Andrew Bess, Chief Client Officer, Author at Ensemble Health Partners https://www.ensemblehp.com/blog/author/andrew-bess/ Your modern revenue cycle solution Fri, 17 Oct 2025 13:47:07 +0000 en-US hourly 1 https://www.ensemblehp.com/wp-content/uploads/2023/10/Logo-Chevron-80x80.png Andrew Bess, Chief Client Officer, Author at Ensemble Health Partners https://www.ensemblehp.com/blog/author/andrew-bess/ 32 32 Why Patient Care Collections Are a Lifeline for Academic Providers https://www.ensemblehp.com/blog/why-patient-care-collections-are-a-lifeline-for-academic-providers/ Tue, 22 Apr 2025 13:35:28 +0000 https://www.ensemblehp.com/?p=18132 Academic medical centers are challenged with balancing their mission while grappling with escalating costs and shrinking revenue streams. … Read More

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The stakes to optimize core clinical revenue and cash have never been higher for academic providers. Although providers as a whole experienced an uptick in performance in 2024, celebration across the industry has been subdued throughout Q1 of 2025, as several headwinds continue to brew that are expected to hinder bottom-line performance.

While inflation has stabilized over the first three months under the new administration and providers have experienced 5%-6% top-line growth, reimbursement headaches continue.

These include:

  • Continued payer mix deterioration
  • Increased payer friction
  • Reimbursement rates for commercial, Medicare and Medicaid that lag expected expense growth
  • Increased competition within the hospital sector and across the care continuum

Exacerbating the top-line challenges are continued increases in expenses (7%-10%+), as well as ongoing workforce challenges attributed to increased patient acuity and complexity.

Academic medical centers face unique challenges

Academic medical centers (AMCs) are the backbone of medical innovation and training in the United States, with a three-part mission:

  • Delivering cutting-edge care
  • Educating the next generation of healthcare professionals
  • Conducting groundbreaking research

Compared to their community provider counterparts, AMCs face an even greater and unprecedented challenge: balancing their tripartite mission while grappling with escalating costs and shrinking revenue streams for both operating and non-operating revenue, whereby non-operating revenue can account for up to 35% of total revenues.

Operating & Non-Operating Revenue Estimated Allocation, Academic Provider vs. Community Provider (as % of Total Revenue)

2025 is a critical juncture and inflection point for AMCs as they face continued financial suppression. This makes patient care collections not just a revenue source, but a lifeline for sustaining their unique role in the healthcare ecosystem.

The tripartite mission is under threat

According to a 2023 report from the Association of American Medical Colleges (AAMC), AMCs account for just 5% of U.S. hospitals but provide 37% of all charity care, 26% of Medicaid hospitalizations and a disproportionate share of complex cases.

AMCs’ three-part mission of patient care, education and research is expensive, and the commitment comes at a cost. It’s one that is increasingly difficult to bear as traditional revenue streams like government funding, grants and reimbursements face compression. This is demonstrated by operating margin erosion from 2017 to 2023, and anticipated declines into the foreseeable future.

Operating Margin % for Leading AMCs, 2017 Through 2027 Projected & Key Trends Fueling Financial Performance Compression

Historically, AMCs have leaned on a mix of clinical revenue, research grants and philanthropy to fund their operations, but these sources are under siege due to changing legislation, shrinking traditional patient care and non-traditional reimbursement sources, rising costs, continuing payer friction and other industry trends. These pressures include:

  • Payer mix and continuum of care shifts: Despite modest revenue growth, AMCs will feel the squeeze of caring for heavy MCR/MCD/uninsured patients, increases in uncompensated care, and a continued shift to lower cost of care settings.
  • Reimbursement flattening and contraction: All providers continue to face possible cuts to MCR physician fee schedule, and MCR IPPS and Medicaid rate hikes that lag expense growth.
  • Increased payer friction: Increased initial and final denials (21% CAGR from 22-24 and growing), plus increased cost to collect while seeing declines in cash collections / NPR.
  • Accelerating expense growth: The cost to treat, educate, research and innovate is much higher given the patient profile and mission components that go beyond a traditional hospital, and is without immunity from tariff legislation.
  • Continued workforce challenges: Due to the higher complexity and acuity of AMC patients, the labor needs are typically more specialized and heightened given the need to care for sicker patients, and training and educating providers.
  • Potential crackdown on supplemental revenue: AMCs are often reliant on patient care dollars and other streams to fund their entire mission; they are also grappling with potential 50% cuts to NIH funding and potential slashes to IME, GME, DSH and other programs.
  • Increasing complexities: As the population ages, workforce challenges intensify and potential funding streams dry up, the ability to deliver quality patient care while training the next generation of providers will get more difficult.

While certain movements in DC and evolving payer mix dynamics are less controllable, placing an emphasis on collecting patient care dollars is more controllable, and has never been more important in the outlook and long-term sustainability for academic providers.

Partnership serves as a path forward

Uncollected patient balances can account for 6%-8% of total revenue leakage. For a mid-sized AMC, this could mean losing $60-$80 million annually , revenue that could otherwise fund research staff, facility upgrades or scholarships. With high-deductible health plans on the rise, patients are responsible for more costs, but AMCs often lack efficient billing systems, leading to delays and uncollected balances.

AMCs need to prioritize patient care collections by investing in advanced billing technologies and training staff to educate patients about their financial responsibilities. This can significantly increase revenue, help bend the cost curve and allow providers to not only execute on their clinical mission but also support and fund efforts for continued education, research and innovation.

The cost and ability to bend these cost and revenue pressures are difficult, however. While some providers are equipped to navigate difficulties themselves, most of the industry needs a partner to help right the ship in capturing the patient care dollars to enable and cultivate investment back into patients, providers and community as a whole.

Ensemble has a proven track record of being the partner to drive unmatched results for providers with exceptional service, underpinned by cutting-edge technology and innovation. We focus on:

  • Immediate cost reduction and future risk mitigation through geographic arbitrage and scalability
  • Seamless and thoughtful transition of a non-core business function to a partner that is best positioned to combat industry disruption
  • Ability to reallocate financial resources to clinical care and strategic initiatives which benefit your patient population.

Clients see a 5.2% net revenue lift on average and meet 100% of year-one goals. Learn more about the Ensemble end-to-end approach >>>

The bottom line

Academic providers are facing unique pressures given threats not only to traditional revenue streams, but also to the supplemental sources of income that enable successful execution of their tripartite mission.

Most academic providers, however, are incapable of bending these pressures themselves. The right end-to-end revenue cycle management partner can help support by leading with an innovative, AI-forward approach and exceptional service, leading to unmatched results that can help AMCs stay solvent under intense headwinds.

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]]> Our Approach to Patient Experience https://www.ensemblehp.com/blog/our-approach-to-patient-experience/ Wed, 16 Apr 2025 11:45:48 +0000 https://www.ensemblehp.com/?p=18064 Effective revenue cycle management and effective patient conversations can enhance the patient experience rather than detracting from it. … Read More

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Healthcare is deeply personal for patients. It’s the most important financial transactions we have as American consumers. If fine dining, high-end hotels and VIP concerts can exchange goods and services for money without discomfort, surely, healthcare can too.

But healthcare must learn a thing or two from the industries that have mastered customer service. That’s why ensuring a quality patient experience is so critical, even and especially in the healthcare revenue cycle. Providers don’t have to avoid talking about money. In fact, effective revenue cycle management and effective patient conversations can enhance the patient experience rather than detracting from it, as many organizations fear.

Imagine going to a restaurant. The patient experience is akin to the entire dining experience, from making a reservation to enjoying the meal and paying the bill. The healthcare revenue cycle is like the restaurant’s operations, ensuring that the reservation is confirmed, the meal is prepared and served correctly and the payment process is smooth and transparent.

Now, imagine if your dining bill arrived at the table with completely different pricing than you’d seen on the menu, or that the restaurant’s own coupon was declined at the register with no explanation. Imagine your meal could only be paid for by check, or required you to stamp and post a physical stub with your payment for the night’s dining.

Just as a positive dining experience encourages repeat visits, a positive patient experience in healthcare encourages patient loyalty and timely payments — and a negative experience can build distrust and resentment, even among formerly satisfied patients.

Nothing will kill patient experience faster than getting a bill two weeks after you’ve been seen and not knowing it’s coming.

Susan Milligan, Director of Patient Experience, Ensemble

So, how can revenue cycle operators work to ensure a positive patient experience during every interaction? Different organizations approach this in different ways. Here’s Ensemble’s approach.

The Ensemble Difference

Ensemble educates every single associate on patient experience and why it matters, offering webinars and multimodal trainings on how to have positive interactions and the difference these conversations can make. Even Ensemble employees who are not patient-facing understand the necessity of ensuring a positive patient experience. Patient experience is core to our annual training, regardless of where an associate sits in the revenue cycle.

At Ensemble, we believe that great patient experience is a function of improving three components: empathy, empowerment and engagement. Addressing these ensures that patient-facing associates can communicate effectively, have the tools and processes they need to handle patients deftly and feel valued in their own roles. Increased employee engagement is tied to an improved patient experience.

Empathy

Whether inherent or learned, empathy helps associates sense and anticipate a patient’s spoken or unspoken needs. It’s about connecting at a human level and having conversations that matter. Our teams focus on empathy through effective, caring and compassionate communication at every stage of the patient experience.

Making empathetic conversations part of the daily routine, supporting financial advocacy for patients and clearly outlining benefits prevents unwelcome surprises during times with so many unknowns and will create a positive experience for patients.

Empowerment

Empowering your patient-facing teams makes a difference by improving processes, work environments and experiences. Make sure teams are all aligned on purpose as an organization; every associate should know what patient experience means and that it’s central to your organization’s mission and values. This also means documenting your approach and gaining approval from all necessary participants, so this process can be replicated again and again.

Engagement

If associates feel engaged, they are more likely to deliver a positive experience to others, including patients. Employee engagement can be fostered using open communication, encouraging stretch goals, plus personal and professional development. Management of expectations is key.

This might look like conducting engagement surveys, establishing an Employee Advisory Group (EAG), or consistently recognizing employees for their contributions. Learn more about how to engage employees and ultimately improve patient experience >>>

Empathy + empowerment + engagement = improved experience

Here at Ensemble, we infuse this approach — of leading with empathy, empowerment and engagement — into everything we do.

Every associate is trained annually on the importance and value of patient experience, and we analyze the impact of patient satisfaction on every new solution we deploy. Our engineers take the entire process into consideration, asking themselves at each stage about the hypothetical impacts of technological innovation: If we move this specific lever, for example, what’s that going to do for patients or how will it otherwise impact patients?

It’s a constant consideration — the way we define success for revenue cycle performance always includes patient satisfaction performance, since the two are so closely tied. And, in order to apply our solutions, we need to first analyze and understand how patients are engaging today and then create the appropriate interventions.

Here are specific strategies we have deployed with clients to improve both their revenue and the patient experience:

Improving the registration experience for patients

There’s a difference between implementation and adoption, and at Ensemble we’re not just in the business of implementing tools — we’re thinking about the patient experience at every step.

This is where empathy comes into play, as our associates are taught to always question: “If I was the patient, what would I want to see happen?” Because they are empowered in this way, associates often help innovate new, creative solutions that can be deployed to improve the patient experience.

First and foremost, we identify a friction point for our clients. At Adena Health, patients were waiting unnecessarily during registration, a dissatisfying experience. We proactively took the opportunity to look at how we could streamline processes and reduce that issue. To do so, we:

  • Increased adoption of virtual registration (via MyChart). It’s not just about Epic, it’s about maximizing your EHR to work for you. For Adena, that required understanding the barriers in place. Then, in order to increase adoption, we first had to get patients to understand the benefits of virtual registration themselves. We did that by helping clients have the right educational information available at kiosk so patients could understand what the new process was and what was expected of them.
  • Put a system for instant MyChart activation into place. Associates sat side by side with patients to help them set up their accounts. Through a combination of these efforts, Adena increased conversion rates by 35%, and exceeded its goal of 50% patient adoption within 12 months — an accomplishment even Epic commended.
  • Implemented creative ideas driven by associates. The idea for the instant activation of MyChart was proposed by the patient access staff on the ground at Adena, based on their observation that many registering patients struggled with the technology. Staff also noticed that there was often a huge line waiting to register. Out of this came innovative ideas to allow for digital tools, self-check-in and even physical rerouting of patients in the on-site location. Each of these changes helped improve overall patient satisfaction, and the system saw an 80% decrease in average wait time for outpatient registration.

Improving the financial experience for patients

We see so many organizations that are hesitant to even bring up financial issues, but point of service conversations don’t have to diminish the patient experience — they can actually enhance it. Patient-friendly account resolution helps patients feel prepared to resolve their liability. Through open and transparent communication and education, we reduce continuous worries, like a patient concerned about receiving a bill in the mail after a healthcare encounter.

I think that a well-performing revenue cycle can have a significant impact on the patient experience. It’s the first interaction that a patient or a family member may have in its introduction into the hospital. Once that interaction is complete from a provision of care prospective, you’re one of the last people that our patients or families may have interaction within terms of questions on bill calls to customer service, so the functions that [Ensemble provides] are very, very important.

CFO, Nicklaus Children’s Hospital

At Ensemble, we make sure the right tools are in place so that associates can provide relevant and accurate information to patients and drive successful collections. We provide cohesive training and education to empower these professionals to be subject matter experts on patient experience. This also means providing access to tools like a real-time eligibility tool integrated in a HIS; a patient liability estimator to provide real-time estimates on out-of-pocket liability; and thorough reporting so systems can track how far they’ve come, where their opportunities are, and where to focus future efforts.

Ensuring consistency is key. We provide process documentation and scripting for all locations and areas (ED/OP/IP) to ensure that consistent conversations are taking place regardless of whether it is a scheduled outpatient, walk-in lab or scheduled physical therapy.

We also use data to understand and identify patient issues and resolve them quickly. Whether this is done through education of staff, the creation of job aids or other ways of empathetic communicating with patients on the ground, the results prove this approach out: After implementing a POS collection program, Bon Secours Mercy Health saw a 20% increase in pre-service collections with a consistent quarterly increase in patient satisfaction scores.

When we implement patient-friendly financial processes, associates are empowered to resolve patient concerns quickly and confidently.

The bottom line

We partner with some of the best clinicians in the world who provide the best care experiences — but the logistical and financial bookends to those clinical care experiences should be just as excellent. A focus on patient experience can’t be a set-and-forget process; patients should feel that they are being heard and valued before, during and after their care experiences. We want each touchpoint to be consistent and positive.

To do this, we analyze, intervene and educate appropriately. We measure to understand how patients feel, and then we consistently outline and define solutions to address their pain points.

You can’t do revenue cycle management well without doing patient experience well, but when patient experience is done right, you get results that stretch across both the revenue cycle and patient satisfaction. We know this, and that’s why patient experience is part of Ensemble’s DNA.

By weaving empathy, empowerment and engagement into everything we do, Ensemble’s approach improves patient experience in measurable ways. One strategic end-to-end partnership with a non-profit integrated medical services provider led to greater than a 10% improvement in month-over-month patient experience survey scores. Similarly, with focused training, education and engagement, another hospital system saw a 4% increase in Top Box Scores, which measure the percentage of respondents who gave the highest response possible on the survey scale.

A focus on the patient experience is not just a nice addition to revenue cycle management; it’s fundamental to ensuring patients have a better registration experience, a better financial experience and higher satisfaction with their care all around.

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]]> How Strategic Partnerships Create a Competitive Advantage for Regional Health Systems https://www.ensemblehp.com/blog/how-strategic-partnerships-create-a-competitive-advantage-for-regional-health-systems/ Wed, 12 Feb 2025 19:24:39 +0000 https://www.ensemblehp.com/?p=16162 To remain competitive, regional health systems should seek outside expertise in areas where they lack resources and capabilities. … Read More

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Despite industry-wide headwinds, large health systems are performing better — in both financial and quality metrics. Regional hospitals often struggle to compete, providing services on a smaller scale in a specific area, and with fewer resources at their disposal.

It’s not just that these smaller systems struggle to keep pace — they simply can’t get ahead. Regional systems often operate with thin margins, making it difficult to invest in necessary innovations. By contrast, larger health systems benefit from economies of scale and higher profitability. For example, Tenet Healthcare reported an operating margin of 12.2% in 2023, while many regional hospitals struggle to break even.

Strategic partnerships can help bridge this gap by providing access to resources and expertise that regional hospitals cannot afford independently. Hospitals with strategic partnerships often see improved financial performance and stability. To create value and remain competitive, regional health systems should seek outside expertise in areas where they lack resources and capabilities.

Regional hospitals face systemic challenges

Due to their limited scale and resourcing, regional hospitals often struggle with:

  • Limited ability to recruit top talent: Attracting and retaining skilled professionals, especially in specialized areas like revenue cycle management, is challenging for regional hospitals. According to a report by the Commonwealth Fund, regional hospitals often lack the resources to compete with larger systems in attracting top talent. Moreover, multi-stakeholder collaboration and effective partnerships among healthcare providers and third parties were crucial in achieving health system goals.
  • Constraints on innovation and technology investments: Thin margins and limited capital make it difficult for regional hospitals to invest in cutting-edge technology and innovation. McKinsey’s report on the future of US healthcare highlights that many regional hospitals are unable to allocate sufficient funds to technology initiatives due to financial constraints.
  • Lack of integrated health networks: Unlike larger health systems, regional hospitals do not benefit from economies of scale, deeper reach, and better purchasing power. McKinsey’s analysis on regional health system strategies emphasizes the competitive disadvantage faced by smaller hospitals due to their limited scale.

An end-to-end RCM partnership can help regional systems get ahead

Partnering with specialized revenue cycle management experts can help regional health systems not only shore up their revenue cycle but also gain a competitive edge.

An end-to-end partnership allows hospitals to leverage external expertise and resources, letting providers focus on core operations and clinical outcomes.

  • Access to top talent: Alignment with an RCM partner brings access to a large, skilled workforce. Ensemble employs an extensive workforce of industry-certified associates, enabling regional health systems to tap into talent and expertise that they would not normally be able to acquire on their own.
  • Cutting-edge technology: Investing in advanced technologies is crucial for maintaining a competitive edge in healthcare. Ensemble invests millions into technology and innovation to benefit our entire client base, providing access to generative AI, automation and EHR standardization that can help regional hospitals stay competitive.
  • Economies of scale: Similar to the advantages of participating in a group purchasing organization, partnering with an end-to-end RCM provider unlocks economies of scale. Ensemble leverages its size representing nearly $40 billion in annual net patient revenue to help change payer behavior and negotiate favorable contract rates and terms for its clients. Insights gained from transactional data across hundreds of hospitals also enables process optimization and technology development to solve issues at scale across organizations.

Partnership in practice

An RCM partner brings unique resources and expertise to the table, allowing for a more efficient and effective use of a hospital’s own capabilities. The right strategic partnership can drive results that improve performance system-wide, by:

  • Improving patient experience: Our clients have seen a 27% reduction in patient registration wait times through streamlined patient communications, the delivery of comprehensive training and accelerated pre-service processes. Read more.
  • Preventing lost revenue: Health systems partnering with Ensemble have prevented $80 million in revenue loss by addressing pre-billing errors and inaccuracies through our revenue cycle intelligence engine, EIQ®. Read more.
  • Improving payer performance: A large health system resolved unpaid claims and achieved a 20% rate increase with a major payer through an effective out-of-network strategy and a robust approach to addressing contact language, payer performance and dispute resolution of outstanding AR. Read more.
  • Reinvesting in patient care: By reducing first pass denial rates by 84% in just six months for a department within a large non-profit health system, Ensemble enabled the department to double patient treatment capacity. Read more.

These improvements — including reduced patient wait times, recovered revenue and enhanced payer performance — ultimately lead to a more efficient and profitable healthcare facility, regardless of size or location.

The bottom line

By partnering on the revenue cycle, regional health systems can achieve economies of scale, access top talent and implement cutting-edge technology. These partnerships enable regional hospitals to create strong market advantages and improve patient outcomes.

Because of this, regional health systems should consider strategic partnerships as a key component of their long-term efforts to remain competitive while facing challenging headwinds.

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]]> Opt for Outcomes with End-to-End RCM Vendor Selection https://www.ensemblehp.com/blog/end-to-end-rcm-outcomes/ Wed, 24 Jan 2024 17:06:29 +0000 https://www.ensemblehp.com/?p=12467 When it comes to selecting the right revenue cycle management (RCM) partner, there are crucial factors beyond cost considerations. … Read More

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What you need to know

When it comes to selecting the right revenue cycle management (RCM) partner, there are crucial factors beyond cost considerations. For 43% of executives, the ability to generate revenue lift is their number one most important criterion in selecting an RCM partner; just 24% of executives would prioritize vendor cost above all else. A majority of executives also think it’s important to partner with a single RCM firm rather than with multiple, reducing duplicative work and allowing for integrated, streamlined efforts. Think of the revenue cycle as a value driver and plan your strategy with growth in mind.

As many healthcare executives opt for a single, comprehensive RCM partnership, the high value of performance and outcomes is becoming clear. The real question isn’t merely about selecting an RCM partner — it’s about choosing the right partner capable of driving tangible and meaningful results.

End-to end RCM by the numbers

In a recent survey of more than 100 executives representing organizations ranging from multi-hospital systems to specialty physician groups, 95% expressed a keen interest in pursuing end-to-end RCM managed services to tackle critical business issues.

One robust, comprehensive RCM partnership allows organizations to address challenges and streamline processes in a way that can be difficult and duplicative when revenue cycle responsibilities are spread out across multiple vendors.

Survey results bear this out; not only did 61% of executives state that managed services provide superior results compared to in-house operations, but 60% of executives also think it’s important to partner with a single firm for RCM services.

The majority of executives, then, are seeking integrated solutions that drive comprehensive value across the revenue cycle. But what does that value look like?

A shifting focus: performance over cost

Leaders are honing in on the factors that drive tangible results. When ranking the most important factors in selecting an RCM partner, healthcare executives named their number one most important criterion:

Concerns about revenue lift were far and away the most important factor for choosing an RCM partner. Customer service was ranked as the second most important factor, critical to 29% of respondents, recognizing the importance of a seamless and patient-centric approach within revenue cycle management.

It’s a clear indication that healthcare leaders are placing a premium on partnerships that directly impact the bottom line and an organization’s own customers. This growing reliance on external partnerships signifies a departure from the traditional emphasis on minimizing costs. Now, the focus is on maximizing value.

Reframing the revenue cycle as a value driver

Providers are beginning to shift their perspective from the revenue cycle as a cost center to a value driver. This means changing the viewpoint that a successful RCM strategy is one that simply minimizes costs. More and more, healthcare executives are investing and staffing in order to grow their revenue cycle strategically in a way that improves payment accuracy and reduces revenue leakage.

This might mean investing in patient advocacy efforts, new technology, internally developed capabilities or even commercial opportunities that support the revenue cycle. Nor does investment stop at tools or partnerships. HFMA notes that, for some organizations, having a growth mindset for the revenue cycle may mean funding the professional growth and development of existing staff members. For others, a refocused revenue cycle may call for expanding the talent pool to include those with a laser focus on customer engagement or high critical thinking skills.

Ensuring front-line RCM employees are customer-focused enhances the patient experience — which should be a primary goal for every healthcare organization.

The bottom line

Today’s healthcare executives are selecting vendors based on factors like revenue lift and customer service, emphasizing growth and performance as the true barometers of success.

Now, it’s about what an organization can get out of an RCM relationship, rather than simply what it must put in — and in a competitive healthcare environment where every reclaimed dollar counts, the comprehensive value of a single end-to-end RCM partnership cannot be understated.

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]]> Revenue Cycle Managed Services Fill In-House Gaps https://www.ensemblehp.com/blog/revenue-cycle-managed-services-fill-in-house-gaps/ Wed, 10 Jan 2024 13:56:13 +0000 https://www.ensemblehp.com/?p=12443 By partnering externally for RCM support, organizations gain efficiency, increase agility and are better able to use limited resources. … Read More

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What you need to know

There’s a growing trend of healthcare organizations investing in revenue cycle managed services, supported by trusted vendors. For many, in-house resourcing is no longer feasible given labor shortages, margin pressure and gaps in internal capabilities; for others, the increasing complexity of payor negotiations and decreasing payor reimbursements is fueling this shift. By partnering externally for revenue cycle management support, healthcare organizations gain efficiency, increase agility and are better able to use limited resources — all critical improvements in a difficult industry and environment.

Financial solvency is a cornerstone of sustainable healthcare operations. Much of an organization’s success or failure comes down to how the healthcare revenue cycle is managed, including activities such as identifying and recovering underpayments, negotiating with payors and ensuring proper denials management to resolve existing issues and prevent future claim denials.

As healthcare CFOs and their organizations navigate these complexities, a clear trend has emerged: the significant rise in investment directed towards revenue cycle managed services.

The shift to RCM managed services is already in motion

No longer content with or capable of keeping revenue management processes in house, many healthcare organizations are choosing instead to partner with a third-party vendor, entrusting them with this critical process.

According to a recent survey of more than 100 executives representing organizations ranging from multi-hospital systems to specialty physician groups, 97% of healthcare organizations are already spending a portion of their RCM budget on managed services. Substantial future reallocation is also on the table, with 25% of organizations planning to spend more than half of their RCM budget on managed services in the next five years.

What’s truly telling is the inclination towards and view of managed services as a viable and effective means of addressing operational challenges. An almost unanimous 95% of healthcare leaders say they would pursue end-to-end-managed services to solve key business issues — that is, one comprehensive RCM partnership, versus managing multiple vendors.

The Rise of Revenue Cycle Managed Services, stats about healthcare executives' thoughts on the value of RCM managed services.

Revenue cycle managed services address in-house challenges

One primary benefit of working with a third-party partner is tackling the many challenges that weigh heavily on in-house healthcare operations, including:

  • Labor shortage: 56% of healthcare leaders cited labor shortage as a primary driving force. Managing revenue cycles in-house amid staffing deficiencies becomes an uphill battle, leading organizations to seek external expertise.

  • Margin pressure: The ongoing struggle to maintain margins in an increasingly complex healthcare environment also ranked high, with 49% recognizing margin pressure as a pivotal factor when choosing to work with a vendor.

  • Gaps in internal capabilities: Another significant concern, flagged by 40% of respondents, revolved around missing skillsets and other gaps in internal capabilities. As the healthcare landscape becomes increasingly complex, managing every facet internally has become unwieldy for many organizations.

Other challenges cited by healthcare executives include the complexity of payor negotiations and decreasing payor reimbursements, difficulty in collecting AR, limited EHR/EMR/HIS functionality and increasing organizational complexity overall.

Looking forward with RCM managed services

The trajectory is clear: healthcare financial leaders are reimagining operational strategies by prioritizing external partnerships for revenue cycle management. This shift isn’t merely a trend but a strategic move towards efficiency, agility and optimal resource utilization.

Forging the right partnerships is pivotal. The right partnership can bring specialized expertise and other advantages that a healthcare organization simply may not have the time or resources to train in house, as providers and staff focus on patient care and other clinical concerns.

Managed services aren’t just a nice-to-have option; in today’s environment, the right partnership can be a critical component for sustainable financial health. As the healthcare landscape continues to evolve, embracing managed services emerges not only as a practical choice but as a strategic imperative for financial stability and growth.

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]]> 6 Tips to Ensure Your RCM Partnership Will Go the Distance https://www.ensemblehp.com/blog/find-your-true-match-6-tips-to-ensure-your-rcm-partnership-will-go-the-distance/ Wed, 28 Jun 2023 17:00:00 +0000 https://www.ensemblehp.com/?p=7495 In healthcare, RCM is crucial. Learn how to choose the right RCM partner to streamline processes and achieve sustainable financial growth. … Read More

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Expert revenue cycle management (RCM) has become crucial for healthcare organizations to maintain financial stability and optimize revenue streams. Many of these organizations are turning to RCM partnerships to streamline their revenue cycle processes and achieve sustainable financial growth. However, choosing the right RCM partner and establishing a successful long-term partnership can be challenging.

Odds are you’re one of the 93% of hospital leaders considering strategic RCM partnership to combat margin pressure. Healthcare RCM is a high-impact area that’s prime for support and capable of delivering much-needed financial relief to cash-strapped hospitals.

But entering a committed relationship can be daunting. It requires vulnerability, trust, communication, compatibility and respect (just ask any marriage counselor). You have to find someone who really gets you. Because just like any significant relationship, it takes a lot more than chemistry to make a partnership successful.

Choose the right partner, and you may go the distance together. This will be the company providing complete oversight of all processes throughout your revenue cycle from patient engagement to account resolution. The right RCM partnership can reduce operating costs, streamline vendor management, substantially increase revenue and ultimately allow you to devote maximum focus to patient care and engagement.

Choose the wrong partner, and you may be stuck with them. If done incorrectly, there can be a significant negative impact to your staff, community and your bottom line. But these contracts are typically long, and the integration is extensive. So, like many relationships gone wrong, people often choose to stay in them instead of spending the time and resources required to unwind from the failed partnership. Who wants to go through terminating a contract, finding a new partner and implementing another solution?

Bottom line: It pays to be thoughtful about who you partner with.

6 RCM Tips to Consider When Looking for a Compatible Match

1. Make Sure They’re Who They Say They Are (Don’t Get Catfished)

Talk to the company’s current clients to determine if their results matched the sales pitch. It’s critical to check references and hear directly from your peers who’ve gone through the process. Evaluate their experience and expertise in the healthcare industry. An RCM partner should have a deep understanding of industry trends. Choosing a partner with a proven track record with organizations similar to yours will ensure you feel more confident they will be better equipped to meet your needs and drive positive outcomes. Don’t just take the vendor’s word regarding what they will potentially do for you.

2. Ensure They Share Your Values + You’re Both on the Same Page

Professional partnerships that are built to last have mutually inclusive priorities and shared values. Make sure your mission and cultures are aligned. Maybe you won’t be introducing them to mom and dad, but is this a partnership you’d be proud to announce to your community? Would your employees assimilate well into their organization? Does the vendor have the infrastructure and processes in place to smoothly transition, train and grow your employees?

It’s important to be very clear about what’s expected from each side, what the relationship deal breakers are and what vision everyone is working towards. Discuss your challenges, objectives and goals for the partnership up front. A strong partner will be invested in your vision for the long term and will work collaboratively to ensure your goals and incentives are aligned with theirs.

Ask about their approach to technology. Will they be able to work with your existing systems and tools or require certain technology to be decommissioned? What IT support will your resources require and what training will be provided to your end users?

3. Evaluate Their Technology + Infrastructure

Efficient RCM is reliant on sustaining robust technology and infrastructure. A potential partner should offer robust technological capabilities, including the RCM software, data security measures and integration capabilities. They should have the necessary infrastructure to handle your organization’s volume and complexity, but should also be adaptable and able to upgrade their technology to keep pace as industry requirements shift.

4. Make Sure It’s Not One-sided

Ask your potential partner how they will work to ensure that decision-making about policies and procedures is inclusive of leadership and aligned with your organization’s goals. Will a joint steering committee be established with equal representation by your organization and the vendor? If so, how early in the process? What other cross-functional communication channels will be established?

5. Set Clear Expectations From the Start

Ask them how they get started and how they ensure project success. These types of engagements are incredibly complex and require diligent project management and execution. Ensure the vendor has a process in place to get intimately acquainted with your processes, staff, workflows, systems and areas of opportunity. Make sure you feel comfortable with their ability to create and manage complex project plans and report out on key metrics before and after project go-live to ensure there is no productivity loss or dip in performance during the transition.

6. Look for the “Whole Package”

Ask what they bring to the table outside of day-to-day operational management. The best partnerships are the ones that bring ongoing value to the relationship beyond fulfilling day-to-day obligations.

Will your partner identify issues and help you resolve them, even if it’s not exactly what they signed up for? Will you be able to rely on them for insights and action plans related to payer policy changes to help you stay compliant and avoid preventable audits, claim rejections and denials?

Finding a partner who “completes you” can be difficult, but so worth it. The right RCM partner should provide support when you need it most and should grow beside you, helping you reach your full potential and deliver on your mission, through sickness and health, through good times and bad.

Moving Forward with an RCM Partnership

When you’re ready to optimize your healthcare organization’s revenue cycle and achieve financial stability, it’s important to establish a successful, long-term RCM partnership. Considering each of these factors will help you rest assured your RCM partnership will be well-aligned and drive financial success in addition to enabling your organization to focus on delivering high-quality patient care.

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]]> RCM Outsourcing Guide: Choosing the Right Partner Is Vital to Your Bottom Line https://www.ensemblehp.com/blog/revenue-cycle-outsourcing-guide/ Wed, 14 Jun 2023 16:36:29 +0000 https://www.ensemblehp.com/?p=10845 The right RCM outsourcing partner can impact your bottom line, optimize revenue streams and streamline operations for your organization. … Read More

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When it comes to revenue cycle management (RCM) outsourcing, the process of selecting the right partner for your organization’s financial success is crucial. In the ever-evolving healthcare landscape, managing revenue cycles efficiently has become more challenging than ever. Thanks to increasing complexities, stringent regulations and mounting administrative burdens, many healthcare providers are turning to outsourcing as a strategic solution. However, the key to reaping the benefits of RCM outsourcing lies in selecting the right partner. In this revenue cycle outsourcing guide, we’ll delve into the significance of choosing the right RCM outsourcing partner and how it can significantly impact your bottom line, ensuring optimized revenue streams and streamlined operations for your healthcare organization.

What is Revenue Cycle Management Outsourcing?

RCM outsourcing is the practice of entrusting the management of revenue cycles to external service providers. It involves delegating critical financial tasks and responsibilities to specialized professionals who possess expertise in handling billing, coding, claims processing and other revenue-related functions. RCM outsourcing holds particular significance in the healthcare industry as dedicated firms or vendors can help handle tasks such as patient registration, insurance verification, coding, billing, collections and payment posting. By leveraging the knowledge and resources of an outsourced partner, healthcare organizations can streamline their revenue cycles, enhance financial performance, reduce operational costs and ensure compliance with complex billing and regulatory requirements.

RCM outsourcing enables healthcare providers to focus on delivering quality care while entrusting the intricate financial aspects to experienced professionals, ultimately leading to improved efficiency, increased revenue and enhanced patient satisfaction.

What Are the Benefits of Outsourcing Your RCM?

Outsourcing RCM offers numerous advantages that significantly benefit healthcare organizations.

Ensuring the accurate transmission of data across disparate systems and different departments, without losing anything in translation, is crucial for precise reimbursement and a positive patient experience. RCM leaders must adapt to constant changes and nuanced requirements for how data should be shared, through which systems, and at what time to comply with thousands of intricate rules that vary between payors and service types. 

Bringing in individual vendors and systems to manage different aspects of the RCM process demands meticulous orchestration and oversight to prevent gaps between steps or vendors. This task becomes particularly challenging due to the multitude of ways information and performance are captured and shared. Each vendor introduces their own reporting variation, calculating metrics differently or utilizing specific subsets of data. This leads to discrepancies between vendor reports and the provider’s host system, making it exceedingly difficult to obtain a comprehensive overview of RCM performance and verify it through transparent access to the data and calculations.

“Revenue cycle has its own black box,” explains Marty Bonick, president and CEO of Ardent Health Services, a 30-hospital system in the southeast. “There wasn’t visibility at an executive level to see underlying subcategories within the revenue cycle where we were leaving dollars on the table or what was really happening with denials or underpayments or recoveries. I would ask our vendors to provide an overview of our performance I would get spreadsheets with a bunch of data but no insights.”

RCM outsourcing is a holistic solution that offers a comprehensive approach to revenue management, eliminating the challenges associated with coordinating multiple vendors and ensuring a unified, streamlined process.

Through RCM outsourcing, you can unlock benefits including improving your revenue cycle performance, reducing the burden on administration, cost-effectiveness, enhancing the patient experience and achieving better financial forecasting and management.

Improved Revenue Cycle Performance

By partnering with experienced outsourcing providers, healthcare providers can tap into a wealth of industry knowledge, specialized expertise and advanced technological resources. These partners can implement accurate coding practices, effective claims management strategies and efficient billing processes to optimize revenue streams. By conducting thorough audits, they can identify areas for improvement and implement revenue-enhancing initiatives. Outsourcing partners will also stay up to date with evolving regulations, compliance requirements and industry trends to ensure adherence to billing guidelines, mitigate the risk of penalties and reduce rejections and denials.

With streamlined revenue cycles, healthcare organizations can maximize revenue collection, minimize revenue leakage and ultimately improve financial performance. Outsourcing revenue cycle management empowers healthcare providers to focus on core competencies so experts can handle the intricate aspects of revenue management, resulting in improved revenue cycle performance.

Reduced Administrative Burden + Costs

Trying to manage revenue cycle management in-house can be resource-intensive and result in a financial burden. With RCM outsourcing, you eliminate the need for extensive infrastructure, technology investments and dedicated staff, resulting in significant cost savings. Outsourcing partners operate at scale, spreading costs across multiple clients, enabling them to offer services at a lower cost than if you were to maintain an in-house revenue cycle management team.

Outsourcing can alleviate the stress and administrative burden of keeping up with ever-changing regulations, compliance requirements and industry trends. Through a managed services partnership, you can benefit from the expertise of specialized professionals who are well-equipped to adapt to the dynamic nature of these rules. This ensures your RCM processes remain accurate, efficient and compliant, allowing your internal teams to focus on other critical tasks.

Enhanced Patient Experience

Entrusting revenue cycle management tasks to a dedicated outsourcing partner ensures healthcare providers can allocate more time and resources to patient care. Streamlined revenue cycles allow providers and healthcare professionals to focus on delivering quality treatments, enhancing patient satisfaction and improving overall healthcare outcomes.

An inefficient or poorly run revenue cycle can negatively impact patient satisfaction in several ways. Delays and errors in billing and insurance processing can result in confusion and frustration for patients, whether due to receiving unexpected bills or difficulties understanding financial obligations. This stress can ultimately erode their trust in the healthcare provider.

A disorganized revenue cycle can also lead to longer wait times for appointments or procedures. The scheduling and pre-authorization process needs to be optimized to prevent these unnecessary delays before receiving care to prevent dissatisfaction and the perception the patient’s time and needs are not being prioritized.

Optimizing the revenue cycle through a dedicated outsourcing partner can elevate the patient experience. By leveraging the expertise and technology of a specialized partner, healthcare providers can streamline billing, coding and claims management processes, resulting in faster and more accurate billing, reduced billing errors and enhanced transparency in financial transactions. 

When processes related to financial obligations are smooth and efficient, the patient can focus more on their healthcare journey for a more positive perception of the provider. Reducing the administrative burden on healthcare professionals will also allow them to dedicate more time and attention to patient care, fostering better communication, empathy and personalized treatment plans.

Better Financial Forecasting + Management

Through the expertise of outsourcing partners, healthcare providers and organizations gain access to comprehensive financial reporting and analysis. A good outsourcing partner will generate detailed reports on key performance indicators, revenue trends and financial metrics, providing valuable insights into your organization’s financial health.

This accurate, timely financial data helps healthcare providers make informed decisions, identify potential bottlenecks and implement proactive measures to optimize revenue streams. Revenue cycle management outsourcing also offers robust revenue cycle analytics and predictive modeling capabilities to enable organizations to forecast revenue, identify revenue leakage points and strategize for future growth. Outsourcing partners will utilize advanced technologies and industry best practices to improve revenue capture, reduce bad debt and enhance cash flow management.

Relying on the expertise of an outsourcing partner helps your organization achieve better financial forecasting and management, leading to increased revenue, improved financial stability and long-term sustainability.

What To Look for in an RCM Outsourcing Partner

Choosing the right RCM outsourcing partner is crucial for the success of your healthcare organization. It’s important to apply careful evaluation and consideration of various factors. Your ultimate goal is to select a reliable, capable RCM outsourcing partner with a track record of delivering consistent results for organizations like yours. 

Below are the top considerations when looking for an RCM outsourcing partner.

Understanding Your Organization’s Needs

Every healthcare organization has unique requirements, challenges and goals within its revenue cycle operations. By thoroughly understanding your organization’s needs, you can find an outsourcing partner that aligns with your specific objectives and can effectively address your pain points.

Comprehending your organization’s needs can help a partner tailor their services and solutions accordingly. They’ll take the time to analyze your existing revenue cycle processes, identify areas for improvement and customize their approach to meet your specific requirements. A higher level of understanding ensures a more seamless integration of their services with your existing systems and workflows to minimize disruptions and maximize efficiency.

In addition, working with a partner who understands your organization’s needs can provide proactive solutions, offer valuable insights and adapt their services as your needs evolve.

Experience + Expertise

Having a revenue cycle management outsourcing partner with extensive experience means you immediately get industry-specific knowledge and insights brought to the table. They already understand the complexities of healthcare reimbursement, coding standards, billing regulations and payor requirements.

Their experience and expertise can help you navigate the intricacies of revenue cycle processes, identify potential challenges and implement best practices to optimize reimbursement. Additionally, an experienced outsourcing partner has likely encountered a wide range of revenue cycle scenarios and has developed effective strategies to overcome them. Their track record should demonstrate their ability to deliver results and meet or exceed expectations. You want to ensure your revenue cycle operations are placed in capable hands to stay ahead in the ever-evolving healthcare landscape.

Technology + Infrastructure

Working with a technologically advanced outsource partner means you can leverage state-of-the-art software solutions, automation tools and electronic health record (EHR) systems. These solutions will help streamline billing, coding, claims processing and other revenue-related tasks. A competent partner should have the capability to integrate seamlessly with your existing systems for smooth data exchange and to minimize disruptions.

Having a robust infrastructure is essential for handling the volume and complexity of your organization’s revenue cycle, so working with a partner that has strong infrastructure ensures you’re able to handle high transaction volumes, maintain data security and privacy and ensure business continuity. Technological proficiency contributes to efficient revenue cycle management, enhanced data security and scalability.

Reputation + References

The reputation of a potential outsourcing partner reflects their reliability, trustworthiness and the quality of services they provide. A reputable partner will have a positive track record, demonstrated by satisfied clients and successful partnerships. When evaluating the credentials of a potential partner, it’s beneficial to consider rankings and recognition from esteemed industry organizations. For example, HFMA recognizes healthcare organizations that meet industry standard revenue cycle benchmarks each year. Ask your potential partner how many of their clients have received this designation.

Check references and seek feedback from current or past clients to gain insights into the potential partner’s performance, responsiveness and ability to meet expectations.

It’s also important to inquire about their level of customer support, deadline adherence, billing and coding accuracy and overall client satisfaction. Having a revenue cycle management partner with a strong reputation and positive references instills confidence in their ability to deliver results and establishes a foundation for a reliable long-term partnership.

Additionally, third-party organizations like KLAS Research and Black Book Research release annual rankings of firms across a variety of categories, including RCM outsourcing. It’s essential to gain a clear understanding of the criteria employed by these organizations in formulating their rankings, including how client feedback is obtained and how performance is evaluated.

Communication + Transparency

A revenue cycle management outsourcing partner that provides clear and open communication channels ensures there’s a seamless flow of information between your organization and the partner. Regular, timely communication allows for addressing concerns, providing feedback and sharing updates. It fosters a collaborative relationship where both parties are on the same page regarding expectations, goals and project timelines.

The number one thing is communication. Not everything is going to go perfectly, and the key is how the customer and vendor react.

– Health System CFO

Transparency is equally as important as it promotes trust and accountability. An outsourcing partner who values transparency will provide clear visibility into their processes, performance metrics and financial reporting. They should be open about their pricing structure, contractual terms and any potential risks or challenges. Transparent communication helps build a strong working relationship based on trust and enables you to make informed decisions and monitor the progress of your revenue cycle management effectively.

Potential Risks + Challenges of RCM Outsourcing

Revenue cycle management outsourcing can undoubtedly bring several benefits, but it does come with potential risks and challenges to be aware of. One of the main risks is the potential loss of control and oversight over revenue cycle operations. Depending on a partner for performance can raise concerns about their ability to deliver and prevent financial disruption, ensuring they adhere to agreed-upon service levels. There may also be concerns surrounding data security and privacy as sensitive patient information is shared. 

Additionally, there’s a risk of communication gaps or misalignment of goals between your organization and the outsourcing partner. A lack of clear communication and collaboration can result in misunderstandings and potential errors in revenue cycle management processes, which can negatively impact revenue. It’s also crucial to consider the financial implications as outsourcing does come with associated costs. Evaluate financial feasibility and be sure the potential benefits outweigh the expenses.

Lastly, the transition phase from in-house to outsourced RCM can present challenges like staff training, data migration and adjusting to new processes. Your organization will need to have a well-defined transition plan and effective change management strategies to address these challenges.

While these are very real risks to consider, considering what to look for in a revenue cycle management outsourcing partner upfront can help mitigate these risks to ensure you have a positive experience.

Ensure Less Worry About Your Outsourced RCM With the Right Partner

Partnering with an experienced revenue cycle management outsourcing partner is of the utmost importance for healthcare organizations seeking to optimize revenue cycle processes. At Ensemble, we offer a wealth of healthcare industry-specific knowledge, expertise and a proven track record to ensure a successful partnership. Through this experience, we can help your organization navigate the complexities of patient engagement, coding, billing regulations and payor requirements to ensure accurate and efficient revenue cycle management. With Ensemble’s outsourcing solution, we can help you streamline operations, enhance data security and achieve scalability. If you’re ready to improve financial forecasting, achieve better revenue cycle performance, and allow your team to focus on core competencies, contact us today.

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]]> 3 Tips to Successfully Negotiate Your Next Payer Contract https://www.ensemblehp.com/blog/3-tips-to-successfully-negotiate-your-next-payor-contract/ Mon, 27 Feb 2023 20:57:23 +0000 https://www.ensemblehp.com/?p=10537 Providers must leverage what's in their payer contract, comparative data and price transparency rules to level the playing field with payers. … Read More

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As hospitals and health systems continue to face financial headwinds from rapidly rising expenses, workforce challenges and stagnant reimbursement rates, healthcare leaders are turning to their managed care departments as a critical line of defense against avoidable payer pressure.

Historically, market share has dictated authority during contract negotiations between payers and providers, often giving payers the upper hand. So how can providers of any size level the playing field? They must know what provisions to include in their contracts, leverage comparative data to change payer behavior and use price transparency rules to their advantage.

Here are three tips to help improve your next payer contract negotiation.

1. Find the gaps in your current contracts.

Rates are only as good as the payment terms supporting them, so make sure managed care leaders have a strong understanding of existing contract terms as well as the best practice language required to drive proper reimbursement.

For example, do you have provisions that require the payer to pay, deny or dispute a claim within 30 days or remit payment with interest on day 31? Are you preventing pre-payment review on claims not disputed within 30 days? How are you limiting requests for information, audit volumes and appeal response timelines? Are you restricting bundling of charges and limiting “lessor of” language? How are you protecting yourself against recoupments?

Tracking and maintaining a list of managed care contract provisions and recommendations gives providers a path to increase reimbursement rates and ease costly administrative burdens.

2. Compare payer performance.

Make sure you’re tracking and comparing payer trends across your organization. Build a payer scorecard to analyze performance across your commercial payers and identify trends that need to be addressed during your next negotiation. Focus on metrics like clean claim rate, payment as a percent of charges, denial rates and reasons, underpayments, appeal volumes and win rates and other year-over-year net reimbursement changes.

Illustrative example of a payer scorecard used to track and compare payer trends.
Tracking regional and national payer trends outside of your organization can also help inform your payer strategy. Aggregate payment trends, claim resolution rate and denial information to determine if patterns within your organization are part of national or regional trends. If your average days to first payment are significantly higher than the national average, for example, strengthen provisions that limit claim resolution delays and determine how to reinforce compliance with these terms.  

Showing the total revenue impact of a payer’s behavior and comparing trends with other payers can help influence negotiations and accelerate issue resolution.

3. Use payer price transparency requirements to your advantage.

Research and download corresponding in-network rates for each commercial payer with an upcoming negotiation. The size and scale of the available machine-readable files makes this a labor-intensive project, so create a project plan with enough lead time to download and review potentially thousands of files.

Compare your existing contracted rates with publicly available rates for the same payer across other providers. Look for any large variances between what your facility is paid and what other facilities in your geographic area have contracted for. Focus on high-dollar procedures, items and services, especially those aligned with the unique specialties or credentials of your organization. Consider current and expected patient volumes to accurately estimate the revenue impact of any current rate discrepancies or future adjustments.

And don’t overlook out-of-network payers. Review their payment rates and examine the revenue impact of bringing an out-of-network payor into your network.

Key Takeaways

With razor-thin operating margins, healthcare providers can’t afford to lose precious revenue due to unfavorable contract terms, inadequate protections or unknown contract loopholes. Ensure your organization has a strong managed care team equipped with the necessary data, contract language and negotiating strategy to even the playing field between you and your commercial payers so your organization can improve financial health and continue to navigate industry headwinds.

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Andrew Bess leads Ensemble Health Partners’ payer strategy team, helping healthcare clients across the U.S. improve managed care strategies, negotiate favorable payer contracts, analyze national payer trends and successfully resolve issues by working side-by-side with national payers.

 

 

These materials are for general informational purposes only. These materials do not, and are not intended to, constitute legal or compliance advice, and you should not act or refrain from acting based on any information provided in these materials. Neither Ensemble Health Partners, nor any of its employees, are your lawyers. Please consult with your own legal counsel or compliance professional regarding specific legal or compliance questions you have.

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]]> 5 Reasons Why RCM Outsourcing May Be Right for You https://www.ensemblehp.com/blog/dont-be-late-to-the-party-top-5-reasons-full-outsourcing-may-be-right-for-you/ Fri, 30 Dec 2022 10:30:52 +0000 https://www.ensemblehp.com/?p=7434 Using a third party can help you save money and time while letting you focus on what you do best — patient care. … Read More

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Healthcare organizations share a common mission: improve patient outcomes and support community wellness. But without strong revenue cycle performance, that mission becomes impossible. And with thousands of payor updates per year, the process for getting paid is becoming more complex and labor-intensive. The result? Hospitals suffer losses while payor profits soar. Something is broken. The solution? Outsourcing your revenue cycle function. 

The number of healthcare organizations outsourcing revenue cycle management (RCM) has risen steadily in recent years. Black Book Market Research shows over 90% of hospital leaders are considering outsourcing companies. This matches findings from Grand View Research showing the U.S. RCM market size is expected to grow by more than 11% in the next seven years. 

The pandemic has also intensified market growth. Up to 75% of healthcare leaders reported experiencing adverse revenue cycle impact tied to COVID-19, underscoring the need for hospital revenue cycle transformation. When considering RCM outsourcing benefits, utilizing a third party helps cut costs while allowing you to focus on patient care.  

Here are the top 5 reasons why more providers are exploring full revenue cycle outsourcing:

1) Patient Care 

You can do one thing well, or many things poorly. For a hospital, that one thing must be patient care.  

RCM is time-consuming and complex. A single missed code or billing error can cause havoc in denials and underpayments. Partnering with an RCM outsourcing company eliminates your need to spend hours of back-and-forth with payors, filling out paperwork and fighting to get paid. Let someone whose core competency is fighting on your behalf take that off your plate so you can focus on what’s most important, the patient.  

2) Regulatory + Payor Compliance 

With the inundation of federal, state and local government regulations and payor policies, providers are forced to juggle all aspects of their medical facility. Failure to comply with these rules and regulations could come with serious consequences.  

“The regulations to stay on top of — in terms of changes in charge master and CPT codes and all of the modifications that our payors could sneak in throughout the course of a year — are difficult to keep up with.”  

  • John Starcher, President + CEO, Bon Secours Mercy Health 

Partnering with an organization whose built-in patented processes to track these changes ensures compliance and helps providers to stay ahead of the constant state of flux.  

3) Labor Shortages 

Disrupting events, either national or local, make it hard to find talent to adequately staff your departments. Thanks to COVID-19, this is more evident now than perhaps ever before.  

Compared to pre-pandemic levels, labor expense increased by nearly 15% while full-time equivalents (FTEs) per adjusted occupied bed decreased by 4%. This indicates the rise in labor expense is associated with the demand for higher salaries, not more FTEs.  

With these challenges in mind, consider whether your team’s time is best spent worrying about finding coders or billers or on growing your practice. RCM outsourcing benefits your organization by eliminating the burden from your organization and placing the responsibility on your partner to do what they do best. In turn, you regain bandwidth to focus on clinical excellence.  

There are actions you can take to mitigate the impact of a labor shortage. Here are 6 steps to combat labor shortages and other operational side effects of COVID-19. 

4) Cash Collection Velocity + Accuracy 

The time it takes to get paid is already too long even before introducing denials, billing errors and bad processes.  

The right RCM partner will resolve those challenges. They’ll implement proven best practices and automations to drive monthly cash flow increases and overall collections quickly and efficiently.  

“There’s always this conversation about ‘Do you make it, or do you buy it?’ It would have taken us probably, an easy five years to develop the competency that we needed. And we didn’t have that kind of time.” 

  • Dr. Imran Andrabi, President + CEO, ThedaCare 

With these financial improvements, your organization can reinvest that cash infusion to better serve your patient population. Whether it is increased facilities, better equipment or additional staff, the speed to value quickly adds up.  

5) Cost Reductions 

Between the costs of labor, training, software and hardware, running your own revenue cycle is a costly endeavor. 

Economies of scale help to reduce costs. And when a company focuses solely on being the best at revenue cycle management, they optimize best practices and create efficiencies that benefit their partners. Eliminating the need for providers to carry full-time staff to handle coding and billing saves not only on salaries, but also on office space, benefits, vacation hours and more.  

Partner with a Dedicated RCM Services Team

When you’re considering RCM outsourcing benefits, it’s important to remember that it will only be as great as the company you partner with. Choosing a company that offers professional RCM services and a dedicated team of experts will save you money and time, not to mention maximized claim reimbursements. 

Want to find out how a revenue cycle outsourcing partnership could transform your organization? Contact an Ensemble expert today to get started with a revenue cycle assessment.

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