Assessing Your Ancillary Services RCM Outsourcing Partner: It Starts with Expertise

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

PART 1: EXCELLENCE AND EXPERTISE

As patient care transitions from acute to ambulatory settings, hospitals and IDNs are increasingly leaning on ancillary services to extend the reach of their health systems. Outpatient diagnostic care–especially in pathology, radiology, and clinical laboratories–provides an opportunity to push informed clinical decision-making further ahead in the patient care continuum. That, in turn, improves outcomes.

To deliver on that mission, however, ancillary services need to perform at not only a departmentally sustainable level, but also at one that contributes to the health system’s overall bottom line. With the right revenue cycle management (RCM) outsourcing partner, one that helps realize billing and process efficiencies among outpatient services, that’s entirely possible. And you’ll see the results in:

• Accelerated cash flow
• Mitigation of staffing challenges
• Improved financial margins

If you’re looking for RCM outsourcing help, how can you proactively assess a potential partner’s ability to deliver? And if you already have an outsourcing partner, how do you measure it against potential replacements? For ancillary services providers, it’s helpful to evaluate RCM outsourcing vendors using four key criteria:

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

Understanding these four criteria–and applying them to objectively evaluate the strengths and weaknesses of your current RCM outsourced services provider–can help you determine where you have gaps or are failing to maximize the effectiveness of your RCM processes and practices. In this first of four blog posts, we’ll start with Expertise and Excellence.

A Closer Look: Expertise and Excellence

RCM needs for ancillary services are complex. They’re unique. On one hand, clinical laboratories perform an incredibly high volume of tests–more than 7 billion per year collectively in the U.S. Conversely, radiologic and pathology interpretations are more complex and clinically nuanced than routine clinical tests. Additionally, you have to account for how your department’s work integrates within your hospital’s or IDN’s technology and care-delivery ecosystem–an ecosystem typically optimized for acute care. How do you know if an RCM solutions provider can reliably account for this variation among outpatient diagnostic services?

If you are willing to entrust your department’s billing work to an outsourcing partner, that partner must know what they’re doing. That’s where Expertise comes into play. Expert RCM solution providers know how to deliver the results you expect. Their solutions meet your department’s needs because they know what those needs are. They help you avoid issues before they arise. They adapt nimbly to changing dynamics–from payor-driven to regulatory to those within your health system. They offer consultative value that empowers your team to deliver on its mission.

Excellence flows from expertise. An RCM partner’s solutions perform. Implementations run smoothly. The solutions deliver results–while undergoing iterative, non-disruptive improvements to accommodate change on both a macro and granular level.

How an RCM service provider demonstrates Expertise and Excellence:

Assessing RCM Partner Expertise and Excellence

Because the RCM needs of ancillary services departments are inherently unique, identifying tools to help you assess potential partners can be challenging. One such tool that can help you evaluate Expertise and Excellence is the Black Book Market Research annual report, “Diagnostic/Laboratory/Ancillary Services Revenue Cycle Management: Outsources & Managed Support RCM Services User Survey.” Each year, Black Book Research conducts an in-depth study to understand how diagnostic leaders evaluate outsourced RCM service providers across 18 key performance metrics.

One of the performance metrics (Question 1, page 10) that can help you evaluate Excellence and Expertise is based on the Black Book Market Research team asking study participants to evaluate RCM outsourced services providers on the following statements related to “Strategic Alignment of Vendor Offerings to Provider Goals & Client’s Mission.”

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

For a second performance metric related to Expertise and Excellence (Question 6, page 15), Black Book Market Research asked research participants to assess RCM outsourced service providers on the following statements related to “Breadth of Offerings, Varied Client Settings, Delivery Excellence Across All User Types.”

• Contract services vendor offers industry-recognized horizontal functionality, vertical industry applications, and managed bundled services.
• Vendors routinely drive operational performance improvements and results in the areas they affect.
• Comprehensive offerings are constructed to meet the unique needs of the client’s clinical and business initiatives.

Finally, the third metric related to Expertise and Excellence (Question 11, page 20) is based on the Black Book Market Research team asking participants to evaluate RCM outsourced service providers on statements related to “Vendor Staff Expertise, Compensation and Employee Performance.”

• Outsourcing vendor team is considered top in industry for professionalism and skill.
• Vendor attracts and retains high-performing staff.
• Vendor is focused on building and developing a strong employee team of producers.
• Employees act like owners/leaders.
• The company is moving towards leveraged pay at all levels.
• Vendor is using effective tools to tie performance metrics to compensation policy and compensating top leaders.

Outsourced RCM service providers that rank high for these performance metrics demonstrate the Expertise and Excellence that ancillary services teams need to deliver against their financial and operational goals. They know their business–and, more important, yours. They help your department excel financially in our challenging and constantly changing climate. Better yet, they help influence and shape that climate within and even beyond your health system.

Through objective industry data such as the Black Book Market Research report, backed by the real-world experiences of over 2,000 survey respondents, including more than 450 from hospitals and IDNs, leaders in ancillary services can quantitatively evaluate whether they have partnered with an outsourced RCM services provider that can deliver the financial performance they need.

Expertise and Excellence is but one of four criteria you can use to evaluate RCM partners. The next post in this series covers the second category of core RCM services capabilities–Security, Compliance, and Trustworthiness. Until then, download the full 2023 Black Book Market Research report to see which outsourced RCM service partners can help you accelerate cash collection and improve margins.

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