Selecting the Right Revenue Cycle Management Solution: Key Considerations (Part 3)

Once you’ve established executive buy-in that implementing a new revenue cycle management (RCM) system will deliver real value for your organization, you will undoubtedly begin researching potential solution providers. This is a crucial step to determining which company provides the solution that is best suited to your organization and your needs.

Researching online is useful, but oftentimes you’ll find that solutions sound similar online. Understanding the differences typically comes down to having conversations with representatives of the different providers. Here are some questions that will help you better analyze which solution is the best fit for your organization:

Strategic

1. Is the solution a web-native, multi-tenant, SaaS solution?

This is important for three main reasons:

1. Cost — With multi-tenancy, there are considerable savings in hardware.
2. Upgrade Effort — Multi-tenancy upgrades are seamless, all customers are upgraded simultaneously and as soon as an enhancement is ready, it can be released.
3. Backups and Redundancy — Redundancy for multi-tenancy deployments is easier and more efficient since the clients are all on one system rather than individual instances.

You can learn more about the importance of this question in this paper.

2. Does the solution provider offer the solution for both in-house use with your team managing the process as well as outsourced with their own staff?

This can be important as there may be times that it makes sense for your organization to shift between the two delivery models, or use a hybrid of the two models.

3. How does the solution improve the operational efficiency of your RCM processes?
4. How is the return on investment (ROI) of the solution measured?
5. How does the solution help your company be compliant?
6. How does the solution scale as your volume grows?
7. How does the solution secure your data?
8. How does the solution support PAMA, FASB, and other reporting requirements?
9. Can the solution easily integrate with your LIS and/or other databases to leverage the value of combining clinical and financial data?
10. How does customer input drive solution enhancements?

Functional

1. How does the solution identify and correct claim errors?
2. How does the solution provide full visibility to understand the financial status of every diagnostic activity, at every stage from order submission to payment?
3. Does the solution provide managed services such as ongoing maintenance of data logic, fee schedules, payor edits and regulatory modifications?
4. How does the solution provide business intelligence, reporting, and analytics to support negotiating contracts and managing the business?
5. How does the solution proactively handle denials management?
6. What physician/client and patient engagement tools does the solution provide?
7. Does the solution have a proven-effective appeals process?
8. Does the solution provide access to comparative benchmarking data?
9. Is there one place in the system where all unpayable/unpaid claims are visible (including appeals), or are there multiple queues where different types of errors reside?
10. Does the system save and provide the ability to match source documentation to the individual line items for PAMA reporting?

These are the types of questions that are going to help you distinguish the right RCM solution provider to support your success. If a solution provider can credibly address these types of questions in a way that aligns with your business goals, they are likely a good candidate to move on to contract negotiation.

To learn about XiFin’s revenue cycle management solution XiFin RPM, click here.