The Secret: Why Specialized RCM companies outperform in-house billing teams

It is no news that there is a growing shift in RCM work being transitioned out from in-house billing teams to specialized RCM companies. But this trend also raises a daunting question – why are healthcare providers and business owners unable to achieve their goals, despite having a team under the same roof, but are able to do so with a team off-site?

 I have seen many in-house healthcare RCM teams, made up of well-paid and well-experienced staff that end up doing only certain parts of the RCM processes really well. But the common pain shared by the providers and business owners alike, cannot be simply solved by an in-house team; a fact that providers and business owners are painfully realizing and are coming to terms with it.

Healthcare providers are operating at an age, where reimbursements and margins have been lower than ever. Happy workers who punch out claims and punch in payments, day in and day out, aren’t what the business owners are looking for. They are looking for someone who can help them move their business’s needle. They are desperately looking for help that can give them a stronger footing today, than what they had yesterday and a road-map that keeps them on the safe side of industry curveballs. After all, the year 2020 is full of lessons about curveballs and uncertainty.

To be fair (and unbiased), I have to warn healthcare providers looking to outsource their billing, to do their due diligence, and ensure that they are partnering with the right RCM Company for them. There are RCM companies out there that could leave you in a position much worse than when you first started. I sincerely hope that that does not become your experience.

Here are some of the key reasons why RCM companies are at an incredible advantage vs. in-house teams.

 1.      Focus, compensation and rewards

The primary focus of healthcare providers, hospitals, and clinics is patient care. The primary focus (compensation and rewards mechanisms) of RCM companies on the other hand will be on ensuring a healthy cash-flow and revenue for the healthcare providers (which in-turn enables the providers to fully focus on patient care). 

 2.      Structure

For healthcare providers, their billing team is a cost center. They are not always structured strategically to follow the life cycle of a claim and intervene with knowledge and experience.

RCM Companies are mostly structured as SBUs (Strategic Business Units) that follow the life cycle of a claim while being specific to one healthcare provider’s account.

 3.      Energy

Unfortunately, the cost center mindset of the in-house billing team does not get them the attention and/or the nurturing they need from their leaders every time.

RCM Companies find excuses to celebrate – the overturn of a denial, weekly highest revenue recorded, a new accomplishment.

 4.      Knowledge

In-house teams have insights and knowledge of how the care given to a patient converts into CPTs, ICDs, and charges. However, all of the learning and knowledge is limited to within that practice.

RCM Companies, on the other hand, learn from a vast pool of healthcare providers they work with and bring forth only the best practices and solutions that have worked and advise clients against the ones that have not.

For any healthcare provider or business owner looking to outsource or partner, I will be more than happy to email you a free copy of the transition checklist (no strings attached), that will ensure that all your RCM processes will be in safe hands. Reach out to