Filling Out Your Dance Card: Determining Which Revenue Cycle Management Partner Is Right For Your Practice

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Just recently, a longtime partner of ours, a diagnostic services center based in the West, reported to us some truly amazing revenue numbers from last year’s third quarter. PRN is so proud to have been a part of their story from the time they were just one small location barely beginning to tweak their revenue cycle factors.

Working with a revenue cycle management partner should be more than just a decision about “outsourcing” or staying “in-house.” With PRN, those kinds of distinctions feel arbitrary — we want you to consider us as dedicated to you as any in-house department responsible for optimizing your revenue. Typically, we start working with our clients when they reach a size where in-house billing, collections, follow-ups, coding, proofing claims, accuracy audits, tracking HIPAA and other laws, and all the big and small things that make up a healthy revenue cycle, has simply become too much.

When we see clients having systemic issues with their revenue cycles, we usually see one of three things: 1) The revenue cycle is not fully understood, 2) Not enough attention is being paid to the revenue cycle, or 3) Systems are not being utilized to full capacity.

Not all of these problems mean that you need a revenue cycle management partner, but sometimes it’s much easier for an outside eye to see what you’re too busy or enmeshed to see. The most important thing to know for anyone looking for a revenue cycle management partner is that there are a lot of different companies out there “billing” themselves as experts on the medical revenue lifecycle, so make sure you’re doing your research to separate the wheat from the chaff in this ever-growing and crucial field.

Questions to Always Ask Potential Revenue Cycle Management Partners

Picking a revenue cycle management partner can represent a big step in the evolution of your healthcare organization. Whether you’re looking for a firm to come in for an audit and a set of recommendations, or a long-term partner to implement systems and be at your side as you grow, the right fit combined with the right knowledge is critical.

Think about asking some key questions as you interview potential partners, such as:

  • How do your systems save me time? A partner should be able to cite specific ways they can improve all of the detailed processes that affect your revenue cycle.
  • Do you ever outsource overseas? This is a critical one. Although in some cases you may be able to get the same work quality at a lower cost from overseas outsourcing, be sure to get a clear response to this question. If the answer is “yes, we do,” then at least you’ll be able to ask about the operation and get a clearer picture of where and how important processes are being done overseas, then decide how you feel about it.
  • What are your costs? Make sure there are no hidden fee structures and that you have all the pricing information up front. Fees and payment structures in this industry vary widely, but only you know what your organization can bear. Plus, consider that a good partner that improves your revenue cycle will ultimately pay for itself.
  • What kinds of metrics do you use to measure improvement? Always ask how your partner will establish a baseline and measure growth. Revenue cycle management is about improving your revenue, after all, or at the very least being able to decode where the issues are, so knowing your partner is knowledgeable at setting up key performance indicators (KPIs) and monitoring them is important.
  • Talk about security — what measures do you take to ensure our organizational and patient data? Data privacy and data security are hugely important in today’s ever-more-connected healthcare world. Make sure your potential partner is using up-to-date systems and is compliant with the latest operating standards.
  • What steps have you taken for clients interested in taking advantage of the HIPAA administrative simplification regulations? What about preparation and continued improvement after the ICD-10 transition? Any revenue cycle management partner worth its salt will be able to speak to you in detail about these two recent and key shifts and how they handled potential impacts for their clients.
  • Give me examples of case studies where you have improved reimbursement rates and other key metrics for a similar organization? Good companies have proven track records. Always ask about former and current clients and what your potential partner did for those organizations.

We’re Way More than Your Billing Company

Revenue cycle management is far more than just “medical billing” or “outsourcing medical coding.” A true revenue cycle management partner will always be on the lookout for ways to work with you to improve or optimize your systems to promote efficiency and shorten your revenue cycle, rather than merely going through the motions of a system you’re solely responsible for creating and maintaining.

We can’t count the number of times we’ve encountered a client or prospective client who equates revenue cycle management with the most basic of billing factors. Their previous “partners” never delved into things like percentages of claims rejected for physician queries or proposed solutions like educating individual physicians whose paperwork was consistently returned for improper or incomplete documentation, or similar integrated approaches. Revenue cycle management is so much more than just “days in A/R” or percentage of first submission claims paid — although of course we handle all of that too.

There are only three things a healthcare organization truly can’t do without — great staff, patients, and revenue. Healthcare today is an interconnected ecosystem, and not all organizations can or desire to manage everything related to revenue cycle in-house. With a wealth of great revenue cycle management partners to choose from, you don’t have to. Finding a good fit should be a mutual feeling-out process as you assess your potential partner’s knowledge, infrastructure, and efficiency, and your potential partner evaluates your needs and commitment to improving your revenue cycle. When we begin working with a new client or continue working with a longtime partner, we’re always committed to getting them results and more revenue, helping everyone ultimately provide better patient care.

Physician Revenue Navigators is a leading healthcare revenue cycle management partner, supporting healthcare organizations in all aspects of a healthy revenue lifecycle, including coding, billing, contractual adjustments, collections, HIPAA compliance and more. Contact us to learn more about how we can assist your organization in optimizing your revenue cycle.

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