Ultimate Guide to Outsourcing Your Revenue Cycle Management (RCM) Team
Healthcare organizations are known to treat, save lives and promote overall wellness of their patients. But in order for the system to do it successfully and continually, being financially healthy is key. This is where billing, claims, and revenue generation comes in. Through revenue cycle management (RCM), these crucial financial processes are done and executed in an organized and efficient manner. RCM is a front-to-end process that includes; identification of sickness, patient scheduling, insurance verification, coding, claims submission, denial management and up to payment collection.
Without a solid RCM, a healthcare business may not thrive nor lose its ability to treat patients. Without revenue, the business won’t be able to pay operational bills and employ healthcare professionals. To put it simply, RCM is the source of profit. On top of it all, it unifies the business and clinical side of healthcare. It is important to understand that RCM is called a cycle because it is a management strategy that requires front-to-end transactions. In summary, RCM teams equate to business stability.
The cycle starts when a patient makes an appointment to seek for treatment and ends with claims and payment collection. A disruption of the cycle will result in either denied or delayed payment which contributes to revenue loss. Below is an RCM wheel to fully appreciate the cycle.
Industry News and Trends
Knowing the latest information about the industry trends will give you leverage on how to effectively scale your team, manage your healthcare company and adapt to the changes in healthcare which later on can guide you in making operational decisions for your business. Below is the latest news in healthcare that pushes you to be one step ahead in your business.
Common Pain Points in Healthcare
But the swift shift in care regulations and reimbursement models debilitates most healthcare businesses making it difficult to maintain a stable RCM process. Aside from this, it is important to be aware of the challenges and the vulnerabilities of revenue cycle management. We listed the factors that affect the revenue cycle. For this process to be successfully integrated in your system, being aware of the following is your headstart for an effective RCM.
Billing errors, big or small, create a negative impact on overall patient experience and satisfaction. And do you know that as simple as accidentally documenting incorrect information, may it be the patient’s name or wrong diagnostic code results in revenue loss? This can lead to a large number of claims denials and rejections which ultimately decreases the quality of patient experience. Imagine the effect if billing errors are not correct. This can lead to fine settlements, fraud charges losing trust from your patients.
But a great, high-performing outsourced RCM team can assure accurate medical claims processing, improving average turnaround time from 70% to 95% of claims processed within one hour of submission.
Training is crucial in building a great RCM team especially when ICD codes and claims regulations change frequently. However, training is costly making it difficult for hospitals in the US to support in updating the certificates and providing regular training to their in-house teams. In effect, decline in performance, patient satisfaction, and revenue loss will arise.
But a trusted outsourcing partner will build you an RCM team with the most updated certifications and will conduct regular training on your behalf. Not to mention that your outsourced team will be fully adept with the latest EHR tools because they know the impact in keeping bills error-free. Sufficient and updated knowledge in the RCM system makes processing claims three times faster and improves business’ ROI.
We have established that RCM is complicated. Mismanaged process leads to denied or rejected claims, lagging accounts receivable, and high administrative costs.
But a dedicated RCM team will closely monitor and audit the front-to-end tasks of the revenue cycle which makes them hyperfocus on monitoring accuracy and timeliness in billing up to claims. They detect ambiguity in overall healthcare data may it be as simple as wrong spelling to incorrect coding.
These are just a few of the common challenges in RCM but you can start with these three to effectively manage this cycle and fortify your revenue system. Note that you can create your in house team, but doing so may shift your attention on what your business should primarily focus on, and that is patient care. The key to managing both clinical and revenue elements for your healthcare organization is finding the right outsourcing partner that will circumvent the said pain points listed above.
Incorporating several dimensions of your healthcare business supply chain through outsourcing from vendors that have been aiding healthcare companies is one element to success.
The right outsourcing partner can help you build a team of patient concierge, medical review specialists and other patient inquiry-related concerns who can support your business by freeing clinicians from answering phone calls and responding to appointment inquiries.
Aside from those stated about, there are vast benefits of outsourcing. Let us put that into a list.
Benefits of Outsourcing Overview
Building a healthcare team can be daunting especially there are different kinds of experts in the industry. You need to be aware of the professionals suitable for an RCM system or those that are equipped with the right skills for health informatics. Aside from being aware of interlinking departments, limitations such as talent availability and expensive salary for these experts add another layer of operation challenges.
But with the right outsourcing partner, building a great team of RCM professionals and health informatics experts is one less worry for your business. To fully appreciate how an alliance with the right partner brings great benefits to a company, check the list below:
The right outsourcing company can build a great HC team with the required expertise and competencies that can stay up to date with the latest technologies in the industry.
Great Partner, Great Team
Infinit-O’s RCM Catalog summarizes how a great partner builds great teams.
Infinit-O is a trusted global solutions partner that can help you successfully grow your business.
Cost Comparison per Month:
In-house FTE (full time employee) vs. Infinit-O FTE
|Job Title||Cost per In-house FTE ($ rate)||Cost per Infinit-O FTE ($ rate)||% Savings per Month|
|Account Receivables Specialist||$ 7,064.78||$ 1,600.00||77%|
|Claims Specialist||$ 4,868.86||$ 1,700.00||65%|
|Junior Medical Biller||$ 4,626.69||$ 1,600.00||65%|
Cost Comparison per Year:
In-house FTE (full time employee) vs. Infinit-O FTE
|Job Title||No. of team members||Estimated Annual Cost Savings|
|Account Receivables Specialist||1||$ 65,577.41|
|Claims Specialist||1||$ 38,026.37|
|Junior Medical Biller||1||$ 36,320.26|
For other roles that you wish to add, our Cost Savings Calculator can help you in projecting potential operational cost reductions.
- Cost per full-time employees at Infinit-O dedicated to your company. Estimated total cost (fully-burdened) including total personnel costs, all overheads including workstation, software, and rentals. These are all-in costs, there are no hidden fees and we do not charge separate set-up fees.
- After further identifying your business requirements we can adjust the plans, match you to the right talent, and build you a great team that fits according to your evolving business needs and goals.
Cost Savings Calculator
We understand your needs and want to help you actualize your potential by providing ease of access to talent and building you a great team based on your business requirements.
4 Pillars of Success: People, Process, Technology and Security
A well-established People, Process, Technology, Security (PPTS) Pillars is one sure way to overcome the limited supply of workforce, improve the healthcare delivery system, innovate care technologies to ease manual labor and fortify patient data security in agreement with clinician-patient confidentiality.
Having 4 pillars of success are key in only building a great and high-performing RCM team.
Know more about Infinit-O’s 4 pillars of success and our secret in building a great, high-performing RCM team.
To successfully grow your business and achieve your goals, it starts with proper planning and investing in the right resources. The following companies in the HC industry were able to identify their unique needs and sought help with the right partner who exactly knows how to address their demands.
We’ve gathered the following success stories so you can learn more about their outsourcing journey and how they were able to achieve their business objectives with the help of the right partner.
Infinit-O has been in the outsourcing industry for 15 years, creating long lasting partnerships and endless opportunities to small and medium businesses across the Healthcare, Finance and Accounting, Research and Development, and Customer Service industries.
Our vision is to help small and medium sized companies to grow and prosper by enabling them to experience the full benefits of partnering with an outsourcing company.
We build great teams for our partners through understanding their unique needs in order to help them achieve their business goals and the vision they have for their company. We have rendered a strong combination of business consultancy, process optimization, and outsourced services; all utilizing the latest technology to provide excellent value for our clients.
Get to know us more through these channels:
Infinit-O Information Security
We share 15 years of experience in navigating data privacy laws and regulations. We guarantee strict compliance from the best information security practices with up to date cybersecurity certifications because your data is in our care. At Infinit-O, we not only value your business but acknowledge the importance of information security especially in this digital age. To overcome customary challenges and build a better cybersecurity system that ultimately protects and secures data, we are certified and compliant with:
Learn more about the full list of our Information Security bundle in this Whitepaper.
Infinit-O Key Benefits
Having an extensive and profound expertise in the finance and accounting industry, we’re here to help you build a great RCM team for your unique needs and promise the following key benefits: