RCM Service Levels: What's the Right Fit for Your Practice?

Unlike clothes, a one-size-fits all approach rarely works when it comes to healthcare software—and Revenue Cycle Management systems are no different. Before your practice decides which sort of vendor to rely on for these vital billing services, it’s important to identify which sort of partner is best equipped to meet your specific needs.

revenue cycle management services

There are 3 types of billing companies: light, full service, and boutique.

Light

A “light” level of service is offered by numerous billing software vendors. It’s defined by the following 2 common traits:

  1. Your practice will be responsible for all coding validation and working rejections due to patient demographics issues, eligibility, authorizations, etc.
  2. These services require that there is someone on-staff in the practice who is familiar with the front end of the billing process and capable of getting claims out the door and accepted by the payer—without much assistance from the vendor.

Full-Service

Common, but not as prevalent as light services among software vendors, is a full-service option. Relying on a full-service RCM will likely include the following:

  1. Participation from the vendor in the earlier stages of the revenue cycle, technology tools and trading provided to verify eligibility, demographics and insurance card information during the check-in process made available.
  2. The company will communicate with your practice on how to manage rejections, and also provides feedback on how to avoid rejection-causing mistakes in the future.
  3. Will not require your practice to have skilled billing staff members to work rejected claims in-house.

Boutique

Generally offered by smaller, privately or locally run billing companies, “boutique” services often are focused on a limited number of specialties or provide more oversight. For example:

  1. “Boutique” billing companies go above and beyond simple claims submission, payment posting, and follow-up of accounts receivables.
  2. Higher service fees is best suited to practices who want the billing company to handle all the business and financial aspects of running their practice.

RELATED: Exploring RCM Basics: What Kind of "Rate" is Best?

But how can you know which type is the best fit for your practice’s needs?

The following chart may aid you in determining which of the following features are “must-haves” and which ones your practice may not absolutely require. The type of RCM vendor you’ll require often depends on your practice’s budget, size, or specialty—or a combination of the two.

 

Service

Light

Full-Service

Boutique

Create, Scrub, & Submit Claims

Y

Y

Y

Post Insurance Payments

Y

Y

Y

Work Denials

Y

Y

Y

Create and Send Patient Statements

Y

Y

Y

Provide Financial Reports

Y

Y

Y

Work Rejections

Y

Y

Y

Dedicated Billing Manager

 

Y

Y

Clearinghouse Fees Included

 

Y

Y

Software Included

 

Y

Y

Eligibility Verification

 

Y

Y

Charge Submission

 

Y

Y

Patient Collections Letters/Calls

 

 

Y

Coding Services

 

 

Y

Credentialing

 

*

Y

MIPS Consulting

 

*

Y

Practice Management Consulting

 

*

Y

Payer Contract Negotiation

 

*

*

* Service may require an additional fee

Once you've identified which type of RCM service level your practice needs, it's time to seek out vendors that fit the bill. 

For example, InSync fits neatly into the full-service category. For more information about the specific RCM services we offer, click here

Whichever style of RCM vendor you need, the InSync Team wishes you the best of luck in your search.

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