Reasons why 17 Hospitals and Health systems Outsourced their RCM Operations

What Motivated 17 Hospitals to Outsource Their RCM Operations?

Hospitals and health systems are choosing to outsource most of their RCM operations and functions for various reasons. These hospitals and health systems made outsourcing their RCM a top priority over the course of last year:

1. 1. On December 15, Luminis Health, a company based in Annapolis, Maryland, selected VisiQuate, an AI-powered analytics company, to handle its revenue cycle management operations. 
   2. On December 1, Dayton Children’s Hospital in Ohio announced it had chosen VisiQuate to provide billing analytics services.
   3. On November 29th, Cornerstone Specialty Hospitals in West Monroe, Louisiana decided to partner with CareCloud to take on its revenue cycle management services. 
   4. On November 2, Valley Health System, based in Winchester, Virginia, partnered with Ensemble Health Partners in an effort to improve its revenue cycle operations.
   5. On October 4, Great River Health located in West Burlington, Iowa, announced that it would be outsourcing its medical coding to Omega Healthcare starting November 1.
   6. On August 25th, St. Clair Health, a healthcare organization located in Pittsburgh, picked R1 RCM to be its primary end-to-end revenue cycle management provider for the next 10 years. 
   7. On July 14th, Sutter Health, a healthcare organization based in Sacramento, California, selected R1 RCM to serve as its exclusive end-to-end revenue cycle service partner for the next 10 years. 
   8. On July 7th, OhioHealth, a healthcare organization based in Columbus, Ohio, announced that it will be letting go of 70 revenue cycle employees on November 4th as it outsourced these functions to AGS Health.
   9. On June 27th, Claxton-Hepburn Medical Center, located in Ogdensburg, New York, announced that it is reducing its workforce of 800 people by approximately 5 percent, as it intends to outsource revenue cycle functions.
   10. On May 24th, Conifer Health Solutions reached a multi-year, multi-facility agreement to provide revenue cycle management services for Brookwood Baptist Health, the largest healthcare network in Central Alabama. 
   11. On May 16th, Catholic Health Initiatives (CHI) based in Englewood, Colorado announced a 10-year extension and broadening of its current agreement with Conifer. 
   12. On May 11th, Ardent Health Services based in Nashville, Tennessee, a network of 30 hospitals across six states, expanded its revenue cycle management partnership with Ensemble Health Partners.
   13. On May 9th, ScionHealth, a healthcare organization based in Louisville, Kentucky, selected R1 RCM to provide revenue cycle management services for its 61 long-term acute care hospitals. 
   14. On May 2nd, Nicklaus Children’s Health System, located in Miami, announced that it is transitioning all revenue cycle management operations to Ensemble Health Partners. 
   15. On April 28th, Ensemble Health Partners was selected through a competitive bid process to manage the revenue cycle operations for Campbell County Health, a healthcare organization based in Gillette, Wyoming. 
   16. On January 21st, Day Kimball Healthcare located in Putnam, Connecticut announced its partnership with Ensemble Health Partners as its revenue cycle management partner. 
   17. On January 20th, MarinHealth, a healthcare organization based in Greenbrae, California, selected Optum to provide supply chain and revenue cycle management services.

Why do these hospitals and health system outsource their RCM functions and operations?

Outsourcing creates suitable cost control:

It’s crucial to keep in mind that outsourcing revenue cycle management (RCM) may not completely replace all in-house RCM teams, but it can significantly reduce labor costs. By partnering with an outsourcing company, you can quickly access a team of highly qualified experts to assist with vital RCM functions. This way, in-house RCM staff can be reassigned to other crucial roles such as incident management teams, point-of-entry screening, or telehealth functions. The outsourcing partner can take on these vacant RCM positions, thus reducing costs for the hospital as the in-house RCM staff can be allocated to other areas where they are needed.

Outsourcing is scalable and adjustable according to fluctuating volumes:

Outsourcing revenue cycle management (RCM) functions can be cost-effective for organizations of all sizes, regardless of fluctuations in patient volume. Providers and hospitals may not always know how patient volume will change. For example, telehealth volume may increase unexpectedly, while procedural volume decreases. Outsourcing RCM allows you the flexibility to scale resources up or down as patient volume changes. This can help lower labor costs and make it more affordable for healthcare providers and organizations to control overhead costs while keeping operations running smoothly and efficiently, no matter the level of patient volume.

Outsourcing provides dedicated staffing and streaming of RCM processes:

Contrary to common belief, outsourcing is not just about cost-cutting but a long-term strategy for success. It is about increasing efficiency, improving performance, and promoting ongoing improvement. By outsourcing RCM functions, you’ll gain valuable insights and expertise from revenue cycle management professionals. These experts can quickly identify best practices, provide valuable feedback on how your organization can improve, and identify opportunities for improvement. They can also focus on discovering underlying issues, ways to recover lost revenue, identifying un-coded claims, and new opportunities for clinical documentation. RCM outsourcing can also help to improve collection rates, increase accuracy and reduce aged receivables, boost revenue, enhance reimbursement, and improve cash flow.

Outsourcing allows hospitals and health systems to focus on their core function – Patient care:

The primary focus of healthcare providers and organizations should be on providing excellent patient care and ensuring the best possible patient experience. However, tasks such as billing, coding, payer relations, and clinical documentation improvement often fall outside of their area of expertise. By outsourcing RCM, these providers can focus on their core responsibility and leave key RCM functions to experts in the field. This way they can ensure they are providing the best quality of care while, at the same time, keeping their operations optimized and financially stable.

In the end, it is all up to the hospital or health system’s performance and its leader’s decision-making skills:

Outsourcing may not be the right fit for every hospital and health system, but for those that do decide to outsource their revenue cycle management (RCM), it can lead to positive results. A survey conducted by the Medical Group Management Association (MGMA) found that medical practices that outsource their RCM generally experience improved performance in areas such as collections, staff productivity, and more. However, it’s important to note that not every practice may see the same results and it’s best to assess the hospital or health system’s needs before taking a decision.

If you’re thinking about outsourcing your revenue cycle management (RCM) functions and are not sure where to begin, don’t worry, you’ve come to the right place. There are options available with BillingParadise to help guide your decision-making process and ensure a smooth transition.