Many Challenges, One Solution: The Case for Unifying Your Ancillary Services Revenue Cycle with a Single Partner

Within the hospital or health system, it’s helpful to picture the variety of patient services and care living along a spectrum of clinical complexities. On one end, highly complex encounters encompass a range of situations and conditions that require specialized care, significant resources, and intricate management. These encounters include critical care management, complex surgeries, trauma care, and advanced diagnostic services.

At the other end of the spectrum are simpler outpatient events involving less severe conditions that require relatively straightforward interventions or management. Examples include minor injuries, common illnesses, outpatient diagnostics, and prescription fills.

In the middle, you’ll find ambulatory surgery and subacute care centers. Clinical complexities also tend to match the level of billing complexity for a given encounter, along with the event’s financial weight. After all, a long-term stay in an ICU requires a high level of interdisciplinary care and greater resources than an outpatient blood draw.

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Ancillary services tend to reside on the high-volume, low-cost, low-complexity end of the care spectrum. These encounters include those served by outpatient diagnostics (e.g., clinical laboratory, pathology, and radiology), as well as outpatient and specialty pharmacy.

By their very nature, electronic health records (EHRs) and enterprise revenue cycle solutions are implemented and optimized for the opposite end of the spectrum—the high complexity end. This is where they provide the most value, connecting the clinical and financial aspects within and among high-acuity encounters. However, in terms of billing, smaller clinical events can slip through the cracks. Their relatively lower dollar value isn’t deemed worth allocating valuable staff time and effort to pursue and resolve. This results in services and tests being rendered without payment, leading to write-offs and bad debt.

This, in turn, implies the need for a revenue cycle management (RCM) solution purpose-built to meet the unique needs of ancillary services—one that addresses the financial gaps left by your enterprise systems and complements those systems. Such an approach would help your organization efficiently manage these high-volume, low-complexity claims while sparing you the integration challenges and inefficiencies inherent in deploying solutions unique to each sub department. Here’s why you should consider that solution sweet spot by unifying ancillary services RCM under a single partner.

Unifying Ancillary Services RCM: Key Benefits

1. Efficiency

Choosing a single partner for your ancillary services revenue cycle provides convenience and simplicity, saving valuable time. Centralizing RCM under one partner yields a holistic view of financial operations, allowing for better monitoring, analysis, and decision-making. Integrating data from multiple ancillary services into a single RCM system facilitates comprehensive reporting and analytics, promoting better insights for identifying trends, optimizing performance, and making informed strategic decisions. A unified RCM partner fosters better communication among different ancillary service departments, and improved coordination leads to more efficient information sharing, reducing delays or errors in billing and coding. Resources such as technology, training, and support are consolidated, optimizing resource allocation, streamlining costs, and preventing duplication of efforts across different service lines. Finally, technical challenges, such as integrating an array of divisional solutions within your technology ecosystem and revenue cycle workflow, are mitigated when you opt for a single partner.

2. Expertise

An outsourcing RCM solution provider serving ancillary services processes a range of claims among various but related disciplines, including pathology, radiology, and clinical laboratory. The vendor’s RCM experts possess specialized knowledge in navigating the complexities of billing, coding, and documentation specific to those departments, ensuring accurate claim submissions and reducing the risk of errors or denials. Their understanding of coding intricacies and payer requirements also helps optimize reimbursement rates, identify opportunities to capture the full value of services rendered, and minimize underpayments. RCM professionals stay abreast of changing regulations and compliance standards, ensuring ancillary service claims adhere to all necessary guidelines. This reduces the risk of audits or penalties due to non-compliance. Partner RCM experts can adapt swiftly to changes in regulations or payer requirements, ensuring ancillary service claims remain compliant and accurate. Additionally, their expertise allows for scalability as the healthcare organization grows or adds new services.

3. Augmented Resources

RCM partners offer scalable solutions that adjust to fluctuating workloads. During peak periods or staff shortages, they can step in to manage increased volumes without compromising quality or timeliness. Outsourcing certain revenue cycle functions streamlines operations, allowing existing staff to focus on core responsibilities. This efficiency boost prevents burnout and enhances productivity among in-house teams. When RCM partners handle administrative tasks such as billing, coding, and claims management, they free up internal staff from routine, time-consuming activities, enabling them to concentrate on more strategic initiatives. By offloading revenue cycle management tasks, healthcare staff can allocate more time and attention to patient service and education, improving overall service quality and patient satisfaction. Outsourcing RCM can accelerate billing, claims submission, and appeals processes, which, in turn, can improve cash collections while helping to avoid compliance missteps.

4. Technology

The technology behind an outsourcing solution matters because it must account for wide variability. Technology optimized for ancillary services is inherently more flexible and robust than systems optimized for a single sub-department or discipline. Leveraging a technological foundation with real-time connectivity is required for the current healthcare financial landscape and complex RCM environment. Attributes of effective RCM technology include:

• Workflow Automation: Increases upfront clean claims submissions, minimizing manual processes and one-off decision-making that can lead to errors, compliance risks, or denied/ rejected claims.
• Eligibility Verification: Ensures patient insurance information and demographics are accurate and current for the date services are rendered, improving the likelihood of accurate claims data and expedited claims processing.
• Payor Edits: Helps ensure claims meet payor requirements prior to submission, especially important with changes in payor policies.
• Claims Status: Automates RCM workflows and provides valuable information about submitted claims and the adjudication of the claim.
• Document Storage and Management: Facilitates fingertip access to patient demographics and insurance information, ensuring accurate data points for clean claims submission. RCM partners should have functionalities for securely uploading documents into their platform, reducing administrative burden and costs associated with these processes.
• Patient and Physician Engagement: Provides 24-hour, real-time, convenient online access for patients and physicians to securely interact with providers, review reports and test results, access service and test pricing, fix patient demographics and insurance information, and upload.
• Artificial Intelligence: AI-enabled RCM workflows and analytics solutions support the automation of the RCM process. AI-fueled insights draw from variability, helping the technology react to emerging trends and issues. AI-enabled RCM platforms also reduce the administrative burden for providers, translate payor responses into actionable next steps, remove friction from patient and physician experiences, and adapt to maximize business outcomes.

5. Strategic Partnership

A strategic partnership between a hospital or health system’s ancillary services and an RCM partner involves a collaborative and mutually beneficial relationship aimed at optimizing financial operations. The hallmarks of an effective, strategic partnership include:

• Enhanced Financial Performance: The partnership aims to improve ancillary services’ financial performance by leveraging the expertise and specialized tools offered by the RCM partner. This could involve streamlining billing processes, optimizing revenue collection, reducing billing errors, and accelerating reimbursement cycles.
• Efficiency and Accuracy: Collaborating with an RCM partner allows ancillary services to enhance the efficiency and accuracy of its revenue cycle operations. This might include implementing advanced software solutions, leveraging data analytics for better insights, and ensuring compliance with billing and coding regulations.
• Access to Specialized Expertise: The partnership provides access to the partner’s specialized knowledge and experience in RCM. This expertise can help the hospital navigate complex billing challenges, stay updated with evolving regulations, and adopt best practices in revenue optimization.
• Customized Solutions: Ancillary services and the RCM partner work together to develop tailored solutions that address specific challenges within the ancillary services’ revenue cycle. This could involve creating customized workflows, implementing technology upgrades, or providing staff training to maximize efficiency.
• Long-Term Collaboration: The partnership typically involves a long-term commitment aimed at continuous improvement. It may include regular evaluations, performance reviews, and adjustments to strategies to ensure sustained financial success for the hospital. For clients and vendors alike, financial success and growth represent a shared vision and mutual benefit. With the right partner, the client organization can draw on their partner’s expertise and guidance to sustain and grow the department—and the overall organization.

With a single RCM outsourcing solution optimized to meet its unique needs, your ancillary services department can make a sustainable, meaningful contribution to your organization’s bottom line. As patient care continues to transition away from acute settings, optimizing the financial performance of outpatient services is critical for hospitals and health systems to maintain their foothold in an ever-shifting landscape. Each outpatient encounter, however small or simple, presents an opportunity to extend clinical services to your community and draw patients into your organization to receive care and support.

In essence, consolidating RCM services under one partner for ancillary services promotes standardization, coordination, efficient data management, and specialized expertise. These factors collectively contribute to streamlined operations, improved financial performance, and enhanced overall efficiencies across the healthcare organization’s ancillary services.