The decisions to outsource your revenue cycle management (RCM) and select
an RCM company as your partner should not be taken lightly. The complete
revenue cycle process encompasses many complex functions, including transcription,
coding, billing, and collections. Small improvements in efficiency, quality,
and technology have the potential to deliver significant financial gains
to the bottom line while small errors can negatively impact it.
To help ensure that your choice of an RCM partner is the right one —
that the company you select delivers substantial, sustainable improvements
in profitability and productivity — here are 10 tips that will aid
in your making a more informed decision.
1. Evaluate your current RCM processes and technology. Before diving deep into your search for an RCM company, gain an understanding
of your current RCM operations — whether performed in-house, outsourced,
or a combination of both. This will reveal areas most in need of improvement.
To evaluate your current operations, review some of your more critical
key performance indicators. These can include charge lag (Are you under
three days?), days in accounts receivable (Are you under 40 days?), and
accounts receivable over 90 days (Are you under 20%?).
2. Request an account audit. When speaking to RCM companies, request an assessment of your current account.
This will display their ability and knowledge to determine your current
weaknesses and learn how they plan to recover lost revenue, increase cash
flow, and improve your processes.
3. Inquire about follow-up processes. Ask about established processes to ensure cases are followed up timely
and aggressively. RCM collectors should have ASC experience across payer
types and specialties. Collectors should also have a full understanding
of the ASC industry and options available to help ensure claims are adjudicated
timely and correctly.
4. Learn approach to patient balances. Ask how the RCM companies address outstanding patient balances and contact
patients. Patients should be treated with the utmost respect to ensure
they have a positive experience after leaving the surgery center.
5. Inquire about coding philosophy. Learn as much as you can about how coding is performed. Do the companies
code specific to payers and contracts? Are coders familiar with your state's
regulations? Are they continually educated about federal regulatory changes?
6. Ask about philosophy on noting accounts. Account notes should be very detailed to the point where you can review
the notes and have a full understanding of what has occurred during the
billing process along with next steps to be taken to close the case.
7. Ask about approach to performance measurement and transparency. Find out how companies identify necessary areas of improvement. Do they
offer comprehensive analytics? Do they provide monthly reports that trend
key performance indicators? Do they provide immediate feedback without
8. Be wary of unusually low rates. With RCM services, you get what you pay for. The cheapest vendors are usually
not the best option. Companies advertising very low rates will often not
offer the services critical to ensuring optimized cash flow. They will
likely not have the expertise to work denials, track denial reasons, file
appropriate appeals, and handle contracted payers not paying correctly.
They will also likely outsource services — often to companies with
overseas employees. Many of these vendors are not transparent about their
Also watch out for flat-fee offers. For startup facilities, which aren’t
collecting money at first, a flat-fee model can cover the work provided
by the RCM company at the beginning of the contract. However, as a facility
matures, the flat-fee outsourcing model may not make financial sense.
If an RCM company requests charging a flat-fee rate, the center should
analyze its financials to ensure it isn't paying more in the end when
compared with being billed at a reasonable percentage of monthly collections.
If a center is being charged a flat fee that seems too reasonable (i.e.,
low), it's likely that there are worthwhile services the RCM company
is not performing or providing.
Ask as many questions as necessary to determine whether the company offering
such a rate is planning to take shortcuts and limit services available
to your ASC. These questions may cover topics such as whether the RCM
company is taking shortcuts in the services they are offering, willing
to upload contracts, helping manage contract negotiations, and performing
complete billing, collections, and payment posting.
9. Understand fees associated with cash-pay patients. If your facility accepts cash payments from patients, make sure to learn
how RCM companies handle such payments to ensure you are not charged for
the cash amounts collected. RCM vendors should only charge a fee for payments
received from payers and non-cash-pay patients. The only time it would
be acceptable to charge for cash patients is if the RCM vendor entered
charges and payments into the practice management system for these cash
patients, and that rate should be discounted.
10. Ask for references. Perform your due diligence and take the time to reach out to these references.
Inquire about access and communication with the vendor. Ask references
for an example of an issue their center faced and what steps the RCM company
took to resolve it. A great RCM company will communicate quickly and implement
A successful partnership with a trusted RCM company will last many years.
Over time, such a partnership will become stronger, with the ASC and RCM
company growing and thriving together. Put in the time to perform your
due diligence and take all steps necessary to gain a full understanding
of the companies you are considering as your ASC's partner. This will
allow you to make an educated selection of the company that is deserving
of your business and in a position to deliver on the promise of a strong
partnership. It's much easier and more cost effective to spend a little
more time vetting companies in advance rather than rushing a choice that
may force you to make a difficult and costly change in the future.
Do you have additional questions about selecting an RCM partner? Want to
know why Surgical Notes is the RCM partner of choice for ASCs nationwide?
Contact us today. We welcome the opportunity to speak with you and tell you why we believe our
SNBilling RCM service is the right one for your ASC!