get a better handle on their day-to-day operations.

“A good outsourcing company can help you predict costs on a monthly basis in a way that’s in line with your overall revenue, which helps you better manage your costs,” he says. “It can also apply technology solutions that can help you monitor your progress and might be difficult for an average practice to maintain.”

Trust and accountability are the keys to success, experts say. They offered the following tips for keeping the relationship on track.

1. Assess the service. When interviewing potential vendors, ask for details on how they will handle your account. For example, what is staff turnover like? Will a dedicated representative experienced in your specialty be assigned to you? Does the company assign accounts by geographic region? Remember that national insurers often have different procedures or rules in different states, Enos noted.

2. Set expectations. Transparency in the relationship is critical, said Boland. From the start, establish how you will monitor and assess the billing company’s performance. Enos recommended scheduling weekly conference calls to review dashboard metrics and keeping a running list of questions or issues during the week to address during the call.

3. Delineate responsibilities. It’s important to know exactly what’s included under the contract, said Enos, as some items, such as patient statements, might not be included in the percentage fee and could show up later as unexpected extra costs. To avoid misunderstandings or finger pointing down the road, make sure everyone on staff knows exactly what the outsourcing company is taking on and what remains the responsibility of in-house staff (such as posting copays or collecting at time of service).

4. Monitor reports. A point person on staff, usually the practice manager, should conduct a detailed review of monthly reports and probe further when numbers don’t line up with established goals or expectations.

5. Ask about technology. If the outsourcing company plans to use separate systems for billing and collections, how will you see and obtain that information? Outsourcers bring important tools to the table that help with business intelligence and patient education tools, said Boland. However, the company should also be able to work with your existing practice management system so that the data always remains in your possession.