By Jay Volk, VP of Partner and Corporate Development, ZirMed
Twitter: @zirmed
So you’re considering enhancing your organization’s practice management (PM) offering by adding more sophisticated revenue cycle management (RCM) capabilities. Maybe you’ve even come to the realization that the knowledge, experience, and skillsets that enabled you to create a great PM system don’t necessarily translate directly to developing RCM software—or maybe you’d like to accelerate the development process but don’t want to pull engineering resources away from your core products.
Most PM systems are created by medical/clinical professionals who understand healthcare workflows as they are versus as they should be. This holds especially true within a particular specialty area that differs from others. You see what’s wrong in what exists on the market and develop a PM system to make it better.
The challenge comes when it’s time to bill for the services captured within your superior PM system. Most clinicians who are part of hospitals and health systems (or even midsize to large independent practices) don’t necessarily want to get more involved with the financial side – they’re looking for solutions that help them spend less time and energy on RCM.
That’s one reason PM vendors often seek a clearinghouse/electronic data interchange (EDI) partner rather than trying to build the capabilities themselves when they want to add RCM to their software. They know they don’t have to reinvent the wheel – and that they can deliver better RCM capabilities faster by working with the right partner.
But there’s the rub, as they say. How do you know which of the many choices available to you is the right partner to meet your needs, and your clients’ needs? Here are some things to look for:
Established connections and track record
Dig into the details. Which payers does the potential partner work with, and how does that align with your clients’ needs? Do they have a national scope, and does that fit with where you would like to see your product in five years? How successful have they been? In other words, what do the payers and clients think about the potential partner? What’s their reputation as far as enrollment? How directly do they work with payers on clients’ behalf?
Do more than just ask for references. Look up KLAS® rankings. Check out Black Book™. See how successful the potential partner is at keeping business over the long term, and check their website for case studies.
Due diligence on the front end will save you trouble on the back end.
How they can impact your revenue and market share
The right partner can help you retain business that might otherwise go to another PM system vendor that offers clearinghouse/EDI capabilities your system currently doesn’t. They can also help you capture new business and overcome objections in the sales process. Having a recognized leader on your side (versus an unknown or a company with a poor reputation) can help differentiate your product from similar offerings, enabling you to close more business.
Finally, look into how they manage revenue sharing for clients you share and new shared clients you help bring on board. A partner with a broad reach into markets where you have no or little presence – whether it’s based on geography, specialty, or client size – can help you grow, and grow strategically.
A deep understanding of the payer world
Clearinghouse/EDI capabilities don’t exist in a vacuum. The most impressive, feature-rich RCM system in the world is of little value if it isn’t attuned to the nuanced requirements of your clients’ payers.
A good partner will not only have the technology but will also understand how to scrub and submit claims to meet payer requirements, and how to seamlessly interface with various payer systems to minimize denials and improve revenue flow. They’ll also proactively monitor for changes in payers’ requirements and adjust their software accordingly – so that your clients always have the most up-to-date rules and edits in play.
Integration capabilities
The partner’s technology should easily integrate into your system via application program interfaces (APIs), Web-calls and file transfer protocols (FTPs). A good partner will be able to build APIs quickly and efficiently, regardless of your technology platform, and provide standard or custom integration with Software as a Service (SaaS) technologies to leverage your investments in your current systems and software.
They’ll also help you automate manual processes wherever possible to increase efficiency while delivering streamlined reporting and visibility. Additionally, their technology will be PCI and HIPAA-compliant to ensure data is exchanged safely and securely between systems.
The goals are to present users with a single look and feel to your software (even while a clearinghouse does all the heavy lifting) and to streamline workflows so users can do all their work within a single system.
A dedication to service and support
Don’t just settle for promises in service level agreements (SLAs). Ask to see actual performance metrics from their contact center. Go beyond how quickly they answered calls; instead look to see how quickly issues were resolved.
Check out their denial rates for specific clients and how they compare to rates before they engaged with that client. Again, look at KLAS rankings and Black Book. The combination of all this data will help you form a more complete picture of how they operate on a day-to-day basis.
Make a smart choice
Selecting a partner in any area can be nerve-wracking. After all, while a good choice becomes an enhancement to your business, choosing the wrong partner can do serious damage – and even if it doesn’t, it delays the benefits you can enjoy from picking the right partner. The stakes are even higher when you’re talking about the effect on a client’s revenue, which of course you are when it comes to RCM.
Be sure to look beneath the surface to get to the heart of what really matters to you – and to your clients.
This article was originally published on ZirMed and is republished here with permission.