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