How To Transition To Outsourced RCM Services From An In-House Setup

How To Transition To Outsourced RCM Services From An In-House Setup

Posted on July 2, 2021

Introduction: Outsourcing RCM Services

For many healthcare institutions, even the thought of outsourcing their services to a revenue cycle management service company can be unnerving as it poses many challenges; one of them is coding and billing. Needless to say, medical coding and billing are among the important cogs of a healthcare firm’s machinery. If both are carried out in an accurate and timely manner, they can pave the way for a smooth revenue cycle, and if not then it can bump up costs. Therefore, healthcare firms fear transitioning to an outsourced RCM service from an in-house setup as, if not done correctly, it can affect the firm’s income and put it in a hole. However, the actual scenario is different.

To back it up with statistics, a National Health Insurer report says that around 25% of the claims paid are incorrect because of which healthcare firms have to suffer a loss in the range of 5%-14% of their total entitled revenue. Hence, to receive the entitled amount, the healthcare organization must outsource their RCM services to a well-credited revenue cycle management service company that is expert in matters related to denial resolution, bill modifications, claim appeal tender, and claim follow-ups. One must also look for credentials like whether the RCM services company has expertise in the ICD-10 & ICD 11 coding systems or not. This way a healthcare firm can transition to a reliable and holistic RCM services provider who can safeguard the firm’s liquid assets ensuring a positive cash flow, eventually boosting the healthcare organization’s revenue cycle.

Major Challenge: Loss of Transparency

This is also one of the major challenges of outsourcing RCM services. More often than not, a healthcare organization is accustomed to seeing whatever it needs, on-demand, with an in-house team on hand to explain their observations; it doesn’t matter whether they’re working from an office or home – all the more so considering the current pandemic scenario. But this can be worked out if the RCM services company operates transparently with all of the healthcare organization’s data, providing them access to it 24 x 7.

Bonus tip – Healthcare firms can generate their reports in addition to those the RCM service company should be regularly providing, in which case the fear of losing transparency is instantly dispelled.

Granted, the healthcare organization might have to go through some financial hiccups at first during the transition to outsourced RCM services. But it is one of the most effective ways to reduce costs in the long term and improve efficiency.

With outsourced RCM services, the healthcare organization can be sure of timely reimbursements. It’s because the RCM services company solely focuses on the collection and verification of details regarding patient registration, insurance, diagnosis, and treatment. In the end, the RCM services company provides an accurate record of money that is due at consistent intervals. This gives healthcare organizations a clear picture of their real-time earnings.

Improved cash flows

A revenue cycle management company can deal with bills worth huge amounts of money as they’re equipped with software and hardware technologies to handle the same. After a healthcare organization submits its documents, the RCM services company takes care of everything like medical billing, insurance verification, and AR collections. The RCM services company does all this within a day or two after receiving the documents; this makes room for enhanced cash flows within the healthcare organization.

Steps for Transitioning from In-House Setup to Outsourced RCM Services

Now, it will be convenient to jump on to the next aspect of this article. Here are the important steps for transitioning to outsourced RCM services from an in-house setup:

  • Welcome packets must be finished in a timely fashion
  • The healthcare organization must provide a complete list of insurances with which they are associated with the RCM services company
  • The healthcare firm must identify the authorized signer for each of their insurances
  • They must provide the login credentials of the PECOS and NPPES accounts to their RCM services company
  • They must submit a list of ICD-10 and CPT codes which they can obtain from their legacy billing service company
  • They must provide reports that cover the following – diagnosis table, insurance plans, services (CPT), and referring MD’s
  • They should decide whether or not they need to use a lockbox
  • They should have a clear idea of the average number of billable encounters they need on a daily or monthly basis

If a healthcare organization follows these steps, then transitioning from self-billing to an RCM services company will be a breeze. It is also important that the healthcare organization ensures proper allocation of each insurance in the new system.

Bonus tip – If incorrect people sign the EDI or ERA agreements, there will be billing delays.

How Flatworld Solutions can make the transition easier with top-of-the-line RCM Services

Flatworld Solutions provides high-quality and cost-effective revenue cycle management solutions to global customers. We can help you collect payments on submitted claims, increase the revenue from underpaid claims, and follow up with insurance companies for quick settlements. Additionally, we can also help with your revenue cycle management in healthcare including coding tasks as well as complete patient registration and eligibility verification. Leveraging our expertise can help you –

  • Improve your collection ratio
  • Increase the probability of payment
  • Increase revenues
  • Ensure that all your data is completely safe as we are an ISO/IEC 27001:2013 ISMS certified organization
  • Get 100% coverage of your unpaid accounts while being able up to follow up on hanging payments easily
  • Improve patient, physician, and stakeholder satisfaction
  • Get access to trained personnel without making any additional investments
  • Save up to 60% on your operating costs
  • Access 24/7 services that ensure faster turnaround times
  • Conduct periodic follow-ups to increase collections

Choose Flatworld Solutions for Efficient Revenue Cycle Management Services

Flatworld Solutions has been a pioneer in providing the best quality revenue cycle management services and a series of other healthcare BPO services to global clients. We have some of the most experienced and skilled RCM experts on board who can cater to all your needs. We leverage the latest tools and technologies while delivering top-notch services to clients.

If you are looking for a reliable and cost-effective revenue cycle management service provider, then you have come to the right place. Get in touch with us today!

Interested to know more?

  1. How Much Does Healthcare RCM Services Cost in 2021?
  2. Why is HIPAA Compliance Necessary for Healthcare Data Security?
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