Navigating the Revenue Cycle Landscape: Choosing the Right RCM Partner

Are you looking for a more effective use of your resources? Are your nurses not working to the top of their licensure because they are completing Revenue Cycle Management (RCM) tasks instead of focusing on patient care? If appropriate staffing for RCM tasks is a challenge at your organization, you are not alone. Outsourcing revenue cycle tasks is a solution many healthcare practices, systems, and hospitals are considering, to streamline operations and boost revenue. According to a recent MGMA Stat poll, 41% of medical group leaders will focus on Finance/RCM projects this year.

Choosing the right RCM partner will yield substantial benefits with proper research. Diligent investigation involves more than a Google search; it requires more than the latest technology or the number on the proposal. When selecting an RCM partner, consider your organization’s needs, vendor expertise, processes and procedures, scalability, and value.

Understanding Organizational Needs

First and foremost, understanding where gaps exist is critical; take comprehensive inventory of the practice’s current challenges and opportunities within the revenue cycle. “Identifying pain points, inefficiencies, and growth areas will serve as a roadmap in selecting a partner tailored to your requirements,” said Dana Dove, Vice President of Revenue Cycle Management at LYP Health Management (LYP). “Do you need help with one task, like prior authorizations, or multiple tasks? How much time is your in-house staff spending on RCM tasks? Are you experiencing a high volume of front-end related claim denials? Gathering RCM data will give you a clear picture of what tasks should be prioritized and help focus your search. It also helps determine if you need a full RCM partner or can explore companies offering the flexibility of a la carte services.”

Emphasizing Experience and Expertise

Experience is the cornerstone of trust. Seek an RCM partner with a robust track record in the healthcare industry, particularly those versed in addressing challenges that you experience. “A seasoned partner brings not only knowledge of regulatory landscapes but also insights into industry best practices and innovations,” Dove continues. “Are they certified and up to date with the latest changes in payor requirements? LYP revenue cycle resources are CPC certified by AAPC; that experience helps our clients increase their compliance with federal payer laws. Our teams recognize important factors like timeliness required in filing paperwork and when items are missing, which will lead to denied claims, resubmissions, and lost revenue.” Maintaining a dedicated staff to RCM tasks brings knowledge of industry regulations, compliance standards, benchmarks, and ROI.

Technological Solutions Balanced by Human Engagement

The healthcare industry and the world are exploring the boundaries of artificial intelligence (AI). Innovation drives efficiency: look for RCM companies leveraging technology and data-driven solutions to streamline processes and enhance revenue optimization. At the same time, AI and other automation are not a substitute for human oversight. “The best use of technology, automation, and AI are balanced with dedicated human resources,” Dove adds. “How much will the RCM partner utilize people to review your tasks? Is it the same person or group of people working on your account day in and day out? If there are questions or process changes, what is the communication strategy? Do you have a dedicated account manager onshore who is well-versed in your account?” Using advanced technology is important, but when you balance it with dedicated staffing, your revenue cycle will experience substantial improvement.

Fostering Transparent Communication

Clear and transparent communication is the cornerstone of any successful partnership. Look for an RCM company prioritizing communication, providing regular updates, performance metrics, and actionable insights. “Along with having a dedicated US account manager, look for a partner that keeps lines of contact open,” Dove continues. “LYP’s Client Success Managers (CSMs) schedule weekly status calls to keep productivity and accountability on target. Our clients regularly speak with their dedicated CSM and resources working on their RCM work. Being a transparent partner that serves as an extension of your team, working collaboratively towards shared goals and objectives is our commitment to our clients.”

Adaptability and Scalability

As your organization grows and evolves, so should your RCM partner. Select an RCM partner capable of adapting to your organization’s evolving needs and scaling alongside your growth. Whether expanding services or navigating regulatory changes, an agile partner ensures seamless continuity, sustained success, and uninterrupted revenue flow.

Balancing Cost and Value

While cost is a consideration, focus on value over price; consider factors such as ROI, efficiency gains, and long-term financial health. Investing in a quality RCM partner yields dividends in enhanced revenue performance and operational efficiency. “When you have an experienced RCM partner taking over tasks, it allows your in-house staff to assist more patients/day, easily paying for the RCM resource,” Dove points out. “If your organization isn’t in a place to outsource all RCM tasks, look for a partner who offers a la carte services. At LYP, we customize our offerings to fit our client’s needs, so they only pay for the tasks they need help completing. Our pricing model is a flat hourly rate, which allows our clients to forecast their RCM costs and maximize revenue. Weekly status reporting keeps clients aware of productivity and our team accountable.” Efficiency gains, revenue boosts, and peace of mind have benefits long after cost discussions are over.

Selecting the right Revenue Cycle Management partner is a critical decision for your organization’s financial health and sustainability. Taking time to understand your organization’s needs and goals will help guide you to the right RCM partner. For more information on LYP and our RCM services, please visit https://loveyourpatient.com.

Sources:

MGMA Stat poll, 1/3/24

Dana Dove, LYP Health Management, VP of Revenue Cycle Management