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Creating an Effective Laboratory RFP

  • Steve Nielson, Vice President, XIFIN

How to Ensure Your RFP Communicates Your Vital Company Needs so it Reels in the Best RCM Solutions

Many laboratories interested in gathering competitive information and looking to replace their revenue cycle management (RCM) systems use the traditional request for proposal (RFP) process. However, the concern is whether the laboratory's traditional RFP process has kept up with the RCM industry, which has made sweeping changes over the last several years. In fact, many articles delineate exactly why RFPs often fail to achieve their objectives and what alternatives are potentially more suitable. Let’s take a closer look.

A Changing Industry Prompts New Needs

It’s no surprise that billing and accounts receivables requirements related to reimbursement and accounting standards continue to change dramatically. And as a laboratory, your business must likewise adapt because RCM is critical and must be managed more closely than ever before if you expect to collect for the service ordered by the physician and performed or monitored by the diagnostics provider. Simply put, laboratories have moved from needing software that drops invoices and allows posting of payments from clients, insurers, and patients to solutions that must connect and manage complex and compliant processes, such as:

  • Who on your team is the best judge of the vendors’ comments?
  • How do you fairly compare one vendor to several others? Did the evaluators take into consideration all of the other comments from potentially hundreds of questions?
  • What are the ramifications of just scoring the yes/no answers and not considering the comments?

Choose a Partner Instead of a Vendor  

The primary objective of your vendor procurement process should be choosing a vendor that can be a trusted business partner that will help your organization exceed all your RCM needs. You want an industry expert that will help you modernize your process and prepare you to handle the changes ahead. One way to gain insight into a potential fit is to ask some general open-ended questions about the vendor, their business values, and culture. A vendor with a great solution but disparate values and culture may prove incompatible in the long run.    

Essential Questions to Ask Potential Vendors

Given the tremendous amount of time and effort that goes into an RFP by both parties, it’s important that the RFP be constructed to deliver the information you need to make a good purchase decision. Here are some focused questions and statements that will help keep your RFP current and get answers that will help you make good vendor choices:

  • Describe your financial reporting capabilities, including noting critical details of your ability to produce reports for billing, sales, operations, and the financial group. Be sure to include capabilities related to FASB and PAMA reporting.
  • Describe how your technology and services are distinguished from other products in the same space.
  • Describe the three most essential capabilities you feel your company provides better than other vendors.
  • Describe the security of your system and how it helps ensure we comply with HIPAA and have a malware and hack-proof environment.
  • The appeals process has become an essential requirement for laboratory reimbursement. Please describe how your company/system facilitates the identification and coordination of an appeal and reporting of the success and failure of the appeal.
  • Explain the benefits you believe your technology provides.
  • Explain additional services offered by your company that are included in your fee as well as those services not included.
  • How does your system handle evolving payor requirements?
  • What is your perception of how choosing your company helps our laboratory improve our current billing process?
  • The cost of even unintentional non-compliance can be high. Describe how your company helps ensure we meet compliance (OIG and regulatory) requirements?
  • How can our laboratory be assured that our system will not become outdated in a few years, requiring expensive maintenance, upgrades and/or manual workarounds?


Leverage an RFI to Accelerate the Process

In our experience, laboratory executives who are exposed to the entire range of opportunities when their team is executing an RFP process are better equipped to make decisions, even if their intent is to simply patch up an existing (obsolete) system.

One way to do this is instead of spending many hours writing functionality requirements, send a few questions in a request for information (RFI) format to potential vendors. Ensure that the RFI clearly states your strategic objectives, vision, or areas of innovation so that you can better understand each vendor’s high-level capabilities to help determine the best fit for your business. Once you’ve identified the vendor or vendors that appear to be a good fit, you can address the detailed functionality questions during an interactive system demonstration later in the process. The RCM world for diagnostic providers is dynamic and complex, and a demonstration is a better way to evaluate differences in approach and workflow than a checklist.

The right questions will help immensely, but remember that there is a lot more to the process. Interaction with the vendors and the insight they bring to your team should be integral to your selection process. Also, consider a thorough onsite interactive demo with upper management, including a key RCM representative, to determine if the company has the capabilities and approach that would make a good fit for your strategic vision.

A Focused Evaluation

A critical element of the decision-making process is to perform an actual total cost of ownership analysis. There are many costs that are often overlooked and hard to calculate, and are therefore omitted from the analysis, including the following:

  • Cost related to all the additional resources needed to manage missing and incorrect information
  • Cost to having the appropriate visibility and financial reporting in place to manage your business and pass an audit
  • Cost of resources to ensure your business is compliant with FASB, OIG, EKRA
  • Cost of properly consolidating tests for CMS
  • Cost of having appropriate HIPAA and security in place to avoid patient and financial data from being exposed, hacked, and/or held for ransom.


While an RFI can simplify and focus the information gathering process, sometimes an RFP approach is mandated. If so, use the tips in this article to take a fresh and open approach to the RFP process so that vendors have the opportunity to bring forward solutions that fit your requirements (both stated and unstated), greatly exceed your larger objectives, and become an integral business partner.

For more information, contact us.


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Published by XIFIN
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