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May 29, 2024

Achieve Financial Efficiency: Choose the Best RCM Partner for Your Healthcare Organization!

Febien Caltin is a dynamic professional with 20+ years of extensive experience in the healthcare RCM space. He has expertise in Consulting, and Strategic Planning on solving critical issues healthcare providers face in the RCM process. Febien is committed to the growth of healthcare providers through his immense experience.

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Being a part of the competitive healthcare industry, you’re probably aware of the cut-throat competition raging in the sector. With evolving regulatory norms and a massive volume of information inflow from clients, choosing the right healthcare revenue cycle management (RCM) partner becomes imperative. There’s no denying that healthcare RCM services are a fundamental part of your business. The key challenge lies in shortlisting the best RCM partner.

Let’s explore the critical factors in choosing the right partner for RCM. The right approach ensures that you can boost the efficiency of your organization, reduce costs, and eventually elevate the quality of patient care.

What is revenue cycle management (RCM)?

Revenue cycle management in healthcare is the financial process used by healthcare providers to manage patient service revenue. From registering patients to billing and final balance payments, RCM in healthcare is quite a complicated process.

Successful healthcare organizations need a robust RCM system to streamline administrative data and billing and organize their medical records. This justifies why partnering with the top healthcare RCM companies is crucial.

Therefore, RCM involves complex processes in managing financial transactions. Traditionally, the revenue cycle was managed manually, involving paper-based billing, coding, and claim submissions. This often resulted in human errors, inefficiencies, and delays in collecting revenues.

Thanks to the advent of modern, technology-driven healthcare revenue cycle management solutions, organizations can benefit from sophisticated technologies like AI, Robotic Process Automation (RPA), and ML algorithms. These technologies streamline the revenue cycle processes and automate tasks such as checking medical coding accuracy, processing claims, denial management, and payment reconciliation. This gives hospitals actionable insights to enhance their operational efficiency and financial performance.

With RCM revolutionizing, healthcare providers benefit from reduced billing errors, faster reimbursements, and enhanced regulatory standards like HIPAA.

How to identify your organization’s goals?

In the first place, healthcare organizations need to identify their respective goals before choosing the right RCM partner. The priorities and needs of each organization are unique. This justifies why it’s so important to find one of the best medical billing companies to take care of your RCM. From evaluating the industry expertise to their ability to ensure compliance and security, every aspect needs to be weighed with your organizational goals at the forefront.

Check out the steps to evaluate current RCM processes and define your objectives for improvement.

  • Evaluate your current processes
    A comprehensive assessment of your existing RCM workflows will help you identify the inefficiencies and bottlenecks.

  • Identify pain points
    Next, determine the pain points in the RCM processes. This might be delays in reimbursements, high denial rates, or inaccurate billing issues.

  • Define your objectives
    Based on the evaluation, define clear goals for improvement. The priority might be pacifying payment cycles, reducing denials, or improving medical billing accuracy.

  • Set SMART goals
    Lastly, ensure your objectives align with SMART (specific, measurable, achievable, relevant, and time-bound) goals.

Here are some examples of SMART goals for RCM performance:

  • Reduce denial rates to below 5% within the next 6 months.

  • Improve collections.

  • Achieve a first-pass claim rate of over 95% by implementing new coding procedures by the end of the quarter.

With these methodical steps, your healthcare institution can align with its RCM goals and strike effective partnerships for the best medical billing services.

How to understand the expertise and experience of your RCM partner?

Now that you are looking for a competent RCM partner for seamless revenue cycle management healthcare, how do you evaluate the expertise and capabilities of the service provider? With too many companies in the industry, it’s easy to land in a dilemma.

Here are certain strategic guidelines from experts that can help you narrow down your options.

  • Expertise in Healthcare RCM
    Scrutinize the RCM partner for their expertise in the healthcare domain. A seasoned company will understand medical billing codes, payer requirements, and compliance mandates to ensure smooth operations. This will significantly reduce the number of claim denials.

    Moreover, it's imperative to find an RCM partner specializing in your sub-field within the medical domain such as oncology, dentistry, cardiology, psychiatry, general practice, and other branches.

    Request for references from current or past clients, which will help you understand their reliability, performance, and abilities. Also, inquire about their knowledge and compliance with payer requirements, best practices, and regulatory mandates like HIPAA.

    Kenneth Jeremiah
    Kenneth Jeremiah, Associate Director of Transitions at Plutus Health Inc.
    Kenneth Jeremiah, Associate Director of Transitions at Plutus Health Inc., states, “Many organizations would rather focus on the patient than chasing paperwork...If a billing company handles large aspects of your revenue cycle, you'll have more resources, time, and energy to devote to improving the patient experience”.
  • Technology and Integration Capabilities
    Ensure that the company offering healthcare RCM services delivers you a technological edge. As a proficient RCM partner, they should proactively use AI and ML to streamline the effectiveness of revenue cycles. Besides, leading RCM partners have a user-friendly and secure platform to manage billing processes.

    Closely evaluate their integration capabilities so that they can seamlessly integrate new technologies into your existing systems. Forward-thinking partners incorporate practice management software, EHR, and EMR tools to ensure a smooth data flow.

  • Data security and compliance
    The healthcare industry involves lots of sensitive information about patients. Make sure that the healthcare RCM companies prioritize compliance and security.

    Find out whether or not they adhere to stringent industry standards like the HITECH and HIPAA Acts from reviews and testimonials. Also, they should evaluate the security protocols they are incorporating, including disaster recovery strategies, 2FA, routine audits, and data encryption practices to mitigate risks.

  • Financial implications
    Before you hire one of the leading healthcare RCM companies, determine their pricing structure. Would they charge a certain percentage of the collections, or do you need to fork out a specific monthly fee? Consider your expenses and ROI, looking beyond initial costs and factoring in value-added services. Some of these companies also recommend effective strategies to boost your revenue.

    Furthermore, companies streaming the revenue cycle process in healthcare with their advanced systems should provide multi-channel support. Usually, the leading service providers offer 24/7 support through chat, email, and phone. They also ensure swift response times to address queries and resolve issues promptly. Make sure to review and negotiate clear SLAs with the partner. The agreement should include your expectations, response times, and certain performance standards.

Why outsource Plutus Health RCM services?

Now, let’s find out why Plutus Health RCM services continue to be the first choice for hundreds of successful healthcare organizations. Outsourcing your RCM processes, including ABA billing and ASC billing to this team of experts brings a wealth of benefits to your organization.

  • Impressive track record
    Plutus Health has a demonstrated track record of success while collaborating with healthcare organizations. The seasoned team of professionals here understands every aspect of compliance standards and medical billing. This group of experts specializes in a wide array of healthcare sectors to deliver customized solutions. Working with Plutus Health can help you address the unique challenges you have been facing.

  • Sophisticated technology and seamless integration
    Proactively integrating advanced, cutting-edge technologies into its operational mechanism, Plutus Health streamlines processes for its clients. The experts are competent in using machine learning tools and AI to optimize efficiency in your processes. The top-tier medical billing company offers a user-friendly and robust tech-enabled RCM platform that seamlessly integrates with the practice management and EHR/EMR tools you have been using. Back by AI, Plutus Health’s experts ensure a smooth transition and data flow.

  • Security and Compliance
    Plutus Health is one of the top companies providing secure healthcare revenue cycle management solutions. The professionals comply with industry norms, including HIPAA, ensuring the privacy and security of patient data. They secure your data through regular audits, 2FA, and encryption technologies.

  • Productive financial model
    As a leading medical billing service provider, Plutus Health serves clients of various sizes within the healthcare industry and has flexible pricing models. The value-oriented financial model of the professionals enhances the claim acceptance rates and speeds up your payment cycles. This brings a higher return on your investment.

  • Great customer support
    As one of the best companies providing healthcare RCM services, Plutus Health has developed a strong, multi-channel customer support system. Clients can contact the experts through email, live chat, or phone.
    Considering all these advantages, forward-thinking healthcare service providers are partnering with Plutus Health to streamline their processes. Our technological powers, expertise, financial benefits, and compliance measures make us one of the most sought-after RCM service providers in the healthcare domain.
    Now that you know why Plutus Health stands out as the first choice, reach out to us with confidence to ensure the consistent growth of your healthcare organization.

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Febien Caltin

Febien Caltin is a dynamic professional with 20+ years of extensive experience in the healthcare RCM space. He has expertise in Consulting, and Strategic Planning on solving critical issues healthcare providers face in the RCM process. Febien is committed to the growth of healthcare providers through his immense experience.

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