The decision to outsource Revenue Cycle Management (RCM) or keep the process in-house is one that will have a profound effect on your business. RCM plays a major role in determining one’s business’s cash flow and ensuring quality documentation and compliance is critical to patient care and payor compliance, making it important for one to invest time and thought into this decision.
Though both methods have proven successful for many healthcare businesses, what you choose should be based on a variety of factors such as the age and size of your business, the costs involved in running it, and what you envision for the future growth of your healthcare organization. While outsourcing can be cheaper and more efficient, in-house resources can typically give you more direct control over day-to-day operations. Understanding both of these methods and their pros and cons can help you decide which method works best for your business.
In-house RCM:
Cons
- Rising costs: Costs pertaining to software, staff training for any technology, regulations, employee salaries and benefits, computers and any hardware, and other office equipment extras are always on the rise, which can be quite exhausting for you while running your business.
- Support issues: Hiring a large number of billers as in-house personnel can be costly. Moreover, if your team is small and even one member goes on leave, it can cause problems.
- Development and training: Staff must be trained regularly to keep them up-to-date on any regulatory changes, technological changes, software upgrades, and so on. This can become a losing sum game, as it takes up time, money, and other resources.
Pros
- Direct control over RCM: You have direct control and oversight over financial procedures when medical billing is done in-house. Any billing adjustments you make can be executed immediately. Keeping track of your business’s finances in person can help you be more accountable and transparent.
- Monitoring and controlling abilities: In-house billing allows you to have complete control over your financial transactions. Also, staff accountability and openness are aided by working in-house.
- Confidentiality of your patients: In-house billing allows for greater control over patient records, which is critical for maintaining patient confidentiality.
Outsourcing RCM
Cons
- Fluctuating prices: The majority of billing organizations take a portion of the revenue they collect so the more money your organization makes, the more money you’ll have to pay.
- Limits access to data: It’s possible that you may not have access to all of your patient collections or the opportunity to see billing reports.
- Inappropriate and non-compliant security protocol: Outsourcing your RCM with the wrong outsourcing organization could put you at risk of a HIPAA privacy and security breach. Unauthorized disclosure of PHI, whether deliberate or unintentional, violates HIPAA security guidelines.
Pros
- Less expensive: Billing in-house necessitates office space, technical support, and a dedicated team. Outsourced medical billing, on the other hand, means that the outsourcing organization of your choice bears all these costs, making the process less expensive for you.
- Productivity: Many healthcare companies simply do not have the time to hire, train, and manage RCM coding and billing staff. They’re already overworked taking care of their patients and completing other administrative responsibilities. In such scenarios, outsourcing your RCM can be very much beneficial for your business.
- Keeping records is easier: When billing is outsourced, they keep insurance claim e-reports on a weekly, monthly, and annual basis. This frequent update ensures accurate billing and documentation.
Why Red Road is the RCM solution provider you need.
The healthcare industry is currently dealing with rising regulatory compliance obligations and decreasing bottom lines. As a result, if you chose the right RCM outsourcing organization, it is becoming preferable for your organization to opt for outsourcing RCM. Outsourcing to experts is ideal in order to stay ahead of your competitors and meet the expanding demands of the healthcare industry.
At Red Road, we can show you how to create an integrated outsourcing approach to extend the value of your healthcare organization and assist your teams in focusing more on the truly important drivers for your business and patient outcomes. Red Road is HIPAA-compliant and SOC 2 Type 2 certified, so we are equipped to tackle all of your back-end healthcare business needs and requirements without compromising the security of your data. This allows us to help ensure that your RCM needs are met without any audit risk. We also offer a transparent working environment, which will give you access to data whenever you need it and ensure that you feel like our team is simply an extended part of yours.
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