What to Expect from Your RCM Team: You need a service experience that is bigger than billing and coding

By Bryana McGill and Kristie Cross

For decades, billing and coding services were essentially synonymous with revenue cycle management for facility-based physician practices. There were ancillary tasks to perform, but billing services were the main event.

Today, billing and coding are merely the starting point for effective revenue cycle management. With provider reimbursement falling and administrative burden rising, basic bill processing is not sufficient to maintain profitability. You need an RCM partner who can help you optimize your revenue cycle, identifying opportunities for additional reimbursement, uncovering root causes for denials, and correcting issues that are resulting in underpayments.

How do you know if an RCM vendor can deliver an elevated service experience? Between us, we have several decades of expertise in healthcare RCM, much of it specifically for facility-based physicians. From our perspective, the following attributes are strong indicators of a high-touch service approach.

• Client Success Managers with Proven RCM Expertise
  Healthcare RCM is way too complicated for a client support generalist with a background in sales or customer service. Your Client Success manager needs to be more than a liaison between the practice and the Service Delivery team. RCM optimization requires you to have a true partner who understands your business at a granular level—and for that, they need to have operational experience in healthcare RCM. Look for a Client Success department staffed by professionals with backgrounds including nursing, medical coding, practice management, and even law.   

•  Monthly Performance Insights
  A set-it-and-forget-it approach to RCM is a formula for practice suboptimization. Your RCM vendor should be continually reviewing processes and metrics, providing monthly insights on business performance. By tracking core service metrics, such as Net Collections Rate and Cash Per Unit, your RCM team will notice if a payer begins down-coding certain procedures or if providers are not documenting accurately to support appropriate reimbursement. Together, you can make process improvements that will resolve issues before they impact revenue.

• Value-Added Insights
  From the No Surprises Act, to the Merit-Based Incentive Payment System (MIPS), to the recent AMA coding updates for Evaluation and Management, and changes in payer reimbursement for CRNAs, providers are operating in an incredibly complicated regulatory environment. You don’t have time to master the landscape. While you focus on patient care, your RCM partner should be monitoring regulatory changes, adjusting RCM processes proactively and alerting your team to issues that require attention. Be aware, regulatory changes often lead to workflow and documentation changes on the provider end. A high-touch RCM partner should include expert educators who can help your team upskill to stay ahead of the curve.

• Transparent Technology
  Actionable data can help you uncover issues that lead to denials and underpayments, as well as ways to proactively optimize the revenue cycle. A stale report with month-old data isn’t actionable, however. Meaningful improvements come from having access to real-time performance metrics through dashboards that are updated daily. What’s more, you also need experts who can help you make sense of the data. Self-service options are essential for transparency, but a high-touch support team can turn those data insights into a comprehensive strategy to improve profitability.

• Flexibility and Collaboration
  While we’re all facing the same regulatory and reimbursement challenges, your practice is unique, and you need a partner who understands that. Avoid companies that take a cookie-cutter approach to RCM, limiting you to set services and reports that are the same for every client. Success today depends on being nimble and adaptable to tailor support where it’s most impactful for your practice. Your RCM partner must also be responsive and accessible at all times to guide you around the next reimbursement roadblock.

White-Glove Promise

Ventra Health’s Client Success approach was designed to meet the continual challenges of healthcare RCM with high-touch, white-glove service. Our goal is to develop strong client partnerships with meticulous attention to detail, proactive communications, and highly responsive support.

We believe the experience starts with Ventra’s investment in hiring Client Success representatives who have operational RCM expertise—a commitment that is extremely uncommon in the market today. Our Client Success representatives are not just message-takers. Because they have managed revenue cycle operations directly, they are subject matter experts who can roll up their sleeves and partner with you to resolve any issues that arise.

They use vSight™️, our industry-leading Data & Analytics platform, to help clients understand practice performance and profitability. Client Success team members continually review analytics and identify actionable insights that can improve processes and revenue. They are also supported by our Performance Surveillance Team, an independent group of data scientists focused solely on studying client analytics. Ventra’s core performance metrics are built into our reporting structure to keep the entire team working toward the same goals.

Ultimately, that responsive team approach is the foundation of an elevated service experience. Your practice needs not only revenue cycle services but also data analytics, provider education, payer strategy and contract assistance, and expert technology implementation. Anything less is just billing and coding.