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How to Decide if RCM Outsourcing is Right for You

How To Decide If RCM Outsourcing Is Right For You

Medical billing is a rapidly changing industry that is constantly evolving. New payment models are continually increasing the need to upgrade your technology. Outsourcing is a great option for some practices, but for others, it is best to keep billing in-house. But how do you decide if RCM outsourcing is the right choice for you?


Quite possibly one of the biggest factors in the decision of whether or not to outsource is the cost. Consider the cost of in-house billing. How much does it cost to pay your staff members? What is the total of their salaries, health care benefits, taxes and training?  You also need to take into account the cost of both the software, including its upfront costs and the costs of upgrades, as well as the hardware costs.

On top of all of that, how much does direct claims processing cost? What are the clearing house fees for claims? And then, finally, you need to take into consideration how much your practice actually collects and compare it to the total amount that is billed out to your patients. Once you have this total, compare it to the cost of outsourcing to a reputable RCM vendor.

Billing Process

Consider your billing process. How efficient is it? Inefficient billing processes are those in which your collections decrease while the time it takes to receive your money increases. Oftentimes, third party vendors can decrease the amount of rejected claims as well as the amount of time it takes to get paid.

Turnover Rate

A high turnover rate can be extremely detrimental to the billing process. When you constantly have to train new staff, not only does it cost you more money, it can also severely slow down the entire process. If you’re always bringing in new people just as the ones you previously trained have finally gotten into the swing of things, you might never catch up.

The Age of Your Practice

If you are a new provider, you already have enough on your plate without having to worry about billing. It can only add more stress, especially since you need to worry about getting established all the while trying to find and train qualified employees and make sure they’re a good fit for your practice.

Practice Focus

If you want to be a totally patient-focused practice, and provide the quality care you’ve promised, you might want to consider RCM outsourcing. Having to always worry about billing can take the focus away from your current patients while you try to figure out how to collect from your previous ones. This can hurt your reputation, and result in lost revenue.

Size of Practice

A large practice means lots of patients. A lot of patients means a lot of accounts. With a higher number of accounts, there’s a greater chance of mix-ups and honest clerical mistakes, no matter how good your employees are. Having to deal with such a large number of accounts, as well as any mistakes that may occur, once again takes the focus away from your patients.


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