6 Questions to Ask When Shopping for Revenue Cycle Management

Purchasing an RCM solution only to have “buyer’s remorse” later is never an ideal situation. But it happens. Over my career, I’ve learned exactly how it happens – and what questions should have been asked early in the buying process to avoid it.  

While many of these questions may seem “obvious,” it’s all too common that they’re overlooked – or not given enough attention. It’s essential to clarify what you need most from revenue cycle management software, ferret out hidden costs, and avoid other potential missteps – like not recognizing that RCM pricing is more than a flat percentage rate.  

One of the most common ways customers evaluate RCM solutions pricing is by the flat percentage rate charged. And yes, this percentage is important, but the true cost of a solution can go much deeper.  

For example, a vendor might provide an amazingly low rate only for you to find out later that you’re paying double what you should for statement printing, support is impossible to receive, and your internal team is still stuck reworking claims.  

As you shop, here are a few questions to put at the top of your list.  

• What is the cost for statements? I’ve seen vendors charge double the industry rate for statements while charging a super-low percentage fee upfront. As a result, it’s important to ask the charge for printing and sending your statements.  

• How much do credit card transactions cost? I often notice customers getting hit twice for the same credit card transaction, once for processing the transaction and then for a percentage of the total transaction. For example, you might be charged $0.75 per transaction plus 1.7% of the total amount. Look for RCM software vendors that only charge you once.  

• Will your team work on our older accounts receivable? If so, is that included in the flat percentage? If a vendor won’t work on your old AR, that means it’s back on your internal staff’s plate. Often one of the many reasons to outsource is to lighten your internal staff’s workload, so this is something to consider. And if the cost is not included in that flat percentage rate, what is the cost for adding this service?  

• Do you rework claims denials? I see practices lose huge amounts of revenue because of not fully reworking claims denials. When shopping for a new vendor, ask if they’ll rework older claims, and if so, at what point do they stop working them? Some RCM services won’t work down older claims at all or won’t work anything under a certain amount. For example, one major EHR/RCM company won’t work on anything under $200.We include that service in your flat percentage, so everything is a straightforward and transparent price.  

• Where is your staff located? Regulations are changing, and offshoring billing is no longer allowed in some jurisdictions. Know your local requirements, and make sure your partner companies comply with them. And even if offshoring is allowed, I often hear from clients who say, “I can’t get ahold of anybody” or “They said they would fix this issue, but it still hasn’t happened.” Local teams are often easier to reach and can be more responsive.  

• What happens to our pricing at renewal? Some RCM vendors will give you an amazing introductory price only to have that price increase significantly at your renewal date. If you get a super-low rate, ask about what happens at your renewal.  

In addition to the considerations above, you’ll also want to evaluate your EHR solution. Are you happy with it? Often practices adopt an EHR system because it’s what their biller uses, but it’s not a great fit, and causes staff frustration. If you’re going to make a revenue cycle management software switch, it’s a great time to reevaluate an EHR system that no longer serves you.