By Rhonda Quast
February 25, 2016
As Health Care Reform changes reimbursement from fee-for-service to value-based payment structures, it has become increasingly difficult to maintain efficiencies in Revenue Cycle Management (RCM), educate staff on reimbursement changes and achieve optimal reimbursement rates. These changes, coupled with the revenue cycle team staff shortages that many health care organizations across the country are experiencing makes the option of outsourcing RCM more appealing. As organizations examine the available RCM options, determining the best option for their organization may seem daunting. Contracts can be ambiguous and the use of third-party quality control metrics are typically not addressed. As indicated below, the majority of health care organizations recognize the need for assistance in navigating the options and finding the best solution for them.
It’s Important to Find the Right Vendor
Selecting the right vendor requires due diligence to ensure the integrity, experience and compliance with billing rules and regulations you expect. Whether you’re interested in outsourcing or co-sourcing (outsourcing some elements), carefully review each vendor, rate them against your required criteria and provide insights and recommendations to ensure you will be capturing the full value for services rendered.
Advantages of Outsourcing or Co-sourcing:
Disadvantages of Outsourcing or Co-sourcing:
Obtain an Independent Vendor Review
Already have a vendor? How do you know whether you’re getting what you paid for from your vendor? It’s important to evaluate whether your vendor is meeting performance expectations against the scope of your contract. An independent review can determine whether your vendor is adhering to your hospital’s billing policies and procedures as well as third-party payor regulations.