Pros and Cons of Doing Revenue Cycle Management In-House vs. Choosing a Third-Party Partner

Healthcare providers are experiencing a number of challenges when it comes to their revenue cycle management (RCM):  

1. More time spent in accounts receivable (AR) 

2. Staffing shortages, with either too few employees or employees without deep billing expertise  

3. Ever-changing demands for healthcare documentation 

4. Transition from fee-for-service to value-based care payment models  
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In the face of these challenges, many providers are weighing the pros and cons of keeping their RCM in-house versus partnering with a third-party RCM vendor.  

Keeping RCM In-House

While each practice is unique, many specialty care practices have the same considerations when evaluating whether or not to keep RCM capabilities solely in-house.  

Pros 

1. Direct oversight and ownership of the RCM process: Keeping RCM in-house has the advantages of proximity and immediacy. Many providers are concerned that outsourcing will lead to delays in solutions or a complicated relationship with an external team.  

2. Specialty healthcare providers intimately know their own processes: Practices know the intricacies of their specialty and may doubt that a third-party service will have the expertise needed to get the job done.   

3. Concerns about cost: Improving a current in-house system may seem to be a less expensive approach, but in reality, many practices find that outsourcing RCM projects are more cost-effective when taking into account the costs of finding, training, and maintaining a full-time staff.  

Cons 

1. Time and money lost in finding, training, and maintaining qualified staff: Keeping RCM in-house requires having a reliable team. But what happens when people are promoted, move, or resign? Finding replacements can result in the loss of time and money as your practices spend hours on onboarding and training.  

2. Potentially burning out employees due to increased work: One RCM solution is to increase the workload of current staff, especially if they are efficient and reliable. However, this decision may lead to high levels of stress, burnout, and eventually turnover.  

3. Lower quality of care as time and resources are diverted to AR and collections: Healthcare professionals want to provide the best quality of care to their patients–not to spend precious hours in AR and billing. But collecting revenue earned is vital for keeping practices up and running. Allowing a third party to handle this part of the job allows providers to focus on their patients and still collect what they have earned. 

Third-Party RCM Partner

Pros

1. Reduced time in administrative and AR-related activities: Outsourcing RCM allows healthcare professionals to spend less time in AR and more time with their patients as they have the headcount needed to focus on billing.  

2. Third parties are experts and have the necessary skill sets: With a third party, there is no need to find staff and keep them trained, freeing up much-needed resources to be used elsewhere. Additionally, given the expertise found with third-party partners, many practices find that their billing is completed more quickly and accurately.  

3. Increase efficiency and revenue: Making an error a mistake in billing results in a loss of revenue. RCM partners are experts who reduce billing errors and maximize reimbursements. Plus, streamlining and automating the RCM cycle can lower the rate in denials of claims and create a more efficient front-end office.  

4. Lowers the risk of a conflict of interest: Keeping patient care and collections separate decreases the chance for conflicts of interest; it also lends itself to a more overall positive client experience.   
    

Cons 

1. Manage change: Employees may be hesitant to accept help from a third-party partner, which means providers will need to spend time communicating how the partner can complement employees’ existing capabilities, free-up employees’ time to focus on what they do best, and prevent burnout. Finding the right partner can alleviate some of these concerns. 

2. Challenges in finding the right RCM partner: It will take time and energy to find the right RCM partner for you that is not only compliant but who will also work to meet your specific needs versus a vendor who uses a one-size-fits-all approach.  

But why do you have to choose?

Many practices have found success with a hybrid approach that utilizes the talents and knowledge of their current employees and complements their capabilities, with time and expertise from a third-party partner. Hear from organizations that have benefited from this approach.

Is Choosing an RCM Partner Right for Your Practice?

When evaluating if your company is ready to partner with an RCM company, carefully weigh the pros benefits and cons of outsourcing vs keeping the capabilities solely in-house.  

Learn how we can help by contacting Integra Connect today.