Medical Billing Offshoring Challenges: Why Work Keeps Coming Back from India If you’ve heard the expression “what happens in Vegas, stays in Vegas,” there might be an RCM analog: “what happens in India, stays in India”—or at least, it should. Nearly every medical billing company with offshore operations faces a common set of medical billing […]
The Red Flags Rule in RCM: What You Need to Know (…And Do) Most revenue cycle management companies focus on HIPAA compliance, but many overlook another critical federal regulation: the Red Flags Rule in RCM. This Federal Trade Commission (FTC) requirement is designed to prevent identity theft and fraud—and it has significant implications for medical […]
Improve Profitability: Medical Billing Sales Contracts and SOWs There’s a critical aspect of the marketing and sales process that’s rarely discussed in the medical billing industry but has significant implications for operations and profitability. When securing new clients, many billing companies fail to clearly define what their services actually include. This oversight in medical billing […]
Medical Billing Performance KPIs: Ignore Bad Industry Advice One of the most frustrating aspects of working in revenue cycle management is encountering guidance about medical billing performance KPIs that’s long on buzzwords but short on substance. Recently, I came across a whitepaper from Waystar called “Seven Steps to Sharpen Your Healthcare Revenue Cycle” that perfectly […]
RCM Acquisition Metrics Mergers and acquisitions activity in the revenue cycle management (RCM) space remains robust, with private equity firms and strategic buyers constantly evaluating potential targets. As someone who regularly works with PE groups and RCM companies pursuing growth through acquisition, I’m frequently asked about the most important RCM acquisition metrics to consider during […]
RCM Pricing: Low Rate Clients – Are They Even Profitable? The revenue cycle management industry shows remarkable variation when it comes to RCM pricing. I’ve observed dramatic differences—easily double or more—between competing vendors and even within the same company’s client portfolio. This pricing inconsistency raises an important question: Are low-priced RCM clients actually profitable for […]
HBMA Webinar – “Building an RCM Technology Powerhouse: Starting with Denials” There is so much opportunity in RCM technology…You could set up interfaces to get data from your clients, build a practice management system for billing, create a killer analytics platform, or even develop an AI solution. Excited to announce my upcoming webinar for the […]
In our last podcast, we discussed revenue cycle management (RCM) departments or companies that operate like body shops, impacting overall RCM performance. This applies whether they are in-house departments or external RCM companies, and it isn’t directly related to pricing, although we did suggest some ways this could manifest. Body shops are organizations that throw […]
Body shops in RCM are a subject that I’m very interested in and something I’ve seen not change tremendously, unfortunately, in revenue cycle management over the course of the last few decades. I can’t say I know the complete history of the origins and the early stages of the revenue cycle management industry. In fact, […]
I’m constantly impressed by how bad the data is in healthcare IT systems. We’re encountering one of these clinix data integrity issues again today, and they seem to pop up all over the place. You could consider these to be metadata issues, but in reality, they are data integrity issues. For example, there are some […]