5 Essential Elements of Revenue Cycle Management (RCM) Success: Expertise (Part 2 of 4)

Healthcare leaders look for important financial factors when evaluating existing—and potential—revenue cycle management (RCM) partners, including:

• Increase cash flow
• Collecting more revenue
• Reducing the cost to collect
• Lower your cost to collect
• Accelerating the speed of reimbursement
• Boosting return on cash

Although it’s essential to understand the results your current RCM partner delivers, that’s just a starting point. You can only measure them against past performance—either theirs, a prior RCM vendor, or your organization’s work.

As we introduced in the first of this four-article series, for a complete picture, you need industry data and benchmarks using five essential criteria to frame your evaluation. Your RCM partner must demonstrate these competencies if they’re going to help you achieve your financial and operational performance goals:

1. Innovation
2. Expertise
3. Reliability
4. Security, Compliance, and Trustworthiness
5. Quality of Service and Value

In this article, we’ll discuss assessment criteria related to expertise. How does an RCM partner demonstrate expertise? You can see it when:

• The team clearly demonstrates experience and excellence and consistently performs at a high level
• The range of solutions and service offerings covers your needs and aligns strategically with your mission
• The results produced by the solutions and services your organization has implemented meet or exceed the expected operational and financial performance goals
• Your organization is benefitting from ongoing development and solution and service improvements

Assessing RCM Partner Expertise

As mentioned in our first article, one valuable tool hospitals, radiology, and diagnostic organizations can use to help evaluate expertise as it relates to RCM outsourced services providers is the Black Book Market Research report, “Diagnostic/Laboratory/Ancillary Services Revenue Cycle Management: Outsourced & Managed Support RCM Services User Survey.” Black Book Research conducts an annual in-depth study to understand how diagnostic and ancillary services leaders evaluate outsourced RCM service providers across 18 key performance metrics.

Each vendor’s scores are categorized by segment for each performance metric so organizations can see how other healthcare providers in their segment specifically rated each vendor. The segments defined by Black Book Research are:

• Hospital Laboratories
• Pathology Practices
• Clinical Laboratories
• Toxicology & Public Health Laboratories

Scores are combined across segments to calculate a mean score on each of the 18 metrics for each vendor evaluated. An Appendix (table 23, page 31) contains the 2024 Summary Vendor Scores for all 18 criteria by Radiology and Diagnostic Imaging providers.

Industry expertise, for example, directly informs the solutions and services an RCM partner offers. In addition, a deep understanding of your organization, its mission, and where you want to go will be demonstrated through solutions and services crafted to help you get there.

One of the Black Book performance metrics, “Strategic Alignment Between Vendor and Client Goals” (question 1, table 5, page 13), that can help you evaluate an RCM vendor’s expertise is based on study participants evaluating RCM outsourced services providers on the following statements:

• Organizational structure meets the needs of stakeholders or customers.
• Stakeholder satisfaction is the most important priority.
• Clients are likely to recommend the vendor to similar-sized organizations and types.

A second performance metric related to expertise in the Black Book survey is “Breadth of Offerings, Varied Client Settings, Delivery Excellence Across All User Types” (question 6, table 10, page 18). In this survey question, Black Book asked research participants to assess RCM outsourced services providers on the following statements:

• Vendor offers industry-recognized functionality, vertical industry applications, and managed bundled services.
• Vendor routinely drives operational performance improvements and results in the areas they affect.
• Comprehensive offerings are constructed to meet the unique needs of the client’s business initiatives.
• The breadth of vendor contract management modules offers comprehensive system services and broad modules.

Finally, the third metric related to expertise is “Staff Expertise, Compensation, and Employee Performance” (question 11, table 15, page 23). The team at Black Book Market Research assessed this performance metric by asking participants to evaluate RCM outsourced services providers on the statements including:

• The vendor team is considered top in the industry for professionalism and skill.
• Vendor attracts and retains high-performing staff.
• The vendor is focused on building and developing a strong employee team of producers.
• Employees act like owners/leaders.

For the element of expertise, XiFin scored an average of 9.70. This is 11% better than the 8.71 average score received by the other 9 vendors evaluated in the study for the expertise-related questions. It is also higher than our average score of 9.53 for these 3 expertise-related performance metrics in the 2023 study.

Outsourced RCM services providers that rank high for these performance metrics demonstrate the expertise and excellence that hospitals, laboratories, and diagnostic providers need to deliver against their financial and operational goals. These vendor partners know their business—and, more importantly, yours. They help your organization excel financially and help you influence and shape our constantly evolving healthcare market.

Through objective industry data such as the Black Book Market Research report, backed by the real-world experiences of more than 3,100 diagnostic/ laboratory physicians, clinicians, and specialists, and administrative, IT, and finance leaders from 2,787 provider organizations, providers can evaluate whether they have partnered with the outsourced RCM services provider that can deliver the capabilities needed to help them maximize cash flow, accelerate time to collection, and optimize return on cash.

The next article in this series focuses on the third and fourth categories of essential elements of RCM success: reliability and security, compliance, and trustworthiness. Until then, download the full 2024 Black Book Market Research “Diagnostic/Laboratory Support and Revenue Cycle Management Outsourcing” report to see which outsourced RCM service partners can help you accelerate cash collection and increase profitability. Missed the first article? You can access it here.

If you missed part 1 of this series, read it here, or continue to parts 3 and 4: