22% of Revenue Cycle Leaders Outsource Outpatient RCM Services

Over one in five revenue cycle leaders handle their own inpatient revenue cycle management (RCM) operations but have turned to outsourcing for some ancillary and outpatient RCM processes, according to a study conducted by the Healthcare Financial Management Association (HFMA).

The report, An Analysis of Outpatient Revenue Cycle Management Outsourcing, reflects responses from 157 US-based HFMA members. The research results from a collaboration between HFMA and health information technology company XIFIN.

As outpatient services expanded and staffing shortages increased during the COVID-19 pandemic, revenue cycle leaders have increasingly turned to automation and outsourcing to fulfill their RCM responsibilities.

Nearly 22 percent of respondents that manage inpatient RCM services themselves reported outsourcing some of their outpatient RCM services, while 12 percent want to take this approach in the future.

Almost 10 percent said they would like to outsource all of their outpatient or ancillary RCM services in the future while maintaining their own inpatient RCM processes.

The most common outpatient services healthcare leaders outsourced were anesthesiology, gastroenterology, and urology. Respondents were most likely to consider outsourcing RCM services for remote patient monitoring and medical devices, internal medicine, and radiology and imaging.

Organizations that outsourced RCM services were generally satisfied with their outcomes, the study noted. In addition, leaders who outsourced one function were more likely to outsource more services.

According to respondents, the most challenging aspects of RCM not currently addressed by people, processes, technology, or services were denials and appeals management, prior authorization, and payer relations.

“There is pressure on hospital teams to effectively manage expanding outpatient sources of revenue and expenses,” Bill Voegeli, head of customer research at HFMA and president of Association Insights, said in the press release.

“Many of today’s healthcare financial and RCM teams lack the necessary time, information and/or staff resources to fully understand the opportunities or implications for RCM automation beyond their electronic health record. Our research with XIFIN gives credence to the notion that healthcare finance professionals will benefit by staying up-to-date about ways to optimize the growing area of outpatient RCM and gives RCM executives insight into new avenues for optimization.”

A quarter of respondents reported that their outcomes fell below their objective for process optimization, operational efficiency, and technology requirements and alignment. Outsourcing these services might help improve the success rate of these functions, the study suggested.

When approaching outpatient RCM from a business standpoint, leaders were most focused on patient experience, process optimization, and revenue generation. Financial stability and operational efficiency were also commonly cited business drivers.

While 52 percent of revenue cycle leaders reported using their EHR for RCM services and account receivable (AR) collection, 23 percent said they use a purpose-built RCM solution for their outpatient or ancillary billing instead.

According to the researchers, outsourcing outpatient RCM services to third parties may help organizations focus on high-value inpatient services. Outpatient claims are one of the more complicated aspects of RCM and frequently have errors, missing information, and inefficient process to submit a clean claim, the study stated.

For some practices, outsourcing RCM services has helped fill gaps amid staffing shortages and improve efficiencies.

Experts have said that outsourcing RCM may also help providers lower costs and direct more attention to patient care.