Considerations When Engaging with Consulting Companies
February 29, 2024
Working with our healthcare customers, the XiFin team collaborates with various management consulting organizations and audit firms. It is common for health systems, diagnostics providers, specialty physician practices, pharmacies, and remote patient monitoring firms to undertake consulting or audit engagements focused on enhancing their revenue cycle management (RCM) process. These engagements typically fall into a few categories:
Accounts Receivable (AR) Assessments
Large, public companies often undertake AR assessments to evaluate the effectiveness of their existing RCM processes, gauge productivity, ensure accurate revenue recognition, and pinpoint areas for improvement around bad debt, patient-allowed amounts, the cost to collect, etc. Large consulting organizations, such as KPMG, Pricewaterhouse Coopers (PwC), Ernst & Young (EY), or McKinsey, typically conduct these AR assessments. Initiatives of this nature often follow executive transitions, aiming to assess the “health” of the current processes or to substantiate significant business or technological reforms.
Large, public companies often undertake AR assessments to evaluate the effectiveness of their existing RCM processes, gauge productivity, ensure accurate revenue recognition, and pinpoint areas for improvement around bad debt, patient-allowed amounts, the cost to collect, etc. Large consulting organizations, such as KPMG, Pricewaterhouse Coopers (PwC), Ernst & Young (EY), or McKinsey, typically conduct these AR assessments. Initiatives of this nature often follow executive transitions, aiming to assess the “health” of the current processes or to substantiate significant business or technological reforms.
Start-Up Support
These engagements typically focus on helping new healthcare organizations or medical device companies establish foundational market access and RCM capabilities, including securing code assignments, forming market access contracts, and organizing medical necessity or appeals forms.
These engagements typically focus on helping new healthcare organizations or medical device companies establish foundational market access and RCM capabilities, including securing code assignments, forming market access contracts, and organizing medical necessity or appeals forms.
New RCM Solution Selection and Implementation
A healthcare organization will hire a consulting company to run a request for proposal (RFP) process to evaluate a new or replacement RCM solution. Once the RCM vendor is selected, the firm may also manage the implementation process.
A healthcare organization will hire a consulting company to run a request for proposal (RFP) process to evaluate a new or replacement RCM solution. Once the RCM vendor is selected, the firm may also manage the implementation process.
One-Off Projects
Typically, smaller consulting entities or independent consultants tackle specific challenges such as comparing contract data to what is in the RCM system, converting paper EOBs to electronic formats, reducing prior authorization denials, or developing custom capabilities. AI consulting is the newest service offering.Often, these engagements are initiated by executives who may not be deeply acquainted with the intricacies of the existing RCM solution, sometimes leading to redundancy. We have seen situations, for example, where a consulting firm is brought in to provide analytics or reporting that the customer already has access to through XiFin RPM.
Typically, smaller consulting entities or independent consultants tackle specific challenges such as comparing contract data to what is in the RCM system, converting paper EOBs to electronic formats, reducing prior authorization denials, or developing custom capabilities. AI consulting is the newest service offering.Often, these engagements are initiated by executives who may not be deeply acquainted with the intricacies of the existing RCM solution, sometimes leading to redundancy. We have seen situations, for example, where a consulting firm is brought in to provide analytics or reporting that the customer already has access to through XiFin RPM.
As such, we have developed several key considerations for organizations contemplating the engagement of a consulting firm:
It is crucial to verify that the consulting firm possesses deep expertise in your area of operation. Many large consulting firms boast healthcare practices but might lack in-depth knowledge in areas like AR transformation or RCM, especially in your specialty. This gap can result in significant expenditures of time and money educating consultants about your business’s unique facets. Consider value-based care, which necessitates re-evaluating reimbursement models and the extension beyond traditional payment models. This requires specific and deep expertise in payor policy and behavior and the associated financial modeling. Likewise, if a consulting firm is not deeply familiar with your business, they will spend time and resources to pull data to help them get up to speed.
In the past few years, we have seen consulting companies recommend point solutions, particularly in analytics and artificial intelligence (AI). In some cases, consultants recommended “bolt-on” solutions to add capabilities the organization already has through XiFin RPM. Such recommendations introduce unnecessary complexity and inflate costs. It is essential to ensure you are not paying extra for something you already have or is embedded in your solution and can be turned on. Understanding any downstream impact of adding a stand-alone solution is also critical, as it can impact the overall cost to collect and the solution’s effectiveness. Also, taking data out of a system to apply AI to then drive instructions into an RCM system is not only inefficient but also creates potential risk.
Involving your RCM partner at the outset can offer valuable insights, making the consulting engagement more impactful. For instance, at XiFin, we have metrics and benchmarking data to help determine if the RCM process is performing as well as possible.
We’re always happy to share our experience collaborating with consultants. Certain consulting organizations are better equipped to address certain types of labs or patient monitoring companies, and other consultants are better suited to particular types of engagements, such as building market access. We are happy to provide referrals based on our experience working with many different consulting companies and independent consultants across many types of laboratories, hospitals, and diagnostic providers. We can offer insight that might mean a consultancy or audit firm is not the next best step.
If your organization is considering a consulting or audit engagement that impacts the RCM process, let your RCM partner help. Whether you are an existing XiFin customer or not, we are committed to reducing the cost of healthcare by driving automation to reduce administrative burden while maximizing reimbursement. Leverage our industry-recognized medical and pharmacy billing expertise and experience collaborating with consultants in the RCM space to your advantage.
Contact us if you would like insight on revenue and payor optimization.