By Kumar Shwetabh and Arvind Perumbala
The right revenue cycle outsourcing partner frees your hospital’s leadership to focus on strategic priorities and initiatives.
Today’s healthcare environment is complex. Declining reimbursements, labor shortage, finding the money to invest in technology and analytics – are all part of the hospital CFOs unending list of strategic priorities. Developing the best operating model for your revenue cycle to enhance its efficiency and optimize performance often involves partnering with revenue cycle service providers.
Outsourcing is often associated with the idea of letting go. And letting go is about uncertainty and anxiety about results. By choosing the right partner, you can free up the time and find the investments for the strategic initiatives to propel your organization forward. In our experience, outsourcing can help you in three critical areas:
Scalability
Get an unending supply of qualified and certified revenue cycle resources. Whether it is medical coders that you are looking for or seasoned A/R professionals, the right outsourcing partner must be able to provide qualified resources on demand. Scalability comes from the right hiring, right training, and right fitment of a diverse set of resources for front-end, mid-cycle, and back-end processes. Further, you need skills in finance, technology, and analytics as well.
Automation
You need to work your revenue cycle like the year you are in. In 2022, people speak of automation and processes in the same breath. Your outsourcing partner should bring capabilities in multiple technologies – from measuring and monitoring agent productivity to applying machine learning and AI to reduce workload and improve outcomes.
Transparency
Often the missing link in most outsourced relationships. Transparency is about real-time communication, insightful reporting, and open collaboration. Whether it is flexing-up or flexing-down staffing, providing reports about their team’s performance, or the ability to create collaborative teams, including the hospital and service provider teams – transparency has to be demonstrated in action.
The right RCM outsourcing partner brings
Revenue cycle outsourcing partners can provide multiple benefits, including:
Implementation of efficient processes through the revenue cycle chain
Measure and report individual process-specific SLAs
Provision specialized expertise such as certified coders
Deploy enabling technologies such as workflow automation to provide you with an end-to-end view of outsourced processes
Apply automation to extend the reduction of the total cost of ownership beyond labor arbitrage
Most importantly, enable your leaders to focus on strategic priorities
As a revenue cycle services partner, we often get asked: How do I know if this is the right time to outsource? How can I ensure that we will control the outsourced processes? What benefits will I get by outsourcing my revenue cycle?
Here are a few things to look for in your partner:
Access to improve processes, specialized staff, technology, and automation.
Revenue cycle outsourcing partners can surprise hospitals and healthcare systems with the improved efficiency level they can bring to their revenue cycle. From benchmarking performance with top-ranking hospital systems to creating the underlying processes to achieve best-in-class RCM KPIs, outsourced service providers can bring to bear the ecosystem of scalable processes, automated technology, and secure infrastructure. Their specialized recruitment, training, and certification processes help them deploy high-quality talent consistently, which is a substantial competitive advantage for you in these times of labor shortages.
Flexible outsourcing arrangements. With unpredictable demand patterns in each new wave of the pandemic, you may need to flex up and down your staffing requirement. Partners such as Access Healthcare can offer you the advantage of scale and volume. For instance, you may need 100 AR callers for a short period, and if you are working with a partner currently deploying over 5,000 A/R callers, you can achieve your goal quickly and flex up your A/R team.
Innovation. Not all partners are the same. The ability to scale is one thing, and future-proofing your organization is another. For example, Access Healthcare has invested in developing echo, an robotic process automation platform that leverages AI and ML to offer innovation across the chain of revenue cycle processes. This trait of regular innovation means that the organization has a strong understanding of the client’s needs and will continue to offer solutions that create financial value to the hospital.
Focus on the future – A key question to be answered
Often, outsourcing decisions are taken merely for cost savings reasons. Remember that revenue cycle outsourcing has reached a new level of maturity in the past two decades. The ability of outsourcing to free up the time of hospital CFOs to focus on strategic initiatives is often overlooked as a critical requirement. The cost of not focusing on strategic objectives is very high.
Analytics. The role of analytics in revenue cycle outsourcing is to enable RCM decision-makers to drive strategic changes. With the right analytics, they are equipped to change how they measure quality, pay attention to patient experience, and make investments in new technologies to improve the patient journey. They can help the revenue cycle adapt to changing reimbursement models and evolving guidelines to achieve targeted financial outcomes.
Outsourcing is a two-way street - Importance of transparent communication.
One of the things we highlight in our discussions with our clients is that they are not “outsourcing” but rather “onboarding” a partner. You must know what to expect from your partner. You must document everything and ensure that you have performance data-on-demand and create a framework for continual information exchange.
Hospital RCM leaders must build ways to enable their workforce to focus on improving patient experience. They should also be getting the right insights from their revenue cycle. Insights are necessarily different from reports. The partner should provide insights and get your concurrence on decisive actions.
An effective governance model helps you create the path for transparent communications. Define clearly the reports you want to see, build in multi-level governance structures with daily, weekly, and monthly governance calls, and create a business intelligence framework that gives you powerful insights from operations data.
In conclusion, the decision on the size, scale, and complexity of the outsourcing partnership you want to establish lies in a clear understanding of the partner’s capabilities, technology ecosystem, and ability to help you focus on driving strategic initiatives.
Tips for managing a Revenue Cycle Outsourcing relationship
We provide below the key aspects that you should look for when establishing a revenue cycle partnership.
Due diligence. Before jumping into a contract, understand the partner’s ability to deliver what they promise. Due diligence can help you validate their capabilities and avoid assumptions.
Contracting. Develop a clear contract that specifies – where the partner will deliver services from, SLAs to be achieved, escalation processes and procedures, governance model, technology interventions, and the timeline for deployment.
Transparency. It’s essential to be open about the outsourcing relationship. In many cases, the partnership may shift your employees to the partner. Tell them that this will happen. Transparency is also about technology for real-time reporting and a robust governance model. Get real-time data on agent performance, revenue cycle KPIs, inventories, etc., to continue to be in operational control while letting your partner manage the operational challenges. Your governance framework should provide transparent information exchange and facilitate decision-making.
Future-proofing. Revenue cycle partners you rely on should bring in the technology, i.e., enabling technology and automation to help you reduce costs to collect, propel your organization forward, and make your revenue cycle future-ready.
Give it time. Our experience indicates that it takes time to develop a good relationship. Outsourcing your revenue cycle takes as many as two or three A/R cycles to deliver transformational results. Yes, you will be able to bank labor arbitrage gains quickly, but achieving scalable and sustainable results will take a few cycles. Give it time. Give opportunities to your partner to demonstrate their abilities. Evaluate and make changes with the partner. Repeat.