Is Co-Sourcing the New Outsourcing Solution for RCM?

Nearterm Co-Sourcing Solutions for Revenue Cycle Management: AR Resolution Specialists for Exceptions & RCM Consultants for Management Process Optimization
Nearterm Co-Sourcing Solutions for Revenue Cycle Management

Co-sourcing your revenue cycle management (RCM) professional resources can get you the best of both an all-in-house or an entirely-outsourced RCM solution, according to a recent article written by Carrie Pallardy for Becker;’ Hospital CFO.

With the entirely-outsourced revenue cycle management consulting firm solution you can get good service that handles it all, but you lose autonomy and flexibility. With all-house RCM, you may be good at handling the routine, but it is the exceptions (e.g. dealing with denials, credit balances, bad debt, etc.) that can compromise an otherwise smooth process. The solution: co-source the exceptions and let the co-source help to optimize the RCM process.

Two basic models for co-sourcing RCM functions are presented:

Management overlay. Here, a RCM company or consulting firm will partner with the hospital and health system to help manage the prevention of exceptions and improve the resolution process.

The consulting firm will use your people and teach them to understand, monitor and resolve these exceptions,” says Mr. Sanderson. [Brian Sanderson is National Managing Principal of Crowe Horwath LLP’s Healthcare Services]

Management overlay requires no change in staffing, but puts in place additional standards and integrates technologies such as predictive analytics and machine learning. The hospital or health system’s partner will stay on for a set period of time. After which, some choose to keep the overlay structure in place while others decide to shift the management function entirely back to their own team, once performance has improved sufficiently.

Outsourcing the exceptions. Typically, 15 percent of claims fall into the category of exceptions, says Mr. Sanderson. The remaining 85 percent (i.e. the “clean claims”) hospitals and health systems can in most cases handle efficiently.  In those typical situations, rather than outsourcing in one fell swoop, hospitals and health systems can simply outsource those claims that will be a struggle to resolve.   

Nearterm Co-sourcing Solutions Can Help

For “Management Overlay” Nearterm Interim Healthcare Management

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Winning Over the “Consumer” Patient

Patient as Consumer: The new RCM strategy

In his article, “Why the Billing Experience Matters,” Tomer Shoval provides a clear overview of the expectations of the recent phenomenon known as the “consumer” patient. That is, the patient as consumer expects cutting edge quality care and “a simple, easy-to-read medical bill that they can pay as easily as they do other bills.”

Many studies have demonstrated that a patient’s payment experience colors their overall feelings about a hospital stay…They have discovered that a positive billing and payments experience can impact patient satisfaction and loyalty as well as reduce costs and raise revenue.”

He gives ideas on three ways on how hospitals can meet the expectations of the patient with a consumer-focused revenue cycle management strategy:

  • Mimic consumer strategies
  • Integrate your billing and payment experience
  • Optimize for self-service

“Pioneering healthcare leaders are redefining medical billing by engaging their patients as consumers. If you build a system that empowers patients, your patient revenue cycle can quickly become a strategic advantage resulting in happier patients, higher collections, and lower costs.”

Read the entire article here.

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