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21 warning signs that you need to change revenue cycle management (RCM) service provider

An effective RCM system can reduce the amount of time between providing a service and receiving payment.

surprised

An RCM service provider not offering what it promises should be immediately discarded.

A Revenue Management Cycle (RCM) is a specialized practice used by medical practitioners to track their day-to-day revenue. This cycle begins from the first meeting with the patient and ends at the eventual reimbursement on the patient’s behalf. Many people confuse RCM with medical billing – there is a slight difference between both the terminologies. Medical billing refers to the record-keeping of financial transactions, whereas RCM not only includes medical billing but also integrates other features such as claim processing, denial management, coding and revenue generation.

Modern-day physicians and practitioners are always on the lookout for better RCM service providers in the market – such RCM service providers that not only manage their practice management and billing but also reduce the average collection period of their accounts receivable. There are several RCM service providers in the market, that provide financial reporting services to medical providers based in the US. The purpose of deploying an RCM to a medical practice is to facilitate the providers in tackling the tedious workload of financial transactions so that they can better focus on their patients.

However, a provider should also be mindful that outsourcing RCM is a major decision because RCM ultimately defines how much a provider earns at the end of the day. Therefore, there should be some mechanism of accountability to see if the RCM is managing your workflow in an intended manner and as per the claims made by the RCM service provider. Therefore, practices are strongly advised to keep a vigilant eye on their billing. Here are 21 such signs, for which you should have a constant lookout for and if they do appear, you should consider discontinuing your existing RCM services and see if there are better alternatives available in the market.

Danger Sign # 1: Your RCM service provider does not guarantee you a 5% – 10% increase in collections in the first few months of availing their service.

Danger Sign # 2: Your RCM service provider offers very limited opportunities of scale and does not allow you to integrate features such as EHR and Billing on one platform.

Danger Sign # 3: Your RCM service provider does not ensure complete follow-up and payment posting against all transactions.

Danger Sign # 4: Your RCM service provider has no existing clients which match your profile.

Danger Sign # 5: Your RCM service provider will not give you any additional references, except the ones which are already preprinted.

Danger Sign # 6: Your RCM service provider does not offer open access to their system, in order to check for patient accounts.

Danger Sign # 7: Your RCM service provider does not provide you system-generated reports on your discretion.

Danger Sign # 8: Your RCM service provider does not allow you to have an interaction with the lead biller deputed to your account.

Danger Sign # 9: Your RCM service provider is not doing enough to reduce the rate of denials and claim rejection.

Danger Sign # 10: Your RCM service provider does not provide you with real-time details of various KPIs (Key Performance Indicators) such as copays collected, A/R per payors, denials and payment posting.

Danger Sign # 11: The reporting format adopted by your RCM service provider is difficult for you to comprehend

Danger Sign # 12: Your RCM service provider does not offer you reports to measure your practice performance and highlight areas for improvement as well as allow you to obtain customized reports for insight into your own selected set of performance parameters.

Danger Sign # 13: Your RCM service provider is not doing enough to reduce the average collection period of your accounts receivable (A/R) and streamline revenue collection functions (irregular cash flows).

Danger Sign # 14: Your RCM service provider is offering very little or no transparency in your transactions of every dollar that you’ve earned and you feel that your information is being deliberately kept hidden from you.

Danger Sign # 15: Your RCM service provider is still using manual means to get your work done and is resisting automation.

Danger Sign # 16: There is the negligible positive word of mouth regarding your RCM service provider among your peers who use some form of RCM themselves.

Danger Sign # 17: Your RCM service provider does not offer any guarantee for the turnaround of their services.

Danger Sign # 18:  Your RCM service provider will not agree to do your billing on your software – they insist on using theirs.

Danger Sign # 19: Your RCM service provider cannot automatically accept charges from your EMR.

Danger Sign # 20: Your RCM service provider is not following the latest compliances such as ICD-10 and MU-3.

Danger Sign # 21: Your RCM service provider is not providing enough technical assistance to you and your staff.

If any of these danger signs are present, it is time to make the switch to a better RCM service provider that actually delivers what it promises for its RCM. An RCM is supposed to improve the financial performance of the doctors and therefore it should be wisely chosen. Following are some parameters that can serve as a benchmark when physicians are looking for a suitable billing company for their practice:

  1. Easy to setup: Your RCM service provider not only specializes in starting new practices but also makes it easy to switch from an existing RCM service provider. They make transitioning a simple and cost-effective experience and offer several benefits such as no upfront cost, no software or training cost and no server installation or upgrade fees.
  2. Easy-to-use: At the end of the day, if the RCM software is making sense to you and you don’t find it cumbersome to handle, you should consider using it. It should offer you an interactive dashboard that shows all the information clearly.
  3. No capital expense: The RCM service provider doesn’t ask you to install hefty computer equipment to run their software.
  4. Billing sophistication: Your RCM service provider should offer a holistic approach to inculcate Electronic Health Records, Practice Management and Billing on one platform.
  5. Savings: Efficient RCM systems should reduce denied claims by prompting healthcare employees to enter all the relevant information.
  6. Smart services: An RCM system should have smart analytics and the dashboards integrated into its platform, so it may help the physician to keep track of his overall performance.
  7. Reporting: This means that the RCM system should provide physicians with complete visibility to their transactions and access to customized reports.

In a nutshell, an RCM is designed to assist medical practitioners in handling their billing tasks so that they may focus on other important tasks at hand. Outsourcing RCM is a common practice and every doctor wants a mechanism that can help them in getting most out of their service and helps them in identifying their performance parameters. That being said, a provider should regularly check if their RCM is accomplishing all the tasks as per the claim of the RCM service provider. If all is good, then the provider should continue using that RCM but if there is some inconvenience or discrepancy with the current setup, there is always an option of considering a new RCM service provider.

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