Revenue cycle management service is an integral part of all healthcare organizations because RCM helps streamline revenue generation and improve patient experience. However, there are a few cases where you may really not need to hire a third-party RCM service provider. Here are those scenarios.
- You have an expert in-house RCM team
The first logical reason that you don’t want to hire a third-party revenue cycle management service provider is that you already have an amazing in-house team working for you. As a result, there may not be a need to rope in anyone new. While this sounds like a dream situation, honestly, this doesn’t happen very often because RCM experts are very expensive to hire and retain and third-party service providers are able to lure such experts into their organization because they work for multiple brands, have larger revenue bases, and can actually afford to hire these experts.
- Your denial rate is exceptionally low compared to the industry standards
The average denial rate in the healthcare industry is anywhere from 5% to 10%. Let’s say your denial rate ranges between 2%-3% in the last few years; then, you are definitely doing something well. There is no need to pull in a third-party provider offering revenue cycle management services and mess up whatever is working for you right now. It makes more sense to keep things as they have been.
- You have a limited number of patients, most of whom are self-payers
One of the main reasons why healthcare practices need the help of revenue cycle management service providers is to handle the complexities of billing and coding when the primary payers are the insurance companies. Let’s say you have a small practice that deals with only a set number of regular patients. Most patients self-pay.
In this case, having a couple of billers in-house is enough to keep things progressing from claims generation to reimbursement collection. You don’t need expensive RCM practices.
- You have high-end, upgraded technology
AI has changed the landscape when it comes to medical billing and coding. If you have invested extensively in high-end and upgraded RCM tools and solutions, like automated billing, ML-based coding, auditing, and denials management. These tools, by themselves, are enough to handle revenue cycle management services and you don’t need additional hands on deck to manage the process.
- You don’t make enough to hire a third-party service provider
Another very obvious reason why you shouldn’t hire a third-party revenue cycle management service provider is that you just cannot afford them. Such service providers are expensive investments. However, many smal
l practices still go ahead and hire them because they know the service provider can help them improve revenues from day one, and they would soon be able to make enough to match the fees paid.
However, if you are a practice with no intentions to grow financially or as a brand, then you may be better off handling services on your own. This may be too much of an investment to handle.
Conclusion
In most cases, hiring a third-party revenue cycle management service provider is beneficial in different ways for the healthcare brand. However, in some rare cases, as stated above, you may be better off with an in-house team or just a couple of people to handle billing.
