5 Key Considerations for Selecting an RCM Outsourced Services Partner to Process Medical Device, Remote Patient Monitoring, or DME Claims

Please note: This article series addresses the unique issues and complexities that medical device, remote patient monitoring, and durable medical equipment departments face. If you’re interested in a methodology tailored for clinical laboratories or hospitals and IDN ancillary and outpatients diagnostics departments, we recommend exploring those series instead.

PART 1: INNOVATION

Advances in medical devices, remote patient monitoring, and durable medical equipment (DME) positively impact patients daily. They provide physicians with vital diagnostic and therapeutic information, save time, and reduce healthcare costs.

However, organizations that provide these life-changing technologies often struggle to gain commercial adoption, attain payor coverage, and get reimbursed for services provided. These organizations need solutions and services specifically designed to help navigate these complexities and accelerate adoption, coverage, and reimbursement.

The right revenue cycle management (RCM) partner plays a vital role in facilitating reimbursement from payors and keeping the total cost to collect these reimbursements low. Remote patient monitoring CPT codes, in particular, are being affected by revenue compression. From 2021 to 2022, for example, the Medicare allowable for CPT code 99454 (related to the supply and use of medical devices used to monitor and collect patient-generated health data remotely) was cut by 14%.

A successful revenue cycle management outsourcing partnership delivers results that help medical devices, remote patient monitoring, and DME companies:

• Increase cash flow
• Reduce expenses associated with the RCM process
• Accelerate the speed of reimbursement
• Maximize workflow automation
• Integrate insurance discovery and eligibility checking
• Reduce denials
• Proactively monitor and adapt to payor policy and behavior changes
• Automate and configure appeals processes for payor-specific requirements
• Facilitate ease of interoperability with related technology and systems

Even if your current RCM processes are working well, how do you determine if you could get better results with a different partner? How can you objectively evaluate potential future performance against the results you are achieving with your current solutions and services? And if you’re thinking about outsourcing your RCM services for the first time, where do you start?

Whether evaluating a current RCM outsourcing partner or sizing up new ones, you need a full 360-degree view of their capabilities. To get there, it’s helpful to quantitatively assess potential partners using criteria in five key categories:

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

Understanding these five categories—and applying them to objectively evaluate the strengths and weaknesses of a current RCM outsourced services provider—can help your medical devices, remote patient monitoring, or DME leadership determine where you have RCM gaps. These categories also allow your organization to review the effectiveness of your RCM processes and practices that you have in place. In this first of four blogs, we’ll start by exploring capabilities associated with innovation.

Defining Innovation

Innovation is a critical competency for healthcare technology and service providers, including RCM services providers. New regulatory requirements are regularly introduced. Payor policies and behavior are constantly changing. Patient expectations shift. Technologies emerge, merge, and evolve. It can be challenging to stay current. An innovative RCM partner can mean the difference between profitability and loss. It can also mean the difference between achieving success and falling behind—or even worse, falling out of compliance.

What defines an innovative outsourced RCM services partner? It’s one that:

• Pushes the envelope with new, cutting-edge technology and service enhancements
• Stays abreast of and responds to market changes and your medical device, remote patient monitoring, or DME organization’s unique needs
• Continuously seeks out new ways to help you manage RCM operations more effectively and reduce operating expenses

Behind it all is a partner that thinks creatively and solves problems effectively. An innovative RCM outsourced services partner can grow and adapt to your organization, positioning you for long-term success.

Assessing Partner Innovation

Objectively assessing innovation can be tricky, especially if you’re evaluating a potential partner with whom you have no prior relationship. Industry reports and surveys can offer valuable insight. One excellent resource to help assess outsourced RCM service providers is Black Book Research.

Black Book Research regularly conducts an in-depth study to understand how diagnostic leaders evaluate outsourced RCM service providers across eighteen (18) key performance metrics. The XiFin team associates innovation with several of the eighteen Black Book Research performance metrics. Here are two examples.

For one innovation-related performance metric (Question 2, page 11), Black Book Research asked study participants to evaluate whether RCM services customers are able to increase the accuracy of billing, boost the volume and speed of reimbursement, and reduce overhead “in ways that were difficult or impossible to accomplish before the current outsourced services were implemented.” For these capabilities, which Black Book Research classifies as “Innovation and Optimization,” Black Book Research also asked survey responders to evaluate the following statements:

• Excellence in contract management and managed services
• Providing the highest quality capabilities, processes, technology, staff, leadership, and quality assurance
• Delivering RCM services “above current/former service levels”

A second performance metric (Question 18, page 27) that the XiFin team associates with innovation, Black Book Research classifies as “Best of Breed Technology and Process Improvement Developments.” Survey responders were asked to evaluate outsourced RCM services providers on statements classified by Black Book research as “Integration and Interfaces” including customer perceptions regarding efficacy in:

• Seamlessly sharing information with necessary applications
• Integrating with required backend systems for optimal functioning, including full interoperability with appropriate healthcare organizations and providers
• Administering integration and interface activities precisely
• Creating an ecosystem wherein necessary systems communicate effectively

Organizations that ranked highly in these categories, based on the real-world experiences of over 2,600 survey respondents, demonstrate true innovation, which is crucial to maximizing your medical device, remote patient monitoring, or DME organization’s operational and financial success.

Our next post in this series focuses on outsourced RCM service providers’ performance related to Expertise and Excellence. Meanwhile, download the full 2023 Black Book Market Research report to see which outsourced RCM service partners can help you accelerate cash collection and increase profitability.

Download a free copy of the Black Book Report.

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