5 Essential Elements of Revenue Cycle Management (RCM) Success: Reliability, Security, Compliance, and Trustworthiness (Part 3 of 4)

Healthcare providers require specific revenue cycle management (RCM) capabilities to achieve operational and financial success. To maximize RCM success, laboratories, hospitals, radiology practices, and other diagnostic provider organizations must work with an RCM partner that consistently delivers the essential competencies to:

• Increase cash flow
• Reduce average days in AR
• Lower the cost to collect
• Reduce denials
• Accelerate the speed of reimbursement
• Integrate insurance discovery, eligibility verification, and prior authorization tools and services
• Automate and configure appeals processes for payor-specific requirements
• Facilitate ease of interoperability with related technology and systems

While making the right choice when selecting an RCM partner impacts an organization’s operational and financial performance, it’s vital to continually monitor and evaluate an RCM partner’s capabilities against industry data and benchmarks to ensure the partner continues to be the best choice for an organization’s specific and unique needs and growth goals.

To continue to support operational and financial success, healthcare providers need an RCM partner that consistently demonstrates five essential competencies:

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

In this third of four articles in our series on the essential elements necessary for optimal RCM performance, we focus on the specific competencies related to reliability, security, compliance, and trustworthiness.

The Value of Reliability, Security, Compliance, and Trustworthiness in RCM Relationships

Achieving and maintaining high confidence levels in an RCM vendor’s technology and services reliability, security, compliance, and trustworthiness is vital to a successful, collaborative working relationship that produces meaningful results. At XiFin, for example, we are committed to safeguarding our customers’ data and maintaining a rigorous security program supported by recognized tools, procedures, and processes confirmed by third-party audits, testing, and reviews.

By prioritizing reliability, security, compliance, and trustworthiness, RCM providers demonstrate long-term sustainability. XiFin has earned HITRUST Risk-based 2-year (r2) Certification for its corporate headquarters and managed data center facilities, revenue cycle management platform, XiFin Empower RCM, and supporting infrastructure. Furthermore, we provide software as a service (SaaS) that supports our customers’ compliance with applicable legal and contractual obligations.

Black Book Research Provides a Valuable Tool to Evaluate Outsourced RCM Providers

Laboratories, hospitals, radiology practices, and other diagnostic organizations can evaluate the essential capabilities for effective RCM outsourced services partnership in the 2024 Black Book Revenue Cycle Management Vendor Report. Black Book Research conducts a yearly study to understand how diagnostic leaders evaluate outsourced RCM service providers across 18 key performance metrics. The 2024 report is based on the real-world experiences of over 3,100 survey respondents representing 2,787 provider organizations.

The XiFin team associates five of the 18 Black Book Research performance metrics with reliability, security, compliance, and trustworthiness. These five metrics are outlined below.

1. 1. Reliability (question 12, table 16, page 24)

To help healthcare providers evaluate RCM outsourced services providers’ reliability, Black Book Market Research asked study participants to assess providers on the following statements about reliability, including:

1. 1. • RCM solutions supplier meets agreed terms as evidenced by routine, acceptable service level reporting and industry expectations
      • Depth and breadth of applications/solutions are acceptable in meeting client needs
      • Service reliability is maximized, and outages/downtimes are minimized
      • Solid product and service capacities are demonstrated consistently
      • Service levels are consistently met as agreed
      • Services and support response is expedient and provided with appropriate resources by the vendor team
   2. Trust, Accountability, Ethics, and Transparency (question 5, table 9, page 17)

To help determine an RCM vendor’s reliability and trustworthiness, the Black Book Market Research team asked study participants to evaluate RCM outsourced service providers on the following statements:

1. 1. • Trust in enterprise reputation is important to clients as well as prospects
      • The client possesses an understanding that its vendor organization has the people, processes, and resources to effectively deliver the desired business and results based on its industry reputation and past performance
      • There are no disconnects between promises and delivery
   2. Brand Integrity and Marketing Leadership and Communications (question 13, table 17, page 25)

Black Book Research classifies another performance metric related to reliability and trustworthiness as “Brand Integrity and Marketing Leadership and Communications.” For this evaluation, Black Book Research asked study participants to evaluate RCM outsourced service providers on the following statements:

1. 1. • RCM vendor’s marketing and sales statements/pitches are accurately and appropriately represented by actual product and service deliverables
      • The image is consistent with top software and services rankings
      • Sales presentations and proposals are delivered upon, and corporate integrity/ honesty in marketing and business development are highly valued
      • Company image and integrity are values upheld top-down consistently
      • An elevated level of relevant client communications enhances the vendor – customer/user relationship
   2. Financial Stability and Managerial Viability (question 15, table 19, page 24)

The fourth performance metric in the Black Book Research study, related to reliability, security, compliance, and trustworthiness, asked participants to evaluate RCM outsourced services providers on the following statements about “Financial Stability and Managerial Viability.”

1. 1. • Vendor’s viability, employee turnover, financial stability, and/or cultural mismatches do not threaten the relationship
      • Senior management and the board exemplify strong leadership principles to steward appropriate resources that impact buyers
      • The client is confident of long-term industry viability for this vendor based on investments, client adoption, exceptional outcomes, and service levels
      • Field management is notably competent, stable, and supportive of clients
      • The vendor demonstrates and provides evidence of competent fiscal management and leadership
   2. Data Security, Patient Privacy, and Backup Services (question 16, table 20, page 28)

Finally, the fifth performance metric focuses on security, compliance, and reliability, cornerstones of trustworthiness. For this evaluation, Black Book Market Research asked its research study participants to assess RCM outsourced services providers on the following statements related to “Data security, patient privacy, and backup services.”

1. • To provide secure and constantly dependable service offerings for provider entities and affiliated business units, a vendor has to provide the highest level of security and data backup services
   • The vendor’s service in these two areas (i.e., security and data backup services) is superior to the security and backup system of the client’s past internal systems
   • Cybersecurity practices and protections meet or exceed industry standards and regulations

For the reliability, Security, and Trustworthiness elements, XiFin ranked first with an average score of 9.7, over 15% higher than the average for the rest of the top 10, and 3% higher than it scored in the 2023 study.

Outsourced RCM service providers that evaluate well for these five performance metrics deliver the reliability, security, compliance, and trustworthiness that hospitals, laboratories, radiology practices, and other diagnostic providers can rely on to achieve their financial and operational goals. Objective industry data and benchmarks, including the Black Book Market Research report, help healthcare providers quantitatively determine whether they are working with an outsourced RCM services provider that can consistently deliver the core competencies needed to maximize cash flow, accelerate time to collection, and optimize return on cash.

Download the 2024 Black Book Revenue Cycle Management Vendor Report to see how your outsourced RCM service partner stacks up against alternative providers.

If you missed parts 1 and 2 of this series, read them here: