Essential Competencies for Maximizing Diagnostic Revenue and Cashflow: RCM Compliance, Security, Trust, and Reliability

PART 4: SECURITY, COMPLIANCE, AND TRUSTWORTHINESS

Read Part 1, Part 2, and Part 3.

Diagnostic organizations require specific critical revenue cycle management (RCM) capabilities to achieve operational and financial success. To maximize revenue and cash flow, organizations must work with an RCM partner that can consistently deliver the essential competencies that reduce the cost to collect reimbursements and decrease average AR days.

A successful RCM outsourcing partnership delivers results that help laboratories and diagnostic providers:

• 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

While making the right choice when selecting an RCM outsourcing partner has a significant impact on a diagnostic organization’s operational and financial performance, it’s important 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.

At XiFin, we believe that to continue to support operational and financial success, an outsourced RCM partner must consistently demonstrate five core competencies:

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

In this fourth and final post in our series on the key capabilities necessary for optimal RCM, we focus on the specifics related to Security, Compliance, Trustworthiness, and Reliability. If you missed any of the three previous posts, you can find them here:

• Innovation
• Expertise and Excellence
• Quality of Service and Value

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

Maintaining high levels of security, compliance, trustworthiness, and reliability in outsourced RCM business relationships 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, which are confirmed by third-party audits, testing, and reviews.

XiFin has earned HITRUST Risk-based 2-year (r2) Certification for its corporate headquarters and managed data center facilities, its revenue cycle management platform, XiFin RPM, and the supporting infrastructure of the organization. Furthermore, we provide software as a service (SaaS) that enables our customers to comply with applicable legal and contractual obligations. Additionally, we offer services that make compliance by our customers easier and reduce the compliance concerns that they have to consider.

By prioritizing security, compliance, trustworthiness, and reliability, outsourced RCM providers demonstrate long-term sustainability and a commitment to meeting the customer’s unique needs.

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

Laboratories and diagnostic organizations can evaluate the essential capabilities for effective RCM in the Black Book Market Research annual report, “Diagnostic/Laboratory/Ancillary Services Revenue Cycle Management: Outsources & Managed Support RCM Services User Survey.” Black Book Research conducts a yearly study to understand how diagnostic leaders evaluate outsourced RCM service providers across eighteen (18) key performance metrics. This report is based on the real-world experiences of over 2,600 survey respondents.

The XiFin team associates five of the 18 Black Book Research performance metrics with Security, Compliance, Trustworthiness, and Reliability. These five metrics are outlined below.

1. TRUST, ACCOUNTABILITY, ETHICS AND TRANSPARENCY (Question 5, page 14)

One of these metrics that can help evaluate security, compliance, trustworthiness, and reliability is categorized by the Black Book Market Research team as “Trust, Accountability, Ethics, and Transparency.” For this metric, the Black Book Market Research team asked study participants to evaluate RCM outsourced service providers on the following statements:

• Trust in enterprise reputation is important to clients as well as prospects.
• Client possesses an understanding that its vendor organization has the people, processes, and resources to effectively deliver the desired business and clinical results, based on its industry reputation and past performance.
• There are no disconnects between promises and delivery.

2. RELIABILITY (Question 12, page 21)

In the second performance metric related to security, compliance, trustworthiness, and reliability, Black Book Market Research asked research participants to assess RCM outsourced service providers on the following statements pertaining to “Reliability.”

• Outsourced services 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.
• Services reliability is maximized, and outages/downtimes are minimized.
• Solid product and service capacities are demonstrated consistently.
• Service levels are consistently met as agreed.

3. BRAND INTEGRITY (Question 13, page 22)

Another performance metric related to security, compliance, trustworthiness, and reliability is classified by Black Book Research as “Brand Integrity.” For this evaluation, Black Book Research asked study participants to evaluate RCM outsourced service providers on statements:

• Outsourcing vendor’s marketing and sales statements/pitches are accurately and appropriately represented by actual product and service deliverables.
• Image is consistent with top patient satisfaction 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.

4. FINANCIAL STABILITY AND MANAGERIAL VIABILITY (Question 15, page 24)

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

• Vendor’s viability, employee turnover, financial stability and/or cultural mismatches do not threaten relationship.
• Senior management and the board exemplify strong leadership principles to steward appropriate resources that impact outsourcing 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.
• Services vendor demonstrates and provides evidence of competent fiscal management and leadership.

5. DATA SECURITY, PATIENT PRIVACY, AND BACKUP SERVICES (Question 16, page 25)

Finally, in the fifth performance metric related to security, compliance, trustworthiness, and reliability, 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.”

• In order to provide secure and constantly dependable outsourced service offerings for physician and hospital/IDN affiliate practices and entities, a contract services vendor must provide the highest level of security and data back-up services.
• Vendor’s service in these two areas is superior to the security and backup system of past internal systems.

Outsourced RCM service providers that evaluate well for these five performance metrics deliver the security, compliance, trustworthiness, and reliability that laboratories and 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 diagnostic 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 2023 Black Book Market Research “Diagnostic/Laboratory Support and Revenue Cycle Management Outsourcing” report to see how your outsourced RCM service partner stacks up against alternative providers.

Download a free copy of the Black Book Report.

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