EVALUATING RCM COMPANIES

Transcription

1 A Guide to EVALUATING RCM COMPANIES 10 Things to Consider When Researching RCM Companies

2 ABOUT THE AUTHOR As CEO of GroupOne, Arun oversees the delivery of services to more than 700+ healthcare providers. Under his leadership, GroupOne's annual revenue has increased by more than 500% and number of staff has more than doubled. His vision and innovative leadership continue to guide GroupOne towards its goal of being the leading medical RCM and transcription firm in the industry. Aside from GroupOne, Arun also serves as President of the Board of Directors for Lawrence Township School Foundation. He is committed to growing professionally and personally which led him to become an active member of Vistage executive coaching. Arun s persistence to improve ways of meeting and exceeding client expectations has landed GroupOne on the 34th annual Inc list of fastest growing private companies with a three-year growth rate of 51%. Arun received his MBA from Indiana Wesleyan University and is in the process of obtaining an M.J. degree from the McKinney School of Law at Indiana University. He currently lives in Indianapolis with his wife Meghan and two children. In his spare time Arun balances his work with playing golf or watching the Chicago Cubs. Arun Murali CEO

3 INTRODUCTION Are you thinking about outsourcing your revenue cycle management (RCM) services to a third party vendor? Welcome to the party! Increasing industry complexities and pressures on physician groups to lower operating costs is causing medical practices to look at outsourcing options. Well, outsourcings is nothing new and companies, on-shore and off, are saturating the market with thousands of options - one of which could be right for you. Comparing vendors based on price appears easy, but are you equipped to evaluate other factors in the billing services that may have an overall negative or positive effect on your bottom line? Finding the right billing company for your practice can be difficult and confusing if you ve never considered outsourcing before. In some cases, a lower quoted price may actually be the most expensive option depending on RCM firm performance and the amount of work that remains the responsibility of the internal practice staff. There are many options and paths, but before you make a decision you should determine your practices values and practice objectives as well as how involved you want your vendor to be in both. Here are a few things to consider when deciding which path is right for you.

4 Practice Advisors or Claim Processing Center The term partner is overused, but the basic notion behind the word is a vested interest in what the other partner is hoping to achieve. It is easy to be vested as an RCM company. Since most RCM companies charge a percentage of collections, the more you make in your business the better for the vendor. However, what are the goals for the practice? RCM firms in the market today can range from the small community shops to the large publicly traded multi-national companies. Pricing hasn t varied too much in the past. Basic billing or simple claim processing can be a commodity. However, the recent trend in healthcare has led to a more focused sense of outsourcing. While there are companies out there that will simply provide basic services (bare minimum with primarily automated processes), there are others who have billing experts serving as the de-facto billing manager for your practice. Keeping costs down means trimming the fat off your operation, and billing office managers are a luxury that are simply difficult to afford in today's environment. Furthermore, it can be a challenge just to find local individuals who have the knowledge and skill set needed to maximize your collections in the complex medical payment system. Consider whether you simply need claims processing or prefer a firm that offers more?

5 Resourcefulness This might be a rather vague topic, but let s look at it more closely. If you are looking to a service provider to help you with your RCM process, then are there other parts of your business process that might need that same type of assistance? How efficient is your practice? How qualified is your staff at utilizing your technology? Is your technology going to serve as a platform for your success or is it lacking a few features? Do you have all the tools that will allow you to be a more profitable practice? If your RCM Company is going to be an advisor, then it should be able to point you in the right direction for other tools and business processes that can help improve your bottom line. In the end, you might have all the info and resources you need to expand your practice performance, and for you, a simple RCM company may suffice. But if it helps to get connected to others that can help you be more profitable, find a service provider that goes above the average revenue cycle management of your practice to help you succeed daily.

6 Domestic vs. Off-Shore Operations There is a trend in the industry today where off-shore companies are acquiring US billing companies at a fast pace. This is a trend that is likely here to stay. The opportunity for growth in the outsourcing market is improving drastically, but US vendors are challenged to scale to the needs of clients while at the same time offering a competitive price. Off-shore companies become vital contributors to the RCM process because of this issue. The most important thing when dealing with the on-shore versus off-shore debate is to determine whether your values are compromised by going overseas. Stay away if you don't believe in the ethics of the off-shore vendor, or are skeptical. If you are comfortable with an off-shore vendor, and you are considering the option, then make sure you do your duediligence. Who will you or your patients speak with daily? Who will your escalation point be? Will they be able to answer your questions accurately and in a timely fashion? There are incredible companies out there with off-shore operations either entirely or partially, and the talent they employ is remarkable. However, there are others who will undercut price simply to win your business, and knowing what matters more to you will help you build a successful practice. It might also be appropriate to find US based vendors who have overseas connections or contractors. This would allow you to work with the US based firm on a daily basis at an affordable price.

7 HIPAA Compliance What is your vendor's compliance strategy? With omnibus a fact of life, Billing Companies are liable to HIPAA violations more so than ever. Business Associates who could hide behind their covered entities now have an obligation to be compliant or face penalties. That doesn't mean that your covered entity can shift blame, but that risk is something that needs to be weighed heavily. Ensure that your vendor is aware of the new rules and is ready to protect the privacy and security of your patient records.

8 Complete or Partial Service There are all sorts of billing service providers in the market, and many of them are experts at individual pieces of the RCM process. Some are better coders. Some are better billers. Some are worthy technically. Some are not. There are many with combos of both and fewer still that have all the necessary components. When comparing pricing you need to try to compare apples to apples. Make sure you consider all the parts that need to be done and which parts are left over. Then decide, for the parts that are left over who will handle them and the associated costs. - For instance, who is responsible for fielding the calls of your patients when they have questions about your bills? Can your front office staff handle that responsibility without taking time away from other required tasks; or will you need to hire someone to handle the task? Patient balances are a crucial part of the collections that your practice will recognize. Quickly resolving patient balance issues can determine the degree to which your practice can be successful. Additionally, who will follow up on any rejected or denied claims? Some basic RCM services handle the initial submission of claims but leave the correction of claim mistakes and the appeal of denied claims to the practice staff, which may lack the expertise to correct the errors. Industry wide, an estimated 20% of claims need some sort of correction before they are paid accurately. The cost of the left over pieces can be very expensive, often causing a lesser priced RCM service to in fact be the most expensive.

9 Can You Get In Touch? If you have or have had the luxury of your own billing office, especially one in your physical location, then whenever there was a concern, you could run down the hall and talk to the billing team about it. You might have weekly or monthly meetings with your billing team where you could discuss results, trends, and indicators that help keep your goals on track. How important is being able to stay on top of the business performance of your practice? If you want to stay in the loop and have control then it is vital that you have that same relationship, those same meetings, with your service provider. Your billing company should have clear contacts that are familiar with your practice and that will go over performance and key indicators with you on a regular basis so that your practice performance never stutters. If things are trending the wrong way, you should be able to make the call that will turn things around. If you don t have clear representatives that will go through that information with you, how will your problems be resolved? If you have that clear contact for the regular discussions, that might still not be enough. What about the daily questions you have? We can never be sure of when an issue comes up and in urgent cases will you have someone that is familiar with your practice policies and management that can help? What about coding questions, will you have access to coders familiar with your specific situation and specialty?

10 Use of an Integrated Use of an EHR Integrated System EHR System If you are already using an EHR then you are aware that it not only takes time to learn how to use it but also how to use it to its full capacity. When considering an RCM firm, is the firm going to have the right experience needed and what you expect in order to get clean and accurate claims out the door and paid? Right experience includes the expertise to advise you on the best practice of workflow with your EHR. Is the billing expertise primarily from the paper days or is the firm capable of success through the use of modern EHR software? You ll also need to consider how you are going to manage your workflow if your office staff will be using one system at the practice and the billing company using another software to submit claims. How will you access the information on your claims if it is not the same system you have at the practice? How will your staff know if a patient owes money? Will the use of another system cause a delay in your practice getting paid? Integrated software will keep your practice on task by allowing information to flow seamlessly throughout the system therefore reducing the need for double entry and ultimately saving you time. There are numerous inefficiencies in nonintegrated systems, and per a recent survey completed by Black Book Market Research 97% of business managers confirm that an innovative, seamless, RCM/PM/EHR system would ensure long term practice independence, and greatly improve productivity and profitability. Choosing a billing company that is willing to provide the service on your integrated practice s EHR will give you the transparency you need to your claims and hold the appropriate teams accountable.

11 Ease of Transition If you do decide to outsource the revenue cycle management can you say it will be forever? That is a lengthy commitment. Most practices aren t sure if outsourcing is going to be the best option for their practice for the next couple of months or if they want to forever have one company do the billing. Taking into consideration the possibility that someday you may want to change billing companies or bring the billing back in house is imperative to your vendor selection initially. After all, it is your data we are talking about and your patient relationships in the software. Here are a few questions to ask yourself during your RCM service research: How will the transition happen if the billing company doesn t meet your expectations? Will you be able to keep your software? If you keep the EMR, what will be the costs associated with it after you change your billing service provider? Don t risk losing your data if the partnership doesn t work out. It can be a huge risk to the financial stability of your practice and eventually affect your patient relationships.

12 Coding Compliance Does the RCM service include certified coders as part of the claim creation and submission process? Or, will you have certified coders on your practice staff. As the OIG continues to place more emphasis on proper clinical coding, especially among EHR users, it may be important for your practice to partner with an RCM firm that includes coding review and assistance. Some RCM firms rely completely on the provider and EHR automation to determine coding without any review by certified coders. Involvement by certified coders, whether in-house or through the RCM service, may not only help with compliance, but also may provide a level of expertise that helps practices increase revenue by coding to appropriate levels. Furthermore, providers may prefer access to coders so that they can ask questions about proper coding in unique situations and request guidance on proper coding in general. The coding presence becomes even more important with the recent transition to ICD-10. Ask the RCM firm what they have done to prepare for ICD-10 and how the transition went for their clients. Determine whether it s better for your practice to have the coding expertise in-house or provided by the RCM firm.

13 Binding Contract Will the RCM firm require you to be locked into a long term agreement, or will you have the option to end the relationship based on your preference or the company s lack of performance? When entering into an agreement with a revenue cycle management company, recognize what it is that is being offered and to what you are agreeing. Also be clear on what will happen if either party does not follow through on the contract agreement. Will there be repercussions if you need out of the contract? Perhaps the service is not adequate or your employment or business situation changes. Ask the revenue cycle firm what the process is if you want to terminate the relationship. Be prepared to have the conversation with your vendor in case of the dreaded worst case scenario. Revenue cycle management is a service to your practice. If the service is not what you are promised are you going to be able to find another service provider in 2 months or 2 years? Can you afford to be locked into poor or mediocre service for even a few months, not to mention the long term commitments required by some RCM firms? Quality firms should be willing to keep you because of their quality service and not solely because they locked you into a long term agreement.

14 LET S GET STARTED We would love to talk about your search for a medical billing service and what you are hoping to achieve by outsourcing your medical billing. Let s analyze your existing operations and brainstorm some ways you can improve your revenue cycle management. TALK TO US