RCM Partner:

In today’s complex healthcare economy, having good data is the key to successful practice management. When the RCM partners’ financial success is aligned with that of the practice’s, it creates a win-win situation because both parties benefit from achieving the optimal revenues.

Not all RCM partners have the capabilities necessary to align with your needs and maximize this type of relationship. Additionally, for the post-acute long-term care practice, finding a partner who understands the unique business model can be critical.

Your practice does not operate the way that an office-based practice does, and your partner should clearly recognize that. Asking for references from other post-acute long-term care practices can give you insight into how well your RCM partner understands your practices infrastructure.

We offer our thoughts in the way of some critical questions to ask when evaluating a professional services RCM partner for your practice:

• Charge Capture – Can the RCM partner provide the tools to help your providers achieve 100% charge capture, assuring you that every service performed by your practitioners will be billed?
• Credentialing – Can the RCM partner handle all the credentialing and enrollment activities for providers with all payors, regardless of the state and can they maintain the cadence of quarterly and annual credentialing activities required by payors?
• Data transfer – Can they work with your practice’s EHR to extract the data needed for billing? How much experience do they have successfully interfacing with these types of systems?
• Coding – Is their coding staff certified and trained in the specifics of your practice specialty and post-acute care coding?
• Documentation – how do they support and respond to your coding questions and documentation issues? Can they help to educate providers on improving documentation in order to obtain appropriate reimbursement?
• Claims – what is the vendor’s turn-around time for submitting claims once they have the charges from the provider? Will they report this metric to you regularly?
• Accounts Receivable Monitoring – how are claims and payments handled once they have been submitted? What is the process for follow-up of unpaid or slowly paid claims?
• Secondary Insurance Billing – What is the RCM partners process for handling secondary insurance billing activities and the patient balances that may result?
• Denials Management – do they work denials aggressively to prevent revenue loss and payment delays? Is this critical information categorized and regularly reported back to the practice for process improvement?
• Data Analysis and Trending – does the RCM partner work with the practice on a regular basis to review the data and identify areas that might need management attention? Is their system sophisticated enough to provide easy access to data through dashboard analytics and reporting?
• Support for MIPS Measures Reporting – do they provide the coding expertise and analytics needed to enable your practice to successfully report the critical MIPS measures of quality and clinical practice improvement activities?

If your current RCM partner can’t provide this level of service, or if your in-house billing team doesn’t have the data or skills to perform this kind of analysis, it’s time to evaluate alternatives. Choosing the right RCM partner is not a simple task but the above questions are a helpful framework for finding the best fit for your practice.