Developing an effective and systematic approach to revenue cycle management (RCM) is an essential step towards financial stability for ambulatory surgery centers. But given the challenges of simply running a business in this rapidly changing health care landscape, not every ASC has the time or the in-house expertise required to master the nuances and details of RCM metrics.
For ASCs in this situation, outsourcing the RCM process has become a popular choice. By working with an RCM vendor, ASCs can take advantage of having a dedicated, expert unit look after RCM concerns. This frees up ASC personnel to focus on quality of care and the patient experience.
To help ASCs evaluate potential RCM vendors and choose the one that’s the best fit for their practices, the online journal Medical Economics suggests asking the following 10 questions:
How much does it cost and what is included in the price?
Depending on the size and complexity of the RCM services offered, the cost of hiring a vendor can differ widely. As a result, it’s important for ASCs to be absolutely clear about what exactly they are getting for their money. Vendors should have no problem providing a detailed outline of everything that their fees include. They should also be open and transparent about what services come at an extra cost. In addition, ASCs should be sure to ask how fees are calculated. For example, does the vendor charge a flat monthly fee, or is the fee based on a percentage of the total amount the vendor collects?
Are there performance guarantees?
An ASC’s due diligence process (including seeking references and testimonials from other clients) should reveal the standard of performance that can be expected from the RCM vendor. However, it may still be helpful to ask vendors whether performance guarantees are a part of their proposal. Incentives given when a vendor exceeds pre-determined goals or penalties imposed when goals are not met are two common strategies that can help provide ASCs with peace of mind about performance standards.
What technology will the vendor be supplying?
One of the biggest advantages for ASCs that choose to outsource RCM is the ability to access technology that the ASC would be unable to afford or maintain on its own. However, it’s important to clarify whether the practice will also be expected to supply any technology, as well as how any vendor-supplied technology will integrate with the technology the ASC currently employs.
Where in the world are the call center employees working from?
As a growing number of RCM vendors are outsourcing this aspect of their businesses, call center employees are now often located in other parts of the world. RCM vendors should be open in disclosing information about call center locations to ASCs. They should be forthcoming about details like call center hours, language fluency of the employees, and their knowledge of relevant local laws and regulations.
What is the length of the contract?
ASCs that are looking to utilize RCM outsourcing for a limited period of time rather than making a long-term commitment should clarify contract lengths with prospective vendors to avoid penalties in the event of early termination.
What are the termination clauses?
An exit strategy from the contract should be clearly laid out, both from the perspective of the ASC and the RCM vendor. ASCs should have a thorough understanding of the circumstances under which they can opt to end the contract – for example, if the vendor doesn’t fulfil particular obligations. Additionally, the contract should state what fees or penalties may apply if an ASC chooses to terminate the contract early or without an accepted reason.
Is the vendor certified?
Upholding industry best practices is an absolute must for any reputable RCM vendor. Organizations like the Healthcare Financial Management Association and the American Association of Healthcare Administrative Management not only set industry best practices that all vendors should be familiar with, they also provide certification to RCM professionals. Choosing a certified vendor can help ASCs feel confident that they have the most knowledgeable representatives possible handling their affairs and dealing with their patients.
How is sensitive health information protected?
An RCM vendor will be handling significant amounts of confidential health data, and protection of that information is of paramount importance. ASCs should ask prospective vendors what measures are in place to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA). Similarly, vendors should be ready to make risk assessments available to their potential clients.
What is contained in vendor reports and how often are they made?
Regular reports are the best way for an ASC to assess an RCM vendor’s performance, so it’s important to clarify early on what is expected from these reports. At the very least, they should include an analysis of accounts receivable, what percentage of accounts have been in receivable over a 60-, 90-, and 120-day period, a rundown of which payers and providers have accounts in each category, and an analysis of what claims have been denied and why.
How does the money transfer process work?
The way that an RCM vendor handles the transfer of money to an ASC could have an impact on the capacity of the ASC to meet its financial obligations. As a result, this process should be clearly outlined from the beginning. For example, some RCM vendors choose to send a monthly check after collecting on behalf of their clients, others send money to a lock box, and still others make direct deposits in real time.