Keys to Increasing Cash Flow: 5 Things to Consider When Choosing an RCM Partner

PART 1: INNOVATION

Read Part 2, Part 3, and Part 4.

The indicators of a successful revenue cycle management (RCM) outsourcing partnership live in the details—and the results. With an existing partner, you’ll know if your relationship has helped your laboratory:

• Increase cashflow
• Reduce expenses
• 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 customize appeals processes for payor-specific requirements
• Facilitate ease of interoperability with related technology and systems

But even if you’re seeing positive momentum in all (or most) of these attributes, how do you determine if you can do better with a different partner? When gauging potential success with a new partner, how do you weigh them against the proven, tangible data and experience inherent in your current relationship? And if you’re taking your first step toward RCM outsourcing, where do you even 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 assess them—tangibly and concretely—using five key criteria:

1. Innovation
2. Expertise
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 your current RCM outsourced services provider—can help your laboratory determine where you have gaps or are failing to maximize the effectiveness of your RCM processes and practices. In this first of four posts, we’ll start with innovation.

Defining Innovation

Innovation, once a nice-to-have, has become a critical competency for healthcare technology and service providers. An RCM service partner is no exception. Regulations change. Payors rapidly and unpredictably shift their methodologies. New tests join the diagnostic mix. Patient expectations evolve. Technologies emerge, merge, and evolve. There’s a lot for you to keep up with. An innovative partner can mean the difference between profitability and revenue loss. It can also mean the difference between your lab’s active participation in the dynamic healthcare landscape – or being left out in the cold.

What makes for an innovative partner? For RCM outsourced services, it’s one who:

• Pushes the envelope with new, cutting-edge technology and service enhancements
• Stays abreast of and responds to market changes and customer recommendations
• Continuously seeks out new ways to help customers manage RCM operations more effectively and reduce their operating expenses

Behind all that is a partner who thinks creatively and differently. One that sees beyond the current state and into future possibilities—both the exciting and scary ones. In an innovative partner, you want an organization that not only grows and adapts with your lab, but also brings its innovative drive into your organization, positioning you for long-term success.

Assessing Partner Innovation

Honestly assessing something like innovation can be tricky, especially if you’re evaluating a new potential partner with whom you have no established relationship. Industry reports and surveys offer valuable, valid insight into RCM service providers and their overall performance. An excellent resource here is Black Book Research.

Each year Black Book Research conducts an in-depth study to understand how diagnostic leaders evaluate outsourced RCM service providers across eighteen (18) key performance metrics. Those performance metrics directly inform the five partner assessment criteria mentioned above, including innovation. Here are two examples of how.

For one performance metric (Question 2, page 11), Black Book Research asked study participants to evaluate whether RCM customers experienced increased accuracy of billing, accelerated the speed of reimbursement, and reduced overhead costs “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 such attributes as:

• 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 informs innovation, Black Book Research classifies as “Best-of-Breed Technology and Process Improvement Developments.” Survey responders also evaluated outsourced RCM services providers on “Integration and Interfaces” metrics, 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 lead in these categories are proven innovators, backed by the real-world experiences of over 2,600 survey respondents. And an innovative partner is crucial to maximizing your laboratory’s cashflow.

Our next post in this series focuses on the second category of RCM services performance, Expertise and Excellence. Meanwhile, download the full 2023 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.

Download a free copy of the Black Book Report.

DOWNLOAD NOW