A Revenue Cycle Management (RCM) company handles the billing processes for healthcare entities, such as private practices, hospitals, and specialty clinics. The revenue cycle can be outsourced in part or in whole and includes:
- Patient pre-authorization
- Eligibility and benefits verification
- Claims submission
- Payment posting
- Denial management
- A/R follow-up
- Reporting and analytics
Should You Use an RCM Company?
The healthcare billing landscape continues to evolve, requiring expertise in regulatory compliance, payer requirements, and advanced billing technologies. Many practices struggle to find and retain qualified staff with the necessary skills to manage the complexities of revenue cycle management. An RCM company can help by offering specialized expertise, automation, and strategic insights to improve financial performance.
To determine whether outsourcing your revenue cycle management is right for your practice, consider key performance indicators (KPIs) that reflect the health of your billing operations:
Key Revenue Cycle Performance Metrics
- Days in A/R – Measures the average time it takes to collect payments due.
- Optimal: Less than 30 days
- Average: 30 to 45 days
- Poor: More than 45 days
- Percentage of A/R greater than 120 days – Indicates the proportion of accounts receivable unpaid after 120 days.
- Optimal: Less than 10%
- Average: 10-20%
- Poor: More than 20%
- Adjusted Collection Rate – The percentage of total reimbursement collected after contractual adjustments.
- Optimal: 99% or higher
- Average: 96-99%
- Poor: Less than 96%
- Denial Rate – The percentage of claims denied by payers.
- Optimal: Less than 5%
- Average: 5-8%
- Poor: More than 8%
If your practice falls into the poor or average range for any of these KPIs—or if you lack visibility into these metrics—it may be time to consider outsourcing your RCM. Improving these metrics can lead to significant gains in cash flow, efficiency, and profitability.
Additionally, outsourcing RCM allows physician owners to focus on patient care while ensuring the financial health of their practice. The result? Greater peace of mind and more satisfied patients.
What to Look for in an RCM Company
Not all RCM companies are created equal. Here are key factors to consider when choosing the right partner:
- Seamless EHR Integration: Your RCM provider should integrate smoothly with your electronic health record (EHR) and practice management system to ensure data accuracy and workflow efficiency.
- Domestic-Based Services: Offshoring can introduce challenges such as language barriers, time zone conflicts, training inconsistencies, and compliance risks. Choosing a U.S.-based RCM provider ensures adherence to U.S. healthcare regulations and billing best practices.
- Transparency & Reporting: The best RCM companies provide comprehensive reporting on KPIs, financial performance, and claims management. They should also offer benchmarking data to help you evaluate your practice’s performance against industry standards.
- Proactive Process Improvement: RCM companies should do more than just process claims—they should analyze trends, identify inefficiencies, and recommend improvements to optimize revenue cycle performance.
- Specialty-Specific Expertise: Experience in your medical specialty is crucial. Ask about their current clients, industry knowledge, and ability to navigate specialty-specific billing challenges.
How BlueFish Medical Can Help
At BlueFish Medical, we prioritize transparency, efficiency, and results. Our team of U.S.-based RCM experts partners with healthcare providers to optimize billing operations, reduce denials, and improve cash flow.
Why Choose BlueFish Medical?
- Seamless integration with your EHR and practice management system
- U.S.-based team with deep expertise in medical billing and compliance
- Advanced analytics and reporting to provide full visibility into your revenue cycle
- Proactive revenue optimization strategies tailored to your practice
- Performance guarantee to minimize denied and appealed claims
If you’re ready to strengthen your practice’s financial health and focus more on patient care, contact us today to learn more about our RCM solutions.
Editor’s Note: Updated February 2025