The challenges brought about by the pandemic have impacted hospitals and provider practices in unique ways. For example, volumes have returned to normal for some while still lagging for others. The same can be said for margins and staffing shortages, as some organizations are still struggling with these ongoing challenges. In other words, there are no blanket statements or solutions that apply to all organizations at this time. Each has challenges specific to them, which is why outsourcing has become an invaluable option in this post-pandemic “new normal.” With outsourcing, organizations can customize a plan that meets their unique needs.
A Growing Outsourcing Trend for Revenue Cycle Management
According to a report by Kaufman Hall, 63% of health system leaders have at least one outsourcing solution in place, with revenue cycle processes at the top of the list.1 This makes perfect sense when you consider that outsourcers can deliver revenue cycle benefits that providers might never be able to realize on their own. The following are just a few examples:
- Benefits from the latest automation technology without large IT investments
- Provides access to highly skilled, multi-shore talent pools at lower costs
- Delivers high-quality results that can reduce errors, denials, lingering days in A/R, and write-offs
- Offers a higher level of payer expertise that enables quicker and more proactive identification of payer trends for more timely intervention, facilitating faster, more accurate reimbursement
- Improves cash flow through more effective accounts receivables management
- Allows providers to concentrate more on patient care and core competencies and less on administrative burdens
Outsourcing all or a portion of the revenue cycle allows providers to achieve optimal revenue efficiencies with lower costs and less overhead.
Compliance and Risk Management
In addition to revenue cycle process improvements, outsourcing can significantly enhance an organization’s compliance and risk management efforts, thereby reducing potential lost revenue from denials, takebacks, penalties, and more. Outsourcers can address all of these issues through more effective payer management—something that’s become increasingly difficult for provider organizations. Between March 2020 and March 2022, payers implemented more than 100,000 coding and reimbursement changes.2 Just staying on top of these changes requires a herculean effort, especially for organizations experiencing high turnover rates or revenue cycle staffing shortages. Because outsourcers typically have access to a larger pool of revenue cycle experts, they can develop a level of payer knowledge that many providers can’t.
Leveraging outsourcers can help providers:
- Improve regulatory compliance
- Elevate documentation quality and support CDI efforts
- Ensure coding accuracy
- Mitigate payer audits and investigations
Three Elements to Look for When Choosing an Outsourcing Partner
The first element to consider when choosing a revenue cycle outsourcer is global access to highly skilled revenue cycle experts—both onshore and offshore. These companies will have a broader network of resources and access to high-volume recruiting divisions. This means they not only have a larger pool of candidates to pull from but also the ability to fill vacancies more quickly. This enables them the ability to scale as the provider’s needs fluctuate.
It is vital that providers choose a revenue cycle partner with long-standing expertise in U.S. healthcare processes.
The second element to look for in a partner is expertise in building extensive, multichannel payer relationships so they can work with and manage those payers on the provider’s behalf. This can help mitigate issues and better identify resolutions. For example, uncovering a problem with claim adjudication can help determine when to uphold or down-code appeals. This type of proactive intervention can help improve revenue performance.
The third element providers must look for in an outsourcer is extensive technology investments. Partners that invest in automation technology are better able to streamline processes, improve quality, increase productivity, and lower costs. Automation technologies enhance the revenue cycle by removing manual, error-prone workflows for faster, more consistent, and more effective processes and workflows. The best partners are always looking for innovative new ways to leverage the latest technologies to bring long-term benefits to their clients.
Technology investments that would take an average hospital years to implement and even longer to achieve a positive ROI on can be reached much more quickly with the right outsourcer. This return can benefit hospitals by way of lower fees and improved revenue.
The Bottom Line Benefits of Outsourcing
These are challenging times for hospitals and physician practices alike. Entrusting all or a portion of revenue cycle processes to an outsourcer can help providers achieve improved efficiencies, lower costs, and more timely, accurate reimbursement. Conifer is an excellent choice.
Conifer Health optimizes every stage of a provider organization’s revenue cycle through proven methodologies, repeatable processes, flexible technologies, and measurable performance.