If you are running a small medical practice, it means you have to juggle patient care with the endless paperwork, billing codes, and insurance claims that keep your doors open. Even though you are passionate about treating people, chasing payments, or decoding the codes often become part of your job.
Now, you have two options: hire an in-house team for RCM operations. Or partner with a healthcare revenue cycle management company that takes care of the operations while you stay focused on patient care.
While both options are good, partnering with an RCM company offers benefits in terms of cost-efficiency, expertise, and efficiency. Wondering how? Keep on scrolling to find out!
The Unique Challenges Faced by Small Practices
Small medical practices face financial and operational challenges when compared to established healthcare systems. For example, your small practice operates on a limited budget with fewer staff who have to handle multiple responsibilities from scheduling to claims submission. At the same time, large hospital and dental systems can hire certified coders and financial analysts to handle the entire billing department.
Here are some problems that your internal team might face:
- Constantly changing payer rules, which need continuous monitoring and adaptation
- Complex coding that needs specialized knowledge and regular updates
- High denial rates could affect your revenue.
- Staffing shortages leave your team burdened with responsibilities.
- Expensive billing software that exceeds your budget without assured results
- Compliance risks that expose you to violations and penalties
For small practices, managing billing internally can quickly become overwhelming, given the problems. That’s why many of the small medical and dental practices prefer to outsource the billing and RCM tasks to an offshore team that manages these responsibilities on their behalf.
What Does a Healthcare Revenue Cycle Management Company Do?
An RCM company handles your entire financial cycle, right from when a patient schedules a medical or dental appointment until you receive the final payment. Here are the key services that RCM companies provide:
- Insurance verification before appointments, ensuring you know exactly what’s covered for both medical and dental procedures
- Accurate charge capture and correct medical and dental coding for all services provided
- Clean claim submission (medical and dental) electronically to insurance companies
- Denial management, including investigation of reasons and immediate appeals for medical and dental claims
- Patient collections with timely statements and follow-up on outstanding balances for medical and dental services
- Performance tracking to identify bottlenecks in your medical and dental revenue cycle
- Regulatory compliance, staying current with changing healthcare regulations, payer requirements, and medical and dental coding updates
Benefits for Small Practices when Partnering with an RCM Company
When you decide to work with the RCM firm, it has the potential to benefit your practice’s financial well-being through:
1. Low Overhead Costs
When you outsource RCM, you immediately save on overhead costs. It includes salaries, benefits, and payroll taxes for the entire billing department staff handling medical and dental billing. You won’t have to spend the money allocated in the budget on staff training and further education for dental coding updates, CDT changes, or payer-specific dental policies. Equipment costs, including expensive billing software, practice management systems, dental clearinghouses, upgrades, and IT support, are also avoided.
2. Better Cash Flow
With the right experts in charge of the revenue cycle, your cash flow increases. Expert RCM companies know how to accelerate the reimbursement process for both medical and dental claims. They know how to submit claims faster and understand dental-specific requirements such as tooth numbers, surfaces, narratives, X-rays, and pre-authorizations. They are also aware of the importance of submitting the claim correctly and following up on medical and dental denials, helping increase your revenue streams in the right manner.
3. Access to Specialized Expertise
RCM companies have experts who have experience of several years in this field and have handled hundreds of clients. This implies that they have an insider understanding of complex medical contracts and dental insurance fee schedules, annual maximums, waiting periods, and frequency limitations. They also understand how to leverage AI automation technology for claims scrubbing, dental eligibility checks, pre-treatment estimate analysis, and predictive analytics on denial patterns.
4. Improved Compliance
RCM companies try to stay updated on the latest changes in the regulations. They will ensure that the billing practices adopted and implemented by them will be in accordance with the latest and current standards.They remain up to date with ICD-10, CPT, CDT codes, HIPAA guidelines, payer-specific dental documentation rules, and policy updates. This significantly reduces your risk of audits, penalties, and revenue loss.
When Outsourcing RCM Makes the Most Sense?
Outsourcing makes sense when:
- You’re planning to expand services or add new providers.
- You experience seasonal patient volume fluctuations that burden your staff.
- You lack specialty-specific billing expertise.
- You’re opening a new practice and want to start with optimized billing processes.
In-House vs Outsourced RCM: A Quick Comparison
The choice between in-house and outsourcing often depends on dental and medical practice size, budget, and your preference for control or efficiency. In fact, many practices use an outsourcing model, especially for coding or denials management. Here’s a brief comparison of in-house vs outsourced RCM:
| Factor | In-House RCM | Outsourced RCM |
|---|---|---|
| Cost | Pay salaries, benefits, and software every month | Pay based on collections or per claim |
| Setup | Need to hire and train staff, buy software | Vendor is ready to start right away with team and necessary software |
| Control | You manage everything directly | Vendor handles the work for you |
| Expertise | Depends on your team’s knowledge | Get access to billing experts |
| Flexibility | Hard to add more staff quickly | Easy to scale up or down as needed |
| Technology | You buy and update your own systems | Vendor provides all the technology |
Conclusion
Revenue cycle management is important to ensure your practice’s growth in a competitive healthcare industry. You deserve financial stability, with less administrative stress, and the freedom to concentrate on what you do best: caring for patients. A trusted RCM partner will make the complex billing into a streamlined process that protects your revenue and supports your mission.
If you’re ready to transform your practice’s financial health, contact CEC. We offer complete healthcare revenue cycle management services, specifically for small practices.
FAQs
Q: Will I lose my dental billing control if I outsource it?
Of course not. Genuine RCM companies offer transparency through their reports and updates. The control will be yours, while experts take care of everything for you.
Q: How much can I expect to save through outsourcing RCM?
Small dental and medical centers may benefit from a decrease of 30-50% on billing expenses while experiencing an increase in revenue collection. The extent of the savings varies based on the partner you select.
Q: How long does it take to transition to an outsourced RCM company?
It takes about 30 to 90 days, depending on the complexity of your practice. Your partner will walk you through each of these steps.
Q: Does the RCM company specialize in my healthcare specialty?
Some RCM firms specialize in given specialties, such as dermatology, anesthesiology, or primary care. Make sure to pick one that provides expertise in the chosen specialty.
Q: What if my patient volume varies by season?
Outsourcing RCM helps you scale easily depending on your requirements. This means your contractor will handle your RCM services according to your patient volume without adding extra expenses.