There are loads to learn about RCM companies and the way they extend their support in the healthcare industry. To review RCM companies, it’s important to know how they work and learn, how they benefit healthcare organizations or healthcare professionals. One should know by now that the healthcare industry’s reimbursement laws aren’t going to stay constant and be as they are. They undergo changes continuously.

They reform, mould, and reinforce themselves as the system matures, necessitating the need for constant financial vigilance amongst medical practices. Associating with the RCM companies is the only choice for healthcare professionals. It has been the go to option for the most, especially those who haven’t got a billing department annexed to their healthcare’s business frontier.

It means most of the endeavors can be taken care of by outsourcing RCM companies and the healthcare providers would be free to go ahead with what actually matters most to them- patient care. In this article, let’s check the FAQs while reviewing RCM companies.


Do RCM companies provide the summary of account receivable?

  • Keeping the monthly AR under 1.5 times the monthly charges is the ideal target.
  • Days in AR = Total AR ÷ Avg. daily charges
  • As the AR days increase, cash flow to your healthcare organization decreases, thus lowering the means to pay or hire better staffs and physicians.
  • It also affects the practice groups’ and its ability to invest in current generation tools and technology. So, higher the average AR days, the more negative its impact on your ability to treat patients better.
  • AR is grouped under 5 classifications, which are 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days. Questions to ask :
  1. Do they have an organized system in order to keep track of and follow through the pending AR?
  2. Would they be providing you with periodic analysis of AR, and assisting you with recommendations based off of it, so that your hospital’s overall financial performance can be boosted?


Do they offer denial management on your existing claims?

  • An analytics survey found that “44% of the participating hospital executives indicated that they use revenue cycle management vendor solution to manage denials, while 31% use manual process and 18% use homegrown tools, but surprisingly, 7% are unsure about their denial practices.”
  • Whatever maybe your choice, a proven fact is that a dedicated RCM company is more capable and efficient at managing insurance denials than a medical practice.
  • It’s also essential to check if they have any denial management platform. If the answer is “yes”, opt for a quick demo before proceeding.
  • Also check if they incorporate a team dedicated for denial management. Choose to go for a con-call and throw in few of the existent concerns.


Can they track and analyze rejected claims?

  • A research reveals that “about 20 to 30 percent of the claims that are raised get rejected on a regular basis”. Another suggests that “of these rejected claims, almost 80 percent are left unprocessed.”
  • From sloppy documentation to issues such as up-coding/under-coding, there are multiple reasons why the claim could get rejected.
  • It needs a team of expert billers to handle all these rejections at a moment’s notice. An established billing company can afford that.


Can they offer code analysis based on existing medical practice’s history?

  • Reports such as ‘top used codes’, ‘top paying codes’ and ‘most denied codes’ go a long way in keeping you updated on revenue flow.
  • RCM companies that can work out these details and provide alternative solutions that could save you from a lot of trouble and some money will prove to be a resourceful billing partner.
  • Additionally, RCM companies ensure continual training & orientation of its staffs on the latest resource or updates in the healthcare industry. That will give the healthcare organization an edge in revenue handling.


How good are they at contract analysis?

  • Coverage plans will change from state to state. Some states would offer extended coverage and other states might only cover the program’s set “minimum requirements” laid down by the federal governments.
  • So RCM companies can demonstrate expertise on the contract’s pros and cons in depth. They significantly influence the healthcare organization’s revenue flow in a positive way.


Can the billing company add value to the business with fee scheduling knowledge?

  • Medicare fee schedules are usually updated once a year. They also bring many changes in the reimbursement values.
  • Hence, it’s mandatory to know completely about these Medicare updates.
  • For example, a healthcare professional from California sees 1000 patients in a month. Of those 1000, there are 500 patients who are billed under a single code, which is ‘CPT code: 99241’.
  • If Medicare pays $150 per claim for that code, the total reimbursement healthcare professional should receive will be 500 * $150 = $75,000.
  • In case Medicare revised the fee schedule for this code to $100 instead of its previous $150, during the next billing they would be left with a negative difference of a whopping $25,000 as reimbursement.
  • Healthcare professionals would need a medical billing company which is aware of those changes and is capable of passing on the warnings on time and effectively.


Do the certified coders take care of the coding needs?

  • It has been revealed that about 80% of rejected claims are the results of wrong coding.
  • Under-level coding and general coding can leave constraints on your revenue flow. So it’s important to ensure that the billing service providers can handle your coding processes with certified coders.
  • Coding to the highest level of specificity will help you get the most out of your services. So, the medical billing company should be proficient at that time.


Do they utilize specific specialty coders?

  • When any medical billing company is ready to boost the productivity to a certain degree, a professional with expertise in your ‘specific specialty’ can do even greater good for the healthcare organization.
  • RCM companies with specific specialty coders can potentially shift your revenue graph north almost instantaneously!


To choose the best outsourcing RCM companies, please refer to the qualities that fit your healthcare practice. It helps in maximizing the revenue with lesser efforts.


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