Outsourcing your revenue cycle management (RCM) is a big decision for any eyecare practice. The right RCM partner can streamline your billing processes, help you recover revenue, and allow your team to focus more on patient care by relieving a lot of the day to day admin work that comes with claim filing. But how can you be sure that your current partner is providing the level of service your practice needs? Maybe you have started to notice some frustrations or shortcomings and wonder if there is a better solution. Here are five key areas to evaluate to ensure you’re working with the right billing partner.
Is communication always clear and easy?
Clear and consistent communication is essential when outsourcing billing services. Does your RCM provider keep you informed and reachable when you need them? Good communication means you’re not left guessing about the status of your claims, and it allows for quick resolutions when issues arise. This means you’re not waiting days, or getting ghosted when you need an answer to a question. Ask yourself:
- Does your RCM partner provide regular updates on claim statuses?
- Are they accessible and available to address any questions or concerns in real-time?
- Do they make billing processes and practices easy to understand for your team?
Without transparent communication, small issues can escalate, leading to billing delays and cash flow interruptions. If communication feels like an obstacle with your current provider, it may be time to reevaluate your partnership.
Are claim denials managed proactively and effectively?
Denial management can make or break the effectiveness of an RCM partner. Denials are an inevitable part of billing, but handling them efficiently is critical to avoid revenue loss. Your RCM partner should be proactive in identifying and correcting issues that lead to denials and in appealing them when possible. Consider:
- Is your RCM provider actively identifying patterns in denied claims?
- Do they communicate why certain claims are denied and what steps are taken to prevent future denials?
- Are they able to handle denials quickly enough to prevent revenue from slipping through the cracks?
If your partner struggles with denials or lacks a strong denial management process, you could be losing out on significant revenue opportunities.
Have you seen a noticeable improvement in AR?
The time it takes for your practice to collect payments is a major indicator of financial health. An effective RCM partner should be working to reduce your days in accounts receivable (AR), ensuring that payments are received promptly. Regular review and reduction of AR days can improve cash flow and minimize bad debt. Ask yourself:
- Has your AR performance improved since partnering with your current RCM provider?
- Do they have strategies in place to consistently lower AR days?
- Are they regularly reviewing aged claims and following up on any unpaid claims?
If your AR days haven’t improved or seem to be increasing, it might be a sign that your RCM provider isn’t as effective as they should be.
Has your bottom line improved over time?
Outsourcing your billing services should bring tangible benefits to your bottom line. While it can take time, you should see gradual improvement in revenue over time. Your RCM provider should be committed to maximizing your revenue and helping your practice grow financially. Consider:
- Are you seeing a steady increase in collections over time?
- Does your RCM provider help you identify areas for financial growth within your practice?
- Are they transparent about their fees and the value they’re bringing?
If your practice’s revenue hasn’t seen any improvement since outsourcing, it could mean that your RCM partner isn’t delivering on their promises.
Are you maximizing every patient encounter?
Every patient interaction is an opportunity for revenue. The right RCM provider will help maximize the revenue per patient encounter by ensuring that claims are coded and billed correctly. Effective billing translates into higher reimbursements and minimizes missed revenue. Ask yourself:
- Has your average revenue per patient visit increased since working with your current RCM provider?
- Does your RCM partner conduct audits to ensure coding accuracy and maximize reimbursements?
- Are they optimizing billing processes to capture all available revenue for each encounter?
If there hasn’t been an increase in average revenue per encounter, your current provider might not be maximizing your revenue potential.
At the end of the day, outsourcing your RCM is supposed to reduce stress, not add to it. If your current provider isn’t delivering results in these five areas—communication, denial management, AR improvement, bottom-line impact, and revenue per encounter—it might be time to reevaluate the partnership. The right RCM partner will not only support your financial growth but also give you peace of mind so you can focus on what matters most: your patients.