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Revenue Cycle Management (Part 2): WHY Does Partnering Make Sense for your Organization

When uncovering the WHY, organizations should consider partnering with an RCM provider in the same manner they would for auditing, taxes or human resources. 

Here are some reasons why an organization would look for a revenue cycle partner.
•   Declining Revenue and Growing A/R
•   Instability in Staffing and Training
•   Inability to Meet and Maintain Evolving Compliance Requirements

In addition to the concerns listed above, rapidly changing payer requirements, and rising operating costs underscore the imperative need for an effective Revenue Cycle.  Let’s be honest, most visits by our underserved patients are unplanned or underinsured, which presents a financial obligation, patients are often ill-prepared to meet.  An unprepared patient, coupled with a loosely managed revenue cycle, may leave an organization struggling to meet its own budgetary and financial obligations.
Declining Revenue and Growing A/R
Declining revenue may happen for a number of reasons including a decline in patients served changes to your payer mix, or inefficient revenue cycle workflows.  In each of these scenarios, organizations should seek to understand how they are managing their key performance indicators, as this is often the first opportunity to see changes that may impact revenue.
Perhaps revenue is down, but patient volume and charges are steady.  As the reimbursement landscape continues to shift more responsibility to the patient, organizations should be seeking to provide patients with a variety of payment options or risk escalating accounts receivable.  
In addition to managing patient payments, tightly managing payor reimbursement processes is critical to uncover gaps where insurance revenue is lost.  With the right RCM partner, you will have the confidence, with relevant and actionable data, that every claim is processed to 'PAID' and every penny is accounted for. If you are not able to answer these questions, or spend an exorbitant amount of time pulling all of the data together, it may be time to find an RCM partner.
Instability in Staffing and Training
It’s important to know who is doing the work in your office.  The medical office staff member has many options for seeking out and leaving your organization.  Maybe it will be for more money, less driving or a happier work environment; but the job market is driving many long-term staff members to accept other opportunities.  Along with that staff member, goes months or years of knowledge.
COMPdata suggests that the turnover rate in healthcare exceeds 19% annually, which creates many opportunities for issues to pop up in your revenue pipeline.  Whether you are constantly replacing providers, front desk or back office staff, the impact on your bottom line is real.  A revenue cycle management partner with experience training and preparing staff and providers can provide a safety net for your bottom line.
If you are experiencing a high turnover in your billing department it may be a good opportunity to seek out an RCM partner.  If your current back office is unable to keep up with the constant changes in providers, or you operate in an area where qualified staff are hard to come by, you should consider partnering.
Inability to Meet and Maintain Evolving Compliance Requirements
Compliance requirements are creating new opportunities within healthcare organizations given the steep penalties for breaches, and the importance of protecting confidential patient information.  There is no place more susceptible to compliance concerns than the RCM process.  Billing teams must be vigilant in protecting patient information and employ audit processes to ensure that all regulations are being upheld.  There are very steep penalties for mistakes.
Outside of HIPAA compliance, there is compliance with payer requirements as it pertains to coding of visits.  This too can be costly when a visit is coded improperly.  Millions of dollars are left unclaimed annually through Medicare and Medicaid due to coding irregularities.  An RCM partner should staff their teams with certified coders, preferably a coding institution that has name recognition, such as AAPC or AHIMA.
Many organizations feel they cannot afford the salaries of certified coding staff, yet not having staff members with those qualifications can be more costly than the difference in salary.  If you are struggling to implement audit processes, or lack certified coding staff you may consider partnering.
So you’ve reached the point where you’re asking yourself if finding a partner would be a good fit for your organization.  Perhaps your organization is experiencing one or more of the concerns that we've described, and you are ready to take the next step.  It’s a huge decision that will impact your organization and community for years to come and you want to make sure you ask all the right questions.  



Angela Heneise

Angela Heneise has over 25 years in healthcare and revenue cycle management experience. Prior to joining the Visualutions family, Angela spent 19 years as a Practice Administrator and RCM Director in various environments including FQHCs, CHCs and FFS. Angela is an Account Executive for the East Region specializing in Revenue Cycle Management partnerships. She has been with Visualutions for over 8 years.  Solution-oriented and well-versed in the needs of FQHC’s, Angela has found being an Account Executive very rewarding because it allows her to work closely with organizations to solve problems, provide solutions and ultimately, succeed financially.