15 Questions to Ask a Potential RCM Outsource Partner

5 Minute Read
Posted by Global Healthcare Resource & Lisa Eramo on Aug 9, 2023 5:51:24 PM

If your organization is ready to explore potential outsourcing partners to help manage your revenue cycle, you'll be pleased to know there are numerous companies ready to handle your medical coding, medical billing, and patient call center processes. However, finding the perfect partner can be a challenging task. At first glance, all RCM companies may seem similar, with each one promising to prioritize revenue integrity and patient satisfaction. However, it is only when you start asking detailed questions that you uncover the true differences. Doing your research will reveal not all RCM outsource partners are created equal.

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Creating an RCM Outsource Partner Checklist:
Below are fifteen questions to help you find the right fit for your healthcare organization:

1. How long has the RCM candidate been in business? Look for a strong track record with positive customer references and tenured management. Any RCM partner should be able to clearly articulate high-quality results, such as low denial rates, high collection rates, and fast turnaround times. Let the data do the talking.

2. What is the RCM candidate's scope? Can it handle your specialty, provider type, payer mix, and claim complexity? Can it also handle all the functions you hope to outsource? For example, some healthcare organizations may want to outsource their entire RCM process (including medical coding, medical billing, patient access, collections, and denial management) while others may only want to outsource a portion of it. If your organization is the former, can they give you everything you need?

3. Does the RCM candidate employ staff offshore? Ask the vendor to explain the advantages of an international RCM workforce. Also, when RCM staff are located offshore, does a U.S.-based team help manage the relationship with your organization?

4. With which electronic health records (EHR) can the RCM candidate integrate?
What level of EHR proficiency do RCM staff possess with your EHR specifically? How about their experience with your encoder and computer-assisted coding software?

5. What certifications do the RCM candidate's staff possess? Do the certifications meet your organization’s requirements and needs? 

6. What else can the RCM candidate tell you about its medical coding, medical billing, and patient call center staff? For example, are they independent contractors or W-2 employees? What is their average number of years of experience?

7. How does the RCM candidate handle recruiting, retention, and attrition? During times of ongoing healthcare staff shortages, what strategies does the vendor use to attract and keep high-quality talent?

8. How does the RCM candidate train its staff? What resources do they use, and why? Are these reputable sources that leverage trustworthy and timely information? 

9. What is the RCM candidate's process for quality assurance? For example, does the vendor audit coders regularly? What are the ramifications for coders who don’t meet performance standards?

10. What is the RCM candidate's pricing model? Do you pay a flat rate regardless of the revenue collected, or is your payment tied to the collection amount? 

11. What is the RCM candidate’s onboarding process? Clearly define key performance indicators, response time, and turnaround times for collections, claim filing, denial management, and appeals.

12. How can the RCM candidate be a resource to your organization? For example, can it share best practices to avoid medical coding denials, enhance RCM workflows, and reduce aging accounts receivable? What about identifying opportunities for physician education and clinical documentation improvement? Can it help you pinpoint proactive audits to ensure compliance? In terms of data sharing, what reports does the vendor provide regularly? Can it also provide metrics and benchmarks that help you understand performance?

13. Is the RCM candidate SOC2 Type 2 compliant? What data security measures do they have in place? Is the candidate willing to sign a business associate agreement?

14. What are the RCM candidate’s short- and long-term goals? For example, does the candidate plan to expand its team? Leverage new technology to improve efficiency and reduce costs? How do your candidate's goals align with the strategic goals of your organization?

15. In what ways will the RCM candidate serve as an extension of your team? For example, how will it embrace your mission statement and promote strategic goals? Will the candidate attend meetings with internal staff? 

Using an RCM candidate checklist helps you stay focused on what’s most important, and it ensures you ultimately get what you want and need. Remember: Your RCM outsource partner works for and with you. A thoughtful and informed approach to selecting the right partner is paramount.
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Founded in 1999, Global Healthcare Resource has been a leader in revenue cycle management solutions and proudly employs 6,000+ HIPAA compliant coders, billing professionals and patient call center agents. Global operates as an extension of your office to improve productivity and increase ROI.