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Optimizing Financial Health: Key Considerations for Choosing an RCM Partner

By March 25, 2024No Comments

Ensuring the financial health and operational efficiency of healthcare systems is paramount. Revenue Cycle Management (RCM) stands at the heart of this challenge, serving as the linchpin that secures healthcare services’ financial viability and smooth operation.

Choosing the right RCM partner is not just a matter of operational necessity – it’s a strategic move that significantly impacts the organization’s bottom line and quality of service.

The choice involves aligning with a partner that understands the nuances of your healthcare practice, anticipates the evolving landscape of healthcare regulations, and leverages cutting-edge technology to drive results.

Here are the capabilities and qualities your health system should seek in an RCM partner.

Understanding Your Health System’s RCM Needs

Assessing Current Performance

A thorough audit of your RCM performance is the first step toward optimization. Identifying inefficiencies and areas for improvement is crucial in streamlining operations and enhancing financial outcomes.

Expertise in conducting deep-dive assessments enables health systems to pinpoint precisely where enhancements are needed, ensuring efficient resource allocation while facilitating better prioritization and providing a roadmap for future improvements.

Scalability and Customization

As healthcare organizations grow, so do their RCM needs. Solutions that offer scalability and
customization are not just beneficial but essential. Seek customizable end-to-end RCM services that evolve in tandem with your organization. Your RCM partner should complement and elevate your existing team as a partner in transformation.

The success of Berenson Cancer Center is a testament to this approach. Tailored RCM solutions significantly improved financial performance for an organization that struggled with increasing days in A/R, poor RCM process visibility, and lackluster cash flow forecasting.

  • Increased revenue by 15% within 120 days
  • First-time payment rates improved to 98–99%
  • 100% transparency into RCM processes

Evaluating Vendor Expertise and Experience

Industry-Specific Experience

The intricacies of healthcare RCM require not just generic financial management knowledge but deep, industry-specific expertise.

A proven track record in healthcare RCM is a testament to understanding the sector’s unique challenges and opportunities.

Seek a partner whose expertise covers a range of RCM specialties to ensure a comprehensive understanding of healthcare nuance.

Improving Financial Outcomes

Evidence of improved financial outcomes is paramount when selecting an RCM partner. Testimonials and success metrics, including significant revenue collection improvements and efficiency gains, speak volumes.

A radiology group in Washington, D.C., is a prime example, having witnessed remarkable financial turnaround and process optimization after struggling with claim submission delays, 90+ insurance AR, and increasing days in AR.

  • Billing turnaround time improved from 7 to 4 days
  • Reduction in the 90+ Insurance AR from 40% to 15%
  • Reduction in the Days in AR from 49 Days to 25 Days
  • Clean Claim rates improved to 99%

Technology and Integration Capabilities

Advanced Technology

Deploying AI and automation technologies in RCM processes can dramatically improve collections and denial management. Cutting-edge AI and machine learning technologies continue to revolutionize how healthcare systems manage their revenue cycles, ensuring more efficient and effective financial operations.

Seamless Integration

For RCM solutions to be truly effective, they must integrate seamlessly with existing IT systems. Software solutions should be designed for compatibility, ensuring that healthcare systems can leverage advanced RCM tools without disrupting their current operations.

Consider the achievements of a genetic testing client who turned to automation after struggling with integration, manual workflow processes, and inflated administrative costs for process oversight.

  • Real-time invoice and statement delivery
  • Customized invoice aging based on net terms for convenient invoice filtration
  • Built-in dispute management and dispute resolution
  • B2B payment status dashboard

Compliance, Security, and Reliability

In healthcare, compliance and data security are non-negotiable. A commitment to HIPAA compliance and robust data security measures ensures that healthcare systems can trust their RCM processes to be secure and compliant.

An orthopedic group in Nevada faced challenges related to prior authorization securement, increased eligibility-related denials, and non-compliant coding. Their RCM solution led to improved regulatory alignment.

  • 100% transparency into RCM processes
  • Best-in-class and compliant business processes
  • Seamless transition to new, improved Practice Management System to address coding and documentation challenges

Support, Training, and Partnership Approach

The implementation of an RCM solution is just the beginning. Ongoing support and training are critical to ensuring the long-term success of any RCM initiative. SYNERGEN distinguishes itself through our unwavering commitment to client support and continuous education, ensuring that healthcare systems maximize the benefits of their RCM solutions.

It is vital to choose an RCM vendor that views its clients as partners rather than mere customers. A partnership approach benefitted a remote cardiac monitoring company with 90+ insurance AR and a low first-time payment rate.

  • 50% increase in overall revenue
  • Days in AR reduced from 137 days to 68 days
  • First-time payment rate improved from < 55% to > 62%
  • 154% increase in patient collections

RCM Partnership is Not to Be Taken Lightly

Selecting the right end-to-end RCM partner is strategically essential for healthcare systems. It requires carefully considering the vendor’s expertise, technology capabilities, compliance adherence, and approach to client relationships.

Our comprehensive suite of end-to-end RCM solutions exemplifies what healthcare systems should seek in an RCM partner.

Be sure to evaluate your options carefully. Request a SYNERGEN demo today and discover how we can elevate your healthcare system’s financial health.