How to Outsource with the Best RCM Partner: Key Factors for Healthcare Providers

The Overlooked Solution: Why Outsourcing Revenue Cycle Management is the Key to Healthcare Efficiency

Many healthcare organizations find that optimizing their revenue cycle feels like diagnosing a complex illness—full of hidden inefficiencies, unpredictable setbacks, and frustrating roadblocks. 

If you’re looking for the cure, you’ve come to the right place. This article will explore the pivotal advantages, best practices, and real-world successes that come with outsourcing revenue cycle management (RCM) – a critical strategy for thriving in today’s complex healthcare landscape. 

Three Key Takeaways:

Providers face increasing challenges in balancing quality patient care with financial efficiency. It’s virtually impossible to accomplish this dynamic without the right technology, teams, and processes in place. One option that is often overlooked is to optimize your healthcare RCM is outsourcing. 

If the word “outsourcing” has you rolling your eyes, let us share a couple of interesting facts with you before you hit that exit button. 

A November 2024 MGMA Stat poll found that 36% of medical practice leaders plan to outsource their RCM in 2025, reflecting a growing trend towards outsourcing to manage complexities and improve financial outcomes. Additionally, a Kaufman Hall report revealed that up to 61% of providers plan to outsource RCM tasks in the future, underscoring the growing recognition of its benefits.  

We’ll explain why this is significant in further detail. Keep reading! 

Three Key Benefits of Revenue Cycle Outsourcing at a Glance

1. Reduced administrative burden 

By leveraging the expertise of dedicated revenue cycle specialists, healthcare organizations can streamline operations, reduce billing errors, and improve cash flow, all while ensuring compliance with evolving regulations. The right partner can do all of this AND improve the patient financial experience. 

For example, Complex and Denied Claims represent between 3-4% of total revenue. However, the time and resources dedicated to addressing and resolving these claims can be up to five times that compared to standard claims. 

Specialized teams that manage denials and complex claims allow healthcare professionals to prioritize patient care instead of chasing down payers. 

Moreover, this strategic move not only enhances financial performance but also enables medical staff to focus on their primary mission: delivering exceptional patient care.

2. Access Business Intelligence Solutions 

Leveraging business intelligence leads to faster claims processing and reduced revenue leakage. However, the financial burden associated with developing and maintaining these in-house capabilities can be prohibitive for many healthcare organizations. 

This includes:

• Customizable data reporting, analytics, visualization, and publishing tools. 
• Visual KPI Dashboard giving you an at-a-glance view of performance across the entire revenue cycle 
• Leveraging data to gain actionable insights that can identify problems in your revenue cycle before they occur 
• The ability to track revenue goals in real-time  
• Identifying changes upstream in your revenue cycle 
• Analysts dedicated to refining these resources 

These insights can be applied to optimize the processes directly impacting your bottom line. 

3. Improved compliance and security: 

In a heavily regulated environment like the healthcare sector, it is crucial to maintain compliance with state and federal laws and regulations. Experienced vendors ensure HIPAA compliance, reducing risks or penalties related to data privacy and regulatory violations. 

To be even more specific, look for organizations that boast HITRUST r2 Certification, SOC 2 Type II Certification, and PCI DSS Compliance. 

HITRUST r2 Certification signifies that an RCM organization meets rigorous standards for safeguarding sensitive information, reflecting their dedication to maintaining robust security frameworks. 

SOC 2 Type II Certification confirms an organization’s capability to protect hosted and processed data, ensuring that systems are secure, available, and maintain processing integrity. 

PCI DSS Compliance ensures the secure handling of credit card information. 

Revco Solutions is one of few companies that maintains all three. And, as a result of industry-leading data protection standards, we also hold $20 million in cyber liability coverage in the unlikely event of a security incident. 

The Focus is Not Just Billing. It’s the Entire Revenue Cycle.

These benefits are just the tip of the iceberg. We aren’t just talking about billing and coding, although we know that does take up a significant portion of your everyday troubles. We’re talking about streamlining your entire revenue cycle. 

Let’s get more specific and talk about how these all work hand-in-hand. We’ll start with best practices. 

How Revenue Cycle Outsourcing Transforms the Entire Healthcare Operation

Enhancing your financial performance is the main priority and outsourcing enables just that by increasing collections, reducing denials, and optimizing reimbursement rates. 

RCM outsourcing involves partnering with experts who specialize in financial operations, ensuring the efficient submission of claims, payment posting, and denial management – the really tedious work. This collaboration minimizes revenue cycle inefficiencies while maximizing profitability. 

Let’s discuss the five key components of the revenue cycle and best practices for each. This can help you identify where your team may be (albeit unintentionally) falling short and give consideration to outsourcing some or all of your revenue cycle. 

Need some extra help? Check out our free Metrics Mastery email course: 

The Five Key Components of Revenue Cycle Management:

1. Pre-registration & Registration: Ensuring accurate patient information collection to prevent billing errors.
   Best Practices:
   • Accurate Data Collection: Gather comprehensive patient information, including demographics and insurance details, to prevent billing errors.Insurance Verification: Confirm coverage prior to services to reduce claim denials.
   Outsourcing Benefits:
   • Specialized vendors utilize advanced systems to ensure precise data capture and real-time insurance verification, reducing administrative errors. This leads to a more efficient registration process and minimizes the likelihood of claim rejections. This can also help reduce administrative burdens, freeing up your staff to handle other important matters.
2. Charge Capture & Medical Coding: Utilizing certified coders to optimize claim accuracy and reimbursement.
   Best Practices:
   • Certified Coders: Employ certified medical coders to ensure accurate coding and optimal reimbursement.
   • Regular Audits: Conduct coding audits to maintain compliance and identify areas for improvement.
   Outsourcing Benefits:
   • Outsourcing provides access to certified coding professionals who stay updated with coding standards and regulations, which are constantly changing. This expertise significantly reduces coding errors and enhances revenue capture.
3. Claims Submission & Processing: Reducing rejections and denials through timely, accurate claims filing.
   Best Practices:
   • Timely Submission: File claims promptly to adhere to payer deadlines.
   • Error Checking: Implement checks to identify and correct errors before submission.
   Outsourcing Benefits:
   • Vendors employ advanced technologies and automations to streamline claims submission and processing, reducing errors and denials. This efficiency leads to faster reimbursements and improved cash flow that a typical provider office does not have.
4. Denial Management & Lost Revenue Recovery: Implementing strategies to identify, appeal, and recover denied claims.
   Best Practices:
   • Denial Analysis: Identify common denial reasons to implement corrective measures.
   • Appeals Process: Establish a structured process for timely appeals.
   Outsourcing Benefits:
   • Experienced insurance revenue recovery vendors offer dedicated teams to manage denials and recover lost revenue. These denials make up a significant percentage of your revenue, and also a significant amount of time and resources to manage that many providers underestimate and ultimately fall short of. It can take weeks, sometimes months, to follow-up on a single claim. Outsourcing expertise leads to higher recovery rates and reduces the burden on in-house staff.
5. Patient Collections & Third-Party Follow-Up: Enhancing payment collection processes while improving patient financial experiences. In fact, the Healthcare Financial Management Association (HFMA) has highlighted that outsourcing RCM can lead to an increase in collections by 5 to 15%.
   Best Practices:
   • Clear Communication: Provide transparent billing information to patients.
   • Flexible Payment Options: Offer multiple payment methods to accommodate patients.
   Outsourcing Benefits:
   • Outsourced RCM services enhance patient billing experiences and improve collection rates by providing tools to help patients pay quickly and conveniently, such as speech analytics, QR codes, live chat, text-to-pay and more. By delegating these tasks, healthcare providers can focus more on patient care, leading to improved patient satisfaction and outcomes.

By outsourcing these tasks, healthcare providers can ensure an optimized revenue cycle, leading to increased cash flow and financial stability. Yes, that means increasing your bottom line. 

Addressing Common Concerns About RCM Outsourcing

Some healthcare organizations hesitate to outsource their revenue cycle management, fearing a loss of control or increased costs. However, maintaining an in-house team often results in hidden expenses related to staff training, software updates, and compliance risks. Not to mention the opportunity cost of your staff’s time. Partnering with an experienced RCM provider reduces operational inefficiencies, enhances cash flow, and ensures regulatory adherence, ultimately leading to long-term financial benefits. 

However, you still need the right people and processes in place to ensure operations are running smoothly. 

Choosing the Right RCM Partner

Selecting an outsourcing vendor requires careful evaluation. Key considerations include: 

1. Industry Expertise and Proven Success Rates
   A reputable RCM partner should have deep industry knowledge, demonstrated by years of experience and a track record of success. Providers should look for companies that specialize in healthcare financial operations, have experience working with various payer systems, and understand the complexities of coding, billing, and regulatory requirements.
   
   Why It Matters:
   
   • Experienced RCM companies have a higher clean claims rate, meaning fewer errors and faster reimbursements.
   • According to MGMA, top-performing healthcare organizations achieve claims denial rates below 5%, a benchmark that only expert RCM firms consistently meet.
2. Use of Secure, Compliant Technology Platforms
   Given the sensitivity of patient health information (PHI), healthcare providers must ensure that their RCM partner employs secure, HIPAA-compliant platforms to protect against data breaches and regulatory violations. Advanced RCM technology should include automation, artificial intelligence (AI) for claims processing, and analytics tools to optimize financial decision-making.
   
   Why It Matters:
   
   • According to HIPAA Journal, the healthcare industry experiences twice as many cyberattacks as other sectors, making data security a top priority.
   • As mentioned earlier, an RCM company with HITRUST, SOC 2 Type II, and PCI DSS certifications ensures the highest level of security and compliance, protecting healthcare organizations from financial and legal risks.
3. Customizable Solutions Tailored to Provider Needs
   Every healthcare organization has unique needs based on its size, patient population, and specialty. A strong RCM partner should offer scalable and customizable solutions that align with a provider’s workflow rather than forcing a one-size-fits-all approach.
   
   Why It Matters:
   
   • Customizable RCM solutions allow small practices, hospitals, and large health systems to optimize revenue cycles in a way that aligns with their specific operational and financial goals.
   • According to a Black Book Research survey, 80% of healthcare CFOs report that outsourced, tailored RCM solutions improve efficiency and reduce overhead costs by an average of 25-35%.
4. Strong Customer Support
   An RCM provider should offer responsive, knowledgeable, and accessible customer support to handle billing inquiries, resolve claims issues, and provide real-time financial insights. Effective communication and dedicated account management can make a significant difference in maintaining a smooth revenue cycle.
   
   That being said, the best RCM companies don’t just process claims and resolve billing issues; they prioritize compassionate, patient-focused service that reflects your organization’s values. At Revco, we believe in a strong company culture—where employees support each other and are committed to both our clients and their patients—ensuring a higher level of care and efficiency. When your RCM partner truly understands the importance of empathy and communication, they help keep your revenue cycle running smoothly while also enhancing the patient experience. After all, financial health and patient satisfaction go hand in hand.
   
   Why It Matters:
   
   • Poor customer service can lead to delayed reimbursements, frustrated patients, and lost revenue.
   • A survey by RevCycle Intelligence found that 67% of healthcare executives consider responsive RCM support critical to financial performance, with outsourced RCM partners reducing claim processing delays by up to 50%.

Plus, don’t forget these bonus items:

• Transparent Reporting Frequent reporting and open communication channels foster a collaborative relationship, allowing continuous improvements in revenue cycle efficiency.
• Clear Goals and Performance Metrics Establishing measurable benchmarks for collections, denial rates, and reimbursement times ensures alignment between healthcare providers and RCM vendors.

Conclusion

Outsourcing RCM is a strategic solution that empowers healthcare providers, allowing their organizations to streamline billing, patient payment, claims processes and collections while focusing on a patient-centered experience. By leveraging expert-driven solutions, providers can enhance financial performance, reduce errors, and improve overall efficiency. 

Revco Solutions: Your Trusted Partner in Revenue Cycle Management

At Revco Solutions, we specialize in optimizing healthcare financial operations through tailored RCM solutions. Our expertise in revenue recovery, claim resolution, and patient-centered financial engagement ensures improved cash flow and operational efficiency. 

Partner with Revco Solutions Today

Ready to enhance your revenue cycle performance? Contact us today to learn how we can help your healthcare organization maximize collections while improving patient financial experiences. 

By outsourcing your revenue cycle management to a trusted partner like Revco Solutions, your healthcare organization can achieve financial stability, improved operational efficiency, and enhanced patient satisfaction.