Authored by: Paul Koes
At first, the signs might not be obvious. Perhaps claims denial rates increase slightly, your billing team is more overwhelmed than usual, or you experience small dips in revenue. However, these seemingly small changes could signal that your existing RCM solution isn’t working. Also, these changes are sometimes the tip of the iceberg, hiding larger, deeper problems.
Not sure whether it’s time to switch your existing RCM solution? After working with clients for many years and seeing the symptoms firsthand, here are five symptoms to watch for:
1. High rate of claims denials
High claims denial rates are a sure sign that your current RCM system isn’t effectively identifying and resolving billing errors and coding issues. These issues can lead to payment delays and revenue loss for your practice.
Hitting a 100% claims rate isn’t likely, but you want to get as close as possible. If you’re at an 85% clean claims rate and bring in $1 million in revenue monthly, raising that percentage by just 5% is $50,000 of additional revenue monthly, or $600,000 annually.
2. Reduced productivity and efficiency
Staff members spending excessive time on manual billing tasks or navigating cumbersome processes within the RCM system can be a signal that inefficiencies are impacting productivity and, ultimately, revenue generation.
A consistent issue that I’ve seen is challenges associated with staff turnover. I’ve worked with practices where billers who have been there for 30 or more years do everything by hand and have a high clean claims rate. As a result, the practice owner or manager believes all is well with the business.
But when that person leaves the practice, they’re taking years of expertise and knowledge with them. Billing, unfortunately, isn’t a plug-and-play operation. Each office has different insurances, codes, and billing workflows, which take time to learn. Onboarding isn’t easy, and that learning process can disrupt workflows, productivity, and profitability. Improving productivity by leveraging an RCM solution helps resolve these challenges.
3. Lack of integration and scalability
If an existing RCM system lacks integration with other practice management tools, such as an EHR, or can’t scale to accomplish the growing needs of a practice, it might be time to consider a switch.
Also, it’s hard to scale up if you have a single biller. A practice that sees 100 patients per day has 100 bills for that biller to process. Then, when claims rejections occur, the biller has to rework those in addition to the new billings. You can add more billers, but at some point, it makes sense to leverage something that is software based, allowing you to support your team.
4. Inadequate reporting and analytics
Suppose your practice struggles to access timely and accurate financial reports or lacks robust analytics capabilities to track KPIs. These issues can interfere with making informed business decisions and optimizing revenue cycle performance.
For example, if revenue decreases, do you have an analytics tool to help you identify why? Maybe you collected $800,000 per month during the first quarter of last year, but this year’s first-quarter revenue has dropped to $700,000. Reporting and analytics tools can help you explore the data to find clues about what’s happening so you can figure out how to fix it.
5. Poor patient experience
The last sign, but probably one of the most important, is a negative patient experience. You see this in many places, but one of the most obvious is in online reviews. Are patients complaining that it took too long to receive a bill or that they didn’t understand the amount owed?
A modern RCM system should offer patient-friendly features and support that enhance the overall patient experience, such as the ability to pay bills via text or online.
The good news is RCM services aren’t “all or nothing”
As you consider RCM solution options, it’s important to note that it’s not an all-or-nothing proposition. RCM can be a temporary addition that helps offload staff workloads but still includes your staff.
I’ve had practices using an RCM solution just to collect patient payments. This task alone takes a considerable workload off in-office billers, freeing them to focus on other important tasks, such as coding, denial management, insurance follow-up, and more.
Outsourcing just one part of the workflow helps alleviate the burden experienced by in-house billers. It also allows them time to review the submission of the outsourced RCM so that staff can become more comfortable with processes. Then, after the contract expires, the outsourced portion could be returned to office staff, who are now more experienced with the process.
If you’re considering making a change in your RCM process and are curious about the available options, contact us, our experts are here to help.