Anesthesiology, gastroenterology, and urology were the three most popular specialties among revenue cycle leaders that outsource outpatient RCM services.
According to a research by the Healthcare Financial Management Association, more than one in five revenue cycle executives run their own inpatient revenue cycle management (RCM) activities, but some auxiliary and outpatient RCM processes have been outsourced (HFMA).
An analysis of outpatient revenue cycle management outsourcing is included in the report, which is based on input from 157 HFMA members in the US. The study is the outcome of an association between HFMA and XIFIN, a provider of health information technology.
During the COVID-19 pandemic, as outpatient services grew and personnel shortages worsened, revenue cycle directors increasingly turned to automation and outsourcing to carry out their RCM duties.
Nearly 22 – 23% of those that handle their own inpatient RCM services reported outsourcing some of their outpatient RCM services, and 12 – 14% said they plan to do so in the future.
Nearly 10% of respondents said they would like to continue using their own inpatient RCM procedures while outsourcing all of their future outpatient or ancillary RCM services.
Anesthesiology, gastrointestinal, and urology were the most often outsourced outpatient services among healthcare executives. Internal medicine, radiology, and imaging were the industries where respondents were most inclined to explore outsourcing RCM services for remote patient monitoring and medical equipment.
According to the report, businesses who outsourced RCM services were usually happy with the results. Leaders who outsourced one task were also more likely to outsource additional services.
Denials and appeals management, prior authorization, and payer interactions were cited as the most difficult RCM-related issues that are not currently being handled by people, procedures, technology, or services.
According to Bill Voegeli, president of Association Insights and the HFMA’s head of customer research, “hospital teams are under pressure to efficiently manage the growing sources of outpatient revenue and expenses.”
Today’s healthcare financial and RCM teams frequently lack the time, knowledge, and/or personnel resources needed to properly comprehend the advantages or disadvantages of RCM automation outside of their electronic health record. Our study with XIFIN supports the idea that hospital finance professionals will gain from remaining informed about strategies for optimizing the expanding field of outpatient RCM and provides RCM executives with additional opportunities for optimization.
One-fourth of the respondents said that their outcomes for process optimization, operational effectiveness, and technological requirements and alignment fell short of their goals. According to the report, outsourcing certain functions could increase their success rate.
The patient experience, process improvement, and income generation were the three main areas of attention for leaders when tackling outpatient RCM from a business perspective. Business drivers including operational effectiveness and financial stability were frequently mentioned.
While 52% of revenue cycle leaders stated that they utilise their EHR for RCM services and account receivable (AR) collection, 23% claimed they use a purpose-built RCM system in place of it for their outpatient or auxiliary billing.
The study found that companies may benefit from concentrating on high-value inpatient care by outsourcing outpatient RCM services to outside parties. According to the study, outpatient claims are one of the more challenging components of RCM and usually contain errors, missing data, and ineffective processes for submitting a clean claim.
Outsourcing RCM services has enabled some practices to increase efficiency while filling in staffing gaps.
According to experts, outsourcing RCM may also enable providers to cut expenses and focus more on patient care.
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