Revenue cycle management and specialty care: The pros and cons of leveraging an RCM partner

The COVID-19 pandemic, new commercial alternative payment models and the complexity of payer contracts are impacting how specialty care practices manage their revenue cycle. Additionally, the industry is facing unprecedented challenges that result in loss of revenue within practices, including staffing shortages (with either too few employees or employees without deep billing expertise), more time spent in accounts receivable (AR), ever-changing demands for healthcare documentation, and the transition from fee-for-service to value-based care payment models.

In the face of these challenges, many specialty care providers are weighing the pros and cons of keeping their RCM in-house versus partnering with a third-party RCM vendor. While keeping RCM services in-house provides a level of direct oversight and ownership, as well as the appearance of managing costs, keeping RCM services in-house can result in increased costs to find, train and maintain qualified staff. There is also heightened potential for burning out employees due to increased work, and for poor patient and provider experience because the provider is devoting attention and resources to AR and collections versus what they do best: providing quality care to those who need it.

From our experience at Integra Connect, specialty care practices are increasingly specialized and utilizing end-to-end RCM services from a third-party partner for three reasons:

1. It reduces time spent on administrative and AR-related activities. Outsourcing RCM allows healthcare professionals to spend less time in AR and more time with their patients, as they have the headcount needed to focus on billing.

2. Third parties are experts and have the necessary skill sets. With a third party, there is no need to find staff and keep them trained, freeing up much-needed resources to be used elsewhere. Additionally, given the expertise found with third-party partners, many practices find that their billing is completed more quickly and accurately.

3. There is potential to increase efficiency and revenue. Making a mistake in billing results in a loss of revenue. RCM partners are experts who reduce billing errors and maximize reimbursements. Plus, streamlining and automating the RCM cycle can lower the rate of claims denied and create a more efficient front-end office.

Of course, change can be difficult for an organization in the short-term, even when it’s helpful in the long-term. Those organizations that most effectively leverage RCM services first acknowledge that change is tough, and employees may be hesitant to accept help from a third-party partner. However, in our experience, this becomes easier when the RCM vendor can demonstrate their success in complementing employees’ existing capabilities, freeing-up employees’ time to focus on what they do best and helping to mitigate burnout.

Organizations successful at leveraging RCM services also understand that RCM is not a “one size fits all” approach. It will take time and energy to find the right RCM partner that will work to meet your specific needs and goals. This is particularly true for specialty care organizations, such as those focused on oncology and urology, which not only need end-to-end, clinical and operational expertise but must provide concierge-level customer service to ensure the needs of the patient, provider and organization are met.

An RCM partner can offer a holistic approach that augments staff experience to improve operations, financial performance and practice patterns. For specialty care practices, specifically, this often requires a mix of experienced professionals, analytics and automation tools to streamline the practice’s processes, from scheduling the initial appointment to ensuring that all payments are collected from patients and third-party payers.

Hear from specialty care leaders about how they benefitted from Integra Connect’s RCM services at campaign.integraconnect.com/integra-connect-webinar.

Parag Shah is president of practice solutions at Integra Connect.