Criteria to Assess Healthcare Revenue Cycle Management Vendors


The changing regulatory pressures coupled with evolving payments and care delivery models are known to have implications on physician’s time especially when it comes to direct care for the patient. In order to implement better care delivery models many practices outsource either part or the entire RCM process. How can one make such decisions? Based on a thorough analysis of your practice’s revenue cycle process and workflow, you will be able to have better insight into your system’s requirements.

There are two main key metrics to consider when evaluating an RCM service:

1) Costs to collect i.e. the percentage of revenue needed to collect payments; and

2) ROI – return on that investment. But care should be taken, and certain criteria should be met by the RCM vendors, so that they meet your needs and uphold the standards of quality that have been set by you.

Criteria to be employed when Assessing RCM vendors:

  1. Request for Proposal (RFP): This should be the first step that you as a healthcare provider needs to do- put forth a RFP. This should take into account everything that you need to know based on the review of your own practice- the gaps, challenges, what you are looking for, etc. Only if you know what you want, then can you request for certain services, processes and workflows that fit into your own, to help increase your revenues, be it medical billing, coding, or just handling Accounts Receivable (A/R)
  2. Credentials: It is necessary to request for references from the vendors- their clients, how long have they been with them. Moreover, you need to spell out the kind of contract you are looking for also, and who deals with what during the process and workflows
  3. Costing: Based on the size of your practice and complexity of services required, charges collected by vendor should be determined. Know exactly the type of service delivered to know what the payment costs are- monthly or based on percentage of amount, etc
  4. Technology: Know the kind of software they use and if it is compatible with your HER process and workflows, and how it interfaces with your existing technology
  5. Money Collection Process: This is very essential to know how the RCM vendor works on this process, so that your Accounts Receivable (A/R) process does lag behind on cash flows. Often, RCM vendors collect on behalf of their clients and then send a check once a month, or some even send the money to a lock box. There are others who post the collections in real-time via direct deposit.
  6. Compliance: You need to evaluate to determine if the vendor is complaint with all rules and regulations, especially with the Health Insurance Portability and Accountability Act (HIPAA).
  7.  Reporting: What kind of reporting service do they deliver? Reports should be provided regularly & provide a breakdown of denials, and the gap time between date of service and when bills are sent out.
  8. Contracts: Check the kind of contracts they offer. Those that offer flexible termination clauses or that have short-term commitments so that you are not saddled with a RCM vendor that doesn’t perform
  9. Guarantees: Different RCM companies offer different levels of guarantee. Some have performance measures or guarantees that can ensure satisfaction, whereas some may include incentives for exceeding set goals, or penalties if goals are not met.
  10. Value Added ROIs: Besides promising to increase your net revenue, check out RCM vendors who can also provide services that can give fewer days in accounts receivable or manage contract negotiations with payers, or conduct audits to ensure that insurers are paying what they should be based on the contracts.

Anything you do, whether you outsource the RCM process fully or partially, the one main thing that you should always maintain a seamless transition between in-house employees and the RCM vendor’s employees, and keep in mind that patients should never suffer, but receive  & expect the same level of service from both.