Inhouse Vs. Outsourced Healthcare Revenue Cycle Management (RCM): Opportunities and Challenges

As a business owner, you may have considered expanding your business at some point or another. It would also mean that you may have considered hiring additional resources, renting or buying additional infrastructure and taking on other expenses associated with expansion. Chances are, you may have had to drop the plan because of a capital deficit. However, should that be a reason to hold back? Definitely not.

We’re not implying that finances have nothing to do with running a healthcare facility. Obviously, money is crucial for facilitating complex clinical treatments, procedures and meeting other fixed costs such as paying salaries and rent or hiring resources.

Let’s assume you aren’t left with any option but to depend on your in-house team to take on the burden of expansion—they already juggle offering value-based patient care and taking care of day-to-day administrative tasks. Creating even more of a burden for your staff is not only unethical, but also may lead to burnouts.

However, that’s just one of the in-house RCM challenges. It shouldn’t come as a surprise that each step of the patient journey comes with its own difficulties. If not addressed properly, healthcare RCM challenges can lead to major losses.

Wondering what these challenges are and how they can impact your business? Here’s a list.

RCM Challenges and Their Impact on Healthcare Businesses

Lack Of Digital Solutions Hinder Patient Access and Experience

Manual processes demand more manpower time up-front; it adds to the burden, increasing the chance of billing errors and subsequently, claim denials.

Today’s consumers are accustomed to digital-first experiences and prefer using mobile applications. When searching for a provider, they look for facilities like e-consultation or online insurance verification. In fact, according to a survey by Experian Health and PYMNTS, 77% of healthcare consumers who currently don’t use any digital tools would like to switch to a service that offers a patient portal. The automated tools you offer will make a huge difference to the success of your business.

Automation can streamline processes. You can improve the patient journey using digital solutions like patient onboarding softwares which can be accessed online.

Poor Recovery of Patient Overdues

High deductible health plans have patients assuming end-to-end payment formalities. However, these plans come with their own set of difficulties making payments difficult. Bills for multiple procedures or complex treatments often translate into confusion and grievances related to insurance coverage or financing options. That’s where you need efficient collection strategies to optimize your business revenue and minimize the risk of bad debts.

This healthcare RCM challenge can be tackled with the help of a digitized patient-centric payment system. This software should let patients access cost estimates, explore insurance coverage and payment plans. It should also come with multiple payment methods and ideally prompt patients to pay prior to services, minimizing collection efforts at a later stage.

Digital tools can help prioritize accounts that are highly likely to remit payments, map collection efforts of outsourcing service providers and streamline follow-up and collection workflows.

Tedious Processes Increase Chances of Billing Errors

Apart from being a workflow drag, claim denials send your healthcare staff into a loop of claim rectification, submission and delay. As a result, your bottom line takes the hit. Adding to the challenge, denials are known to delay reimbursement by 16 days on average. According to a Medical Group Management Association’s (MGMA) poll, 69% of healthcare leaders reported an increase in claim denials during 2021.

Replace manual processes and tedious workflows with automated solutions to reduce the occurrence of billing errors. A claim management software can ease the staff time by reviewing inaccuracy in medical coding prior to submissions.

We know our job doesn’t end at sharing RCM challenges. The burning question—how can you tackle them? The answer lies in outsourcing.

Benefits Of Outsourcing Revenue Cycle Management

Focus On Value-Based Patient Care

Outsourcing eliminates the need to hire, train and manage resources in processes like billing and coding. Third-party agencies and their staff will take care of all your RCM requisites right from bill payments to follow-ups and collections. As a result, you have more time to use your medical expertise in delivering the best experience to your patients.

Minimal Errors and Increase in Compliance

Outsourcing providers ensure that all your revenue generating processes across patient lifecycle are managed professionally with required expertise. Since these companies specialize in offering outsourced RCM services, it becomes their responsibility to maintain revenue integrity for your business. In addition, they also take care of all RCM-related compliances, adhere to legal formalities and keep up with industry regulations.

These companies work with well-trained staff who are adept at day-to-day claim processing and handling. So, the chances of denials are minimal compared to your in-house staff who, are perhaps, already handling billing operations. The benefit—on-time reimbursements for your practice.

More Operational Transparency

You are wrong if you think outsourcing makes you lose control of your processes. Outsourcing providers periodically generate and share reports of your revenue cycle operations with detailed insights into your business performance. Most providers also tailor their solutions according to your requirement, so you don’t have to micromanage either execution or performance.

These are some significant benefits of outsourcing revenue cycle management. Hopefully, they will help you make an informed choice for your business.

Contrary to popular myths, outsourcing services are an extension of your in-house teams and day-to-day processes. They help you bridge gaps that go beyond your scope of management—because of a lack of time, resources, capital or technology.

HelioNext is a leading provider of revenue cycle management services focused on retaining patients, improving productivity, reducing claim denials and billing errors and optimizing administrative functions.

Find out how our solutions can help you meet the demands and deal with challenges of modern-day RCM. Click here.