3 Factors To Consider When Choosing An RCM Vendor

RCM or Revenue Cycle Management refers to the multi-stage process that starts when a patient schedules an appointment until their medical bill is paid. RCM vendors are significant for healthcare companies to remain financially viable.  

Reliable, steady, and predictable outcomes produced by your RCM vendor will empower your healthcare organization. Choosing a committed outsourcing vendor can establish a long-lasting relationship with your organization and provide adequate medical support solutions.

RCM vendors use various solutions to improve your healthcare organization. When choosing a vendor, you must ensure that the vendor has ready access to these tools:

1. Accuracy: You must choose an RCM vendor that can deliver accurate and error-free information about every patient. The data must be detailed and up-to-date, covering the status of the patient’s insurance. A healthcare system has multiple stakeholders; healthcare providers, insurance providers, and payers. Each of them must have access to accurate patient data. Accurate patient insurance information is key to organizing any healthcare business’s revenue cycle. If the patient data is not verified correctly from the start, there will be payment delays and denials. In the past, medical providers depended on websites and phone calls to verify patients’ insurance-related information. By utilizing a real-time eligibility verification tool, you can get the most up-to-date, accurate information faster than ever before.

2. Streamlined workflow and increased cash flow: The RCM vendor you choose must be able to provide you with a comprehensive solution that simplifies your workflow. Denied claims are unpaid services or lost revenue for any healthcare business. To avoid claim denials, you must ensure that the RCM vendor has complete control over the denial management processes. They should be able to identify and resolve the root causes for denials to get revenues back. By reducing the need for rework, claims are prepared for faster submission and processing. As a result, healthcare organizations experience faster reimbursements.  By tackling denials effectively, your RCM partner must be able to cut down on costs and relieve your employees of administrative hassles.

3. Compliance: Medical billing can be complex because of legal regulations, constantly-changing CPT codes, HIPAA compliance issues, and Medicare compliance issues. RCM vendors typically deploy the best security measures to keep payments confidential and secure. Before you choose a vendor, it is important to inquire about their security measures to protect your sensitive data from cyber-attacks. You don’t want to be the victim of a data breach because of your RCM partner. RCM vendors must be able to share adequate risk assessments and explain to you which measures they are undertaking for HIPAA compliance. Ensure your RCM vendor has the proper certifications to ensure compliance. Their medical coders and billers must have the correct credentials and training to do their jobs effectively without risking non-compliance with standard industry regulations. Despite the availability of software for coding, it is crucial to have knowledgeable and experienced coders on board to enter data accurately. Furthermore, they must follow up on this data to avoid discrepancies with clinics, hospitals, and insurance providers later. 

Consider these three key factors when choosing an RCM vendor. In addition to these factors, ensure they have scalable resources to accommodate higher workloads of claims submission. Business volumes keep fluctuating, and you can keep your operational costs at a minimum. Find an RCM vendor that can adapt to industry changes and facilitate growth. Partners that can scale up operations can help your business stay viable in today’s world.