4 Reasons Revenue Cycle Management Outsourcing is on the Rise

By Caryl Serbin, RN, BSN, LHRM

Outsourcing revenue cycle management (RCM) is a growing trend for healthcare entities. According to an analysis by The Market Report, the RCM outsourcing market will continue to grow at almost 12% over the next five years.

When analyzing this trend from the ambulatory surgery center perspective, there are several elements influencing ASCs on their decision to outsource RCM.

1. Value-based care. An increasing number of healthcare providers are outsourcing RCM to free up their staff to greater support value-based care-related tasks. Besides tackling RCM responsibilities, business office staff have a number of other critical responsibilities, including scheduling patients, verifying third-party benefits, counseling patients on their financial responsibility and filling in for one another during lunches, breaks and vacations.

To meet value-based targets and enhance the patient's surgical care experience, business office staff members are now working with clinical staff to develop and then maintain a process for patient outreach and engagement, which are essential for supporting and achieving the objectives of value-based care. Due to the increased workload being placed on business office staff and the full-time requirements of good RCM, many centers are considering outsourcing RCM tasks to ASC-experienced and qualified companies.

2. Shortage and increased expense of experienced RCM personnel. There continues to be a scarcity of available certified coders (and even more so for certified coders with ASC knowledge) and ASC-experienced billing and collection staff. This is particularly evident in non-urban areas. In addition, the expenses associated with employing and retaining qualified personnel (e.g., salaries, benefits, vacation, sick time, training, continuing education, turnover) is constantly increasing. Outsourcing RCM eliminates the need for ASCs to recruit, train, retain and replace revenue cycle staff and all the numerous expenses associated with these processes.

3. Increased regulations and compliance requirements. With the ongoing changes in revenue cycle regulations and ever-increasing compliance and security regulations, most ASCs require a full-time security/privacy officer to keep their billing personnel current with rules and provide necessary audits. However, for most ASCs, increasing the number of office personnel is not considered economically feasible. Because of this environment of increased scrutiny, many ASCs are turning to outsourcing to eliminate the time, training and updates necessary to keep RCM staff up to date on regulations.

4. Growing patient financial responsibility. Patients are now responsible for a larger portion of their medical care, which has contributed to a decline in elective surgery caseloads in many markets. This development places even greater pressure on ASCs to collect all fees owed.

As mentioned earlier, business office staff are often already overburdened and unable to provide the uninterrupted time necessary to concentrate on the numerous tasks involved in effectively collecting larger payments from patients. This often includes patient education, setting up payment plans, sending payment reminders and answering numerous questions. Outsourcing seems to be an answer many ASCs are turning to in order to reduce business office staff workload (e.g., optimized coding, timely claim submission, third-party and patient collections, denials and appeals, tracking and trending managed care reimbursement, and maintaining a health accounts receivable) so they can focus on those issues that require in-house personnel.

Closing Thoughts

In today's challenging economic and regulatory climate, ASCs nationwide are finding that outsourcing the source of their financial success to experts is a reasonable solution and worthwhile investment. The goal when pursuing such a solution is develop a strong relationship with the revenue cycle company so that it essentially becomes an extension of your business office, freeing up in-house staff and ultimately improving your center's revenue stream.

Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Ms. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.

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