As the healthcare industry continues to evolve and become more complex, healthcare leaders are facing numerous challenges that require their attention. One of the biggest challenges is managing medical billing and revenue cycle management (RCM) processes. In recent years, an increasing number of healthcare leaders have turned to outsourced medical billing and RCM services as a solution to their problems. In fact, research shows that 80% of healthcare leaders are planning to outsource these services in the future. This shift towards outsourcing is driven by a number of factors, including rising costs, regulatory changes, and a shortage of skilled staff. In this article, we will explore the reasons why healthcare providers are turning to outsourced medical billing and RCM services, how this trend is transforming the industry, and the key factors to consider when choosing a reliable outsourcing partner. So, whether you are a healthcare leader looking to streamline your financial operations, or a curious reader interested in the latest trends in the healthcare industry, this article is for you.
Challenge #1 – Staffing Shortages.
Staffing shortages have also impacted medical practices, particularly when it comes to hiring and retaining skilled billing and RCM staff. This shortage of skilled staff can lead to longer processing times, errors, and a backlog of claims. Outsourcing medical billing and RCM functions can help medical practices overcome these staffing shortages by providing access to a team of experts who are trained in the latest billing and RCM best practices. These third-party companies can provide faster processing times, fewer errors, and a more efficient process overall.
Challenge #2 – Inflation
Inflation has impacted medical practices in several ways, including higher costs for supplies, equipment, and staffing. Medical practices that handle their own billing and RCM may struggle to keep up with these rising costs and may find it difficult to maintain profitability. Outsourcing these functions to a third-party company can help medical practices control costs and improve their revenue cycle management. As mentioned below, studies have shown that medical practices that outsource their billing can see a significant increase in revenue, which can help offset the impact of inflation.
Benefit #1: Increased Revenue
One major benefit of outsourcing medical billing and RCM is increased revenue. Studies have shown that medical practices that outsource their billing can see a significant increase in revenue. A study by the Medical Group Management Association (MGMA) found that practices that outsourced their billing saw an average increase in revenue of 11.6%. Another study by Black Book Market Research found that practices that outsourced their billing saw an average increase in collections of 6.8%. This level of increase can surpass the outsourcing cost by 2 - 3 times, creating an instant ROI.
Benefit #2: Decreased Costs
Outsourcing medical billing and RCM can also lead to decreased costs for medical practices. When a practice handles its own billing, it must hire experienced staff and invest in expensive software and equipment. Outsourcing these functions eliminates the need for these expenses. The MGMA study found that practices that outsourced their billing saw a 16.9% decrease in billing-related costs.
Benefit #3: Increased Efficiency
Another benefit of outsourcing medical billing and RCM is increased efficiency. Third-party companies specialize in billing and RCM and have streamlined processes and systems in place to handle these tasks efficiently. This can lead to faster payments and fewer denied claims. In turn, this can lead to improved cash flow for the practice. Furthermore, outsourcing can also free up time and resources for medical practices to focus on patient care and other important aspects of their business.
Benefit #4: Improved Compliance
Outsourcing medical billing and RCM can also lead to improved compliance. Revenue cycle management is complex and constantly changing. Third-party companies have a team of experts who are trained to stay up-to-date with the latest regulations and compliance requirements. This can help prevent errors and reduce the risk of audits and penalties.
Benefit #5: Access to New Technology
Outsourcing medical billing and RCM functions can also help medical practices stay up-to-date with the latest technology and industry trends. Third-party companies typically invest in the latest software and technology to improve their services, which can benefit medical practices that may not have the resources to do so themselves.
Benefit #6: Access to Expertise
Outsourcing medical billing and RCM functions to a third-party company offers medical practices access to expanded medical business, seasoned medical billing and RCM experts, certified medical coders, industry thought leaders and EHR expertise. Third-party companies specialize in these functions and have teams of experts who are trained to stay up to date with the latest regulations and compliance requirements. They have streamlined processes and systems in place to handle these tasks efficiently, which can lead to faster payments and fewer denied claims.
For example, every Revele RCM Client is assigned a Client Success Team of experts, including the following:
Client Performance Manager - Leads Client Success Team (CST) and proactively analyzes their clients ‘ performance and industry changes to identify opportunities for revenue performance.
Billing Resource Consultant - Helps customers with timely issue resolution, process adoption, and ongoing training.
Billing Performance Lead - Oversees day-to-day claims processing and aligns team performance with client expectations and goals.
Coding Resource Consultant - Helps customers improve payment velocity by analyzing denials and rejections. Provides chart audits and ongoing medical coding education. Looks for proper coding techniques to improve revenue optimization. Reviews codes and trends for compliance purposes.
eClinicalWorks EHR Optimization Specialist - Provides ongoing eCW software optimization, conducts annual database reviews, and provides knowledge, training, and recommendations on new eCW software features.
Choosing a Third-Party Company with Expertise in the Practice's EHR System
Most importantly, medical practices should choose an outsourcing partner that will perform all medical billing functions inside the practice's EHR. Avoid any RCM service that utilizes its own internal billing system to submit and resolve claims. In this case, transparency is nonexistent; practices cannot see claim activity. Furthermore, the practice loses control of its AR / claim details, activity, and information, which could be an issue in the event that the practice wants to change the relationship.
When outsourcing medical billing and RCM functions, it's important to choose a company that has detailed experience and expertise with the specific electronic health record (EHR) platform that the medical practice is using. One such EHR platform is eClinicalWorks, which is widely used by medical practices across the United States. Revele is uniquely qualified to provide medical billing and RCM services on the eClinicalWorks software platform. Revele has over 20 years of experience providing medical billing services and has been working with eClinicalWorks software since 2005. In fact, it is the first RCM firm to offer RCM services designed specifically for eCW software users. Revele has helped thousands of providers implement or optimize their eClinicalWorks EHR system. This extensive experience allows Revele to optimize the billing and RCM processes to work seamlessly with the platform's features. This means that practices using the eClinicalWorks EHR can benefit from a streamlined and efficient billing process that is tailored to their specific EHR system. Revele's expertise with the eClinicalWorks software also extends to its ability to navigate the platform's reporting features. The company's team of experts can create custom reports that provide medical practices with valuable insights into their revenue cycle management. These reports can help identify areas for improvement and provide actionable data to optimize revenue.
Future Trends and Conclusion
Recent survey results have indicated that more healthcare leaders are planning to outsource medical billing and RCM services in the future, particularly in light of inflation and staffing shortages. According to a survey by Black Book Market Research, 80% of hospital and health system leaders plan to outsource more revenue cycle management functions in the next year. This further highlights the importance and benefits of outsourcing medical billing and RCM functions.
In conclusion, outsourcing medical billing and RCM functions can help medical practices overcome the challenges of rising costs and staffing shortages while also increasing revenue and improving efficiency. When choosing a third-party company, it's important to consider their experience with the practice's specific EHR platform, such as eClinicalWorks, to ensure a streamlined and efficient billing process. Revele's expertise with the eClinicalWorks software and extensive experience in optimizing the platform for RCM and medical providers’ workflow makes them an excellent choice for medical practices seeking to outsource their RCM functions.
By outsourcing to a company like Revele, medical practices can benefit from increased revenue, decreased costs, increased efficiency, improved compliance, and a focus on patient care. With survey results indicating that more healthcare leaders plan to outsource their RCM functions in the future, outsourcing medical billing and RCM is becoming an increasingly popular solution for medical practices.
At Revele, we specialize in providing tailored revenue cycle management services to medical practices using the eClinicalWorks software. With over 20 years of experience, we have helped thousands of providers optimize their billing processes to maximize revenue and efficiency. Contact us today to learn more about our services and how we can help your medical practice thrive.
This is a true no-brainer! Request a free eClinicalWorks expert analysis of your current eClinicalWorks Software RCM/medical billing performance, process, and workflow.
- Medical Group Management Association (MGMA). (2018). Revenue Cycle Management in Medical Groups.
- Black Book Market Research. (2018). 2018 State of the Outsourced RCM Industry Report.
- Black Book Market Research. (2021). 2021 Revenue Cycle Management Outsourcing Survey Results.
- Medical Economics. (2021). The top 4 medical practice challenges of 2021.
- Hill, R. G. (2016). Why Outsourcing Revenue Cycle Management Helps Hospitals Manage Change. Healthcare Financial Management, 70(9), 80-83.
- Shrestha, P. (2018). Evaluating the Benefits of Outsourcing Revenue Cycle Management Services in the U.S. Healthcare Industry: A Literature Review. Journal of Healthcare Management, 63(3), 167-178.