RCM Services, what do they entail?

The new buzz word for practices has become “RCM Services” but what does that really mean?  There are so many companies that offer RCM services, but not all companies offer the “same” services.  Many vendors simply offer to take over the billing functionality of a practice.  This is great but may not encompass everything you anticipated and therefore may leave you in a tight spot trying to cover portions of the process that might not be covered.   So how do you determine what you need in order to find a company that offers all of the services you need?

In my experience more in this case is definitely better, even though you may not want to utilize every service offered to begin with, it is nice to know the vendor you selected has the capability to take over other services if you want to add them at a later date.  If you choose a company that does not offer all of the services, you may find yourself adding an additional company or switching all together to get the services you need.  So what do I mean by a company that offers all of the services.  Start at the beginning and work your way through the entire process.  Billing begins before your patient arrives, you need to have eligibility verification so you know who the insurance carrier is and what payments you should collect when your patient arrives.  Once the visit is completed the vendor should handle all aspects of the billing including verifying everything has been billed to collect the highest dollar amount. From here the vendor should offer claims follow up, working denials to ensure you are being paid for every claim.  Your vendor should be sending patient statements and even have the ability to handle collections.  This ensures one company is working all of the processes and knows exactly where you are in every aspect of your billing.

On the backside your vendor should be running checks to verify that you are being reimbursed at the contracted rates.  Running, daily weekly and monthly reports to keep you up to date.  Look for a company that has a dedicated account representative that has set meetings to review the reporting.  Again, you may not want to utilize all of these services when starting out but make sure you select a vendor that offers the best RCM services so you can add additional services as needed.