Partnering with technology-enabled companies means health systems need not risk a large upfront investment in new solutions and integration that could also impact productivity. In addition to AI/GenAI, ideal RCM partners utilize advanced technologies such as machine learning, NLP, and robotic process automation to automate repetitive tasks, reduce turnaround time, and increase accuracy.
Clinical documentation. A few RCM companies now offer clinical teams that are fully credentialed and licensed in the U.S. to offload the documentation burden with utilization review nurses, authorization specialists, and other clinical staff. They can play a vital role in identifying systemic issues leading to claim denials. Additionally, these clinical teams can review every patient chart before service to identify PA and medical necessity documentation requirements, reducing clinician burnout and improving retention.
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RCM outsourcing and partnering. Today, more hospitals and health systems are working with experts who have invested in the right technology and processes and have deep domain expertise to align with their financial and operational objectives.
They choose to work with RCM partners who can offer a comprehensive range of services, including claims management and billing, payment posting and reconciliation, accounts receivable management, and collections, denials and appeals management, and underpayment recovery.
Hospital RCM leaders now have a choice of onshore, nearshore, or offshore options, and modular or end-to-end services aligned around outcomes, with the option to go at-risk with shared accountability. This approach provides almost immediate access to much-needed resources with opportunities for scalability.
The best RCM partners have a reputation for helping improve financial performance by as much as 10-20% across collections and denial rates. RCM leaders rely on them as trusted partners who deliver scalability, accuracy, regulatory compliance, and integrity.
Faced with rising costs, diminishing reimbursement, and increasing claim denials, providers must rethink their financial and operational strategies. Those who are willing to embrace strategic partnerships and collaborative approaches will be better able to weather any storm.
About the author: Arnab Sen is Chief Strategy Officer of Omega Healthcare, a leading provider of revenue cycle management and clinical services to US healthcare organizations. The company helps clients increase revenues, decrease costs, and improve the overall patient-provider-payer experience through a comprehensive portfolio of technology and clinically enabled managed outsourcing solutions. Omega Healthcare has approximately 35,000 employees across 13 delivery centers in the United States, India, Colombia, and the Philippines.
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