At its core, revenue cycle management (RCM) is about ensuring payment for services provided to patients. Yet the business-like nature of RCM often leaves physicians feeling ill-equipped and overwhelmed. Kelly Dingwell, principal attorney and CEO of Dingwell Law in Long Beach, CA, focuses on healthcare provider cases. According to Dingwell, physicians who have a firm, realistic grasp of what they do and don’t know about RCM have the best shot of achieving their goals.
Physicians often question when it would be the best time to find a partner. According to Rockford, Illinois CPA and executive vice president of RCM at Experity Monte Sandler, “trigger events” often prompt the search, as such events stimulate a physician’s desire to improve their RCM. One very timely example of a trigger event would be COVID-19, which has led to reduced cash flow and practice management changes for many physicians. Other reasons for seeking out an RCM partner are, commonly, payer rules that undergo quick changes and problems with credentialing and contracting.
A good partner can assist in the effective handling of rejections, denials, and accounts receivable management, which, according to Sandler, could avoid 20% to 30% of unoptimized revenue. Patient registration, which initiates the process of establishing eligibility, authorization, and payment method, is where the RCM begins, and it is at this initiation point where many physicians struggle to obtain accurate information. A quality RCM partner, however, can train a practice to nip such problems in the bud before occurrence.
Although the financial cost may be high, Sandler suggests outsourcing RCM elements like coding, billing, and credentialing. In the long run, having access to otherwise unattainable resources like CPAs, contracting credentialing specialists, certified coders, and compliance specialists is worth it to maximize revenue.
When considering the best fit for an RCM partner, internal medicine doctor Saira Ahmed of New Jersey offers a number of suggestions. Physicians should find an up-to-date certified coder and biller. They should also seek out someone who understands their personal medical specialty and the unique treatment codes that come with it. An optimal RCM partner must have a comprehensive understanding of a physician’s EHR, along with knowledge of the latest technology. Physicians should make sure they have a clear understanding of whether an RCM partner will bill them for denial corrections. Also crucial is having an RCM partner who provides strong reports to physicians and who bills daily, without delay. Ahmed stresses that it is of utmost importance for an RCM partner to be open to communication and one who consistently makes themselves available.
According to Sandler and Ahmed, paying most frequently occurs either as a flat monthly fee or a contingency plan, which charges approximately 5% to 7% of receivables. Sandler suggests that the latter works well when receivables vary. Ultimately, physicians must understand the entire breadth of an RCM partner’s service in order to determine if the cost of partnership will yield optimal revenue.