Revenue Cycle Management Outsourcing Industry

Revenue Cycle Management Outsourcing Industry

Sumit Mahendru, Head of RCM
Sumit Mahendru, Head of RCM
May 2, 2022

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Third-party revenue cycle management (RCM) companies are in demand as healthcare providers look to outsource efforts to experts that can streamline billing operations.

Introduction

As the need for healthcare grows, so does the need for Revenue Cycle Management. The Healthcare Revenue Cycle Management industry has seen healthy growth in the past few years - both from in-house billers and outsourced billers.

In 2021, the American RCM market was valued at over $126 billion. The industry is only poised to grow, with a projected 10.3% growth rate through the year 2030 according to Grand View Research Group*

Why the Revenue Cycle Management industry exists

Billing and reimbursement - also called revenue cycle management - are perennial pain points for many small-to-medium-sized physician practices in the United States. Healthcare revenue cycle management is becoming more challenging today because of the growing complexity of operating an independent medical practice. 

Rapidly changing government regulations, payer rules, new and updated coding, and stringent performance measures make heads spin in the billing departments of physician practices. Teams struggle to keep up, putting a practice’s cash flow and revenue at risk.

Sound familiar? If your practice needs help with revenue cycle management (RCM), outsourcing these operations to third-party experts can be a great idea. Let’s explore the pros and cons of working with an experienced RCM provider. 

Deciding Whether to Outsource Revenue Cycle Management

When considering how to handle revenue cycle management processes, it’s important to evaluate a few different factors. 

Ask yourselves these questions when considering to outsource: 

  • Does your organization have enough staff members on hand to handle RCM operations?
  • Do staff members have the skills necessary to do the work or will additional training be required? 
  • What is your overall budget for revenue cycle management?
  • What is your average daily patient volume?

Benefits of In-House RCM Efforts:

For healthcare providers with smaller patient populations, doing RCM in-house can be a viable option. Doing so will require an experienced and skilled staff that is equipped with the software and tools necessary to run RCM operations successfully. If everything aligns properly, in-house revenue cycle management can deliver quick and effective results.

Benefits of in-house RCM efforts include:

  • More control & ownership over RCM process
  • In-house staff are focused only on your company’s revenues 
  • Faster communication with staff members in charge of operations

Keep in mind, in-house RCM efforts also have some dangers:

  • Staffing problems can lead to unwanted problems and delays with RCM tasks
  • Untrained staff members in charge of revenue cycle efforts can also mistakenly break industry rules and regulations.

For these reasons, many healthcare providers turn to the revenue cycle management outsourcing industry.

Outsourcing Revenue Cycle Management to experts frees up in-house staff to focus on patient care

Benefits of Outsourcing RCM Efforts:

Outsourcing enables healthcare organizations to reduce staffing needs, cut down on training expenses and software, and avoid costly errors.

Turning to an experienced RCM company offers potential benefits to small-to-medium sized physician practices, including:

  • Optimized charges and coding – RCM companies employ certified coders and practice management specialists with deep expertise in compliant coding, reimbursement fulfillment, and overcoming payer denials
  • Lower operational expenses – today’s greater billing demands mean practices must hire more skilled—and expensive—personnel. In addition, overhead, technology, and continuous training costs add to the pile of expenses. It may be more cost-effective to outsource billing responsibilities to an RCM company
  • Maximized reimbursements – outsourcing can also help ensure that all patient visits, charges, and claims are accounted for and billed properly. Automated software systems and human oversight secure reimbursement for every service a practice has performed
  • Faster turnaround times – teams of dedicated medical billing specialists process large volumes of claims rapidly, resulting in shorter revenue cycle times between patient clinical encounters and reimbursements
  • Greater focus on patient care – relieving staff of administrative burdens related to billing and RCM frees them up to focus more exclusively on delivering high-quality patient care. It can improve morale within a practice or organization and increase the likelihood of patient satisfaction—an increasingly important measure these days

Why experience matters in RCM

Athelas, producer of the #1 remote patient monitoring (RPM) platform in the United States, is also a leading provider of RCM services. For nearly 20 years, the company has been helping physician practices increase their revenue and profits.

In short, Athelas’s AI-enabled Revenue Cycle Management program is an end-to-end white glove service. It's premium billing experience at a competitive price has produced:

  • Industry-leading denial rates - 50% lower than the industry average
  • Extraordinarily fast approval rates - 81% first-pass approvals
  • High collections - 94% collections rate average
  • Great visibility: Real-time dashboarding so you can see where your claims are, and when you will get paid
On average, Athelas RCM helps double the monthly collections of clients.

 With the right RCM partner, practices can achieve vigilant control over their revenue cycles from the moment they first see a patient until the closing of all account receivables. Engaging expert RCM services helps ensure all insurance reimbursements are received and all patient account balances paid in full.

If you're interested in learning more on outsourcing your RCM or medical billing, contact our RCM specialists here.

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