Impact Insights

The Benefits of Healthcare Revenue Cycle Outsourcing

In the face of changing industry dynamics, hospitals and health systems are always challenged to sustain a strong revenue cycle. Revenue cycle leaders are under pressure to stay attentive, look for methods to improve cash flow, lower collection costs and stay compliant with regulations. If a health system is to be successful, it must have good billing and tracking methods in place, as well as remain current on revisions to payer reimbursement methodologies, Medicaid, and other healthcare programs. In addition to the “normal” challenges, revenue cycle leaders must also navigate the seemingly never-ending obstacles resulting from the Covid-19 global pandemic.

More providers are turning to healthcare revenue cycle outsourcing as the solution to mitigate these challenges.  Outsourcing can augment the current staff or take over complete responsibility of functions in all areas of the revenue cycle at a fraction of the cost of hiring, training, and ongoing training of full-time employees.

The right outsourcing partner has an experienced staff well versed in industry best practices combined with robust analytics. Communication is also a vital component to any outsourcing arrangement.  A true partner will provide operational feedback so enhancements can be made to process workflows and system configuration settings.

Examples of outsourced deliverables are:

  • Optimizing system automation
    • Identify non-payable CPT codes as non-covered charges
  • Streamlining workflows
    • Routing logic issue causing accounts to inappropriately route to multiple WQs
    • Routing rule containing wrong criteria
  • Reducing accounts receivables
    • Additional resources to work accounts
    • New workflow for netting down accounts
  • Identifying billing errors
    • Billing bundled services separately
    • Charges billed with incorrect revenue code
  • Reducing denials
    • Contract build issues contributing to denials
    • Non-payable CPT codes categorized as denials
    • Incorrect NPI pulling to claims
  • Ensuring regulatory compliance
    • Incorrect use of modifiers
  • Increasing cash flow
  • Improving payer reimbursements
    • Ensuring services billed appropriately
  • Maximizing margin
    • Routing right accounts to right resource at the right time

Contact Impact Advisors to learn more about improving your bottom line with our experienced healthcare revenue cycle consulting team  and our data informed solutions.