What is RCM vendor evaluation? 

RCM vendor evaluation is a systematic process healthcare organizations use to assess and select a suitable revenue cycle management (RCM) software vendor. This evaluation involves five key steps: 

1. Initial research to identify potential vendors based on their reputation, experience, and offerings. Juxtapose vendor strengths with organization needs. 
2. Request for proposal (RFP) to gather detailed information about each vendor's capabilities, pricing, and implementation timelines. 
3. Demos and trials to assess the usability and functionality of the software.  
4. Reference checks to verify the vendor's past performance and client satisfaction. 
5. Technical assessment to ensure integration with existing systems and compliance with regulatory standards.
6. Final negotiations to secure the best terms and pricing. 

By following these steps, healthcare organizations can ensure they choose an RCM vendor that aligns with their operational needs, improves financial performance, and enhances patient care.

Job #1: Where to start your RCM vendor evaluation 

You can evaluate potential RCM vendors before even connecting with a sales rep. Follow these eight steps:

Job #2 before RCM vendor evaluation: Assess your goals 

When healthcare organizations begin evaluating revenue cycle management software providers, they typically have several key goals in mind. Review this list of goals so you can pick the right RCM vendor. 

Is it most important that you: 

• Maximize revenue and reduce revenue leakage: Should this be your goal, it’s critical to ensure that the RCM software vendor optimizes claims processing, reduces denials, and accelerates reimbursement cycles to maximize revenue collection. Consider how you can evaluate manage care contract performance by ranking payers based on how well they reimburse according to agreed-upon contracts. Tracking contract performance empowers healthcare organizations because it:
  
  • determines actual payment accuracy when compared with contracted terms.
  • compares the strength of payer terms relative to benchmarks.
  • models the impact of payers’ proposed rate changes before acceptance of these changes.
• Improve operational efficiency:  If you’re leaking revenue via manual errors, it’s time to look at your financial and administrative processes to determine root causes of denials, underpayments, and costs. 
• Enhance compliance and security:  Penalties are no fun, and those that have lost tens of thousands or more due to compliance breaches don’t want to face them again. If compliance is your organization’s prime directive, ensure the software options you’re evaluating adhere to industry regulations such as HIPAA and HITECH. You also need to ask for proof about its robust security measures. Protecting patient data is your responsibility now.
• Integrate with existing systems: The last thing you want to see on implementation day is glitches between your EHR and other systems and your new RCM software.  Ensure seamless integration with electronic health records (EHRs), practice management systems (PMS), and other relevant software upfront to minimize data entry errors and improve workflow.
• Improve patient experience:  Maybe your surveys are coming back saying patients are confused and frustrated about bills. In this case, you need to enhance patient satisfaction by providing clear billing communications and efficient payment processes. Put your RCM vendors' feet to the fire on how they facilitate billing and communication. 
• Leverage scale:  At the end of last year, it looked like merger and acquisition activity was set to take off. Recent tariff and inflation concerns have limited M&A activity.  Still, once more clarity emerges, healthcare will likely resume consolidation. Given the “Silver Tsunami,” of course, demand will grow as well. 

Growth is great, but it can’t come at the cost of staff and patient confusion and frustration. Evaluate RCM vendor software that can scale with organizational growth and adapt to evolving business needs, offering flexible pricing models and deployment options.

• Data analytics and reporting: Utilize advanced analytics and reporting tools to gain insights into key revenue cycle metrics and performance indicators (KPIs) and make data-driven decisions to improve financial performance.
  
  
• Reduce denials and improve cash flow: Denials are a top concern of healthcare organization CFOs and revenue cycle executives. If you’re struggling with surging denial rates, you’re not alone. Implementing denial management workflows and contract management software ensures you identify and address the root causes of denied claims, thereby improving cash flow and reducing financial losses. Manage denials today and support RCM staff with robust contract and denials management software. 

Take a quick, self-guided tour through a powerful contract and denial management and underpayments identification tool:

• Ensure vendor support and training: Customer service can make or break your organization’s revenue cycle success. In this case study, we shared how an orthopedic MSO leaked revenue because its revenue cycle management system, Experian, failed to identify key areas where payers paid less than the amounts agreed to in their contracts. The client was doubly frustrated when Experian failed to respond to customer service questions and platform issues for weeks.  Choose a vendor that offers comprehensive training and ongoing support services to ensure effective software utilization. It makes the difference between capturing better revenue and watching it disappear into providers’ pockets. 
• Cost-effectiveness and ROI: Evaluate the cost of RCM services against potential savings and return on investment (ROI), ensuring that the solution is financially justifiable. Conducting a thorough assessment of your healthcare organization's goals before evaluating RCM vendors is crucial for selecting a solution that aligns with your operational needs.  

Ultimately, aligning your RCM software with your organization's specific goals will enhance patient satisfaction, improve financial performance, and position your organization for success in a rapidly evolving healthcare landscape.

Job #3:  Conduct your healthcare organization’s needs assessment 

Provider groups, as well as healthcare MSOs and organizations, are excited to discover which vendors will improve the topline while cutting costs. But improvement, like happiness, is an "inside job." No two healthcare organizations are alike either in their opportunities or their challenges.

The  388 RCM companies RCM companies Becker’s Hospital Review recently listed all vary in strengths, weaknesses, and services.

Each of the healthcare RCM companies started by focusing on one or two of the 12 steps in the revenue cycle process. Where Infinx focused on prior authorization and moved to eligibility verification, charge capture, and coding, MD Clarity wanted to get healthcare underpayments software to providers so they could sweep in the revenue they are legally entitled to collect. This unassigned revenue can be used for new projects, acquisitions, equipment, emergencies, and more. End-to-end RCM software companies like WayStar and Experian purport to handle the entire revenue cycle but struggle to do a thorough job on each of the revenue cycle’s 12 steps individually.

With this range, RCM vendor evaluation requires thorough self-evaluation before evaluating revenue cycle management (RCM) vendors. Document where you fall on each of these five parameters: 

3. Technological infrastructure

• Existing systems: Healthcare organizations have different technological infrastructures, including various EHR systems, practice management systems, and billing software. RCM solutions rely on  integrations that connect seamlessly with these systems. Discover whether your prospective vendor uses HL7, HL7-FHIR, X-12, and/or batch processing. Work with your IT department to determine which system will cause the least interruption to your organization’s workflows and the most advantages.
  
• IT resources: The availability of IT resources and expertise varies among organizations, affecting their ability to implement and maintain complex RCM systems. You want to be able to depend on your vendor’s customer service team for implementation and ongoing support. Choose software with an intuitive user interface to streamline workflows and maximize efficiency. Ensure the vendor provides comprehensive training and ongoing support services.

4. Regulatory compliance

• Compliance requirements: Different healthcare settings (e.g., hospitals, ambulatory care) face unique regulatory challenges. RCM software must ensure compliance with relevant laws and standards, such as HIPAA, CPT, and ICD-10. Ask to interview the RCM vendor’s former clients who have had these issues. 
• State-specific regulations: Some regulations vary by state, necessitating RCM solutions that can adapt to these differences.

5. Growth and Scalability

• Future Expansion Plans: Healthcare organizations have different growth strategies, which influence the need for scalable RCM solutions that can accommodate increased volumes or new services.
  
  •  Ask about the vendor's experience in supporting growing healthcare organizations. Look for case studies or testimonials from similar clients who have expanded their operations while using the vendor's services. 
  • Evaluate the vendor's use of cloud-native solutions, which typically offer greater scalability and flexibility compared to on-premise systems. Cloud-based models allow for easier adjustments to increases in data volume and complexity without significant upfront infrastructure costs.
  • Inquire about how the vendor handles increased volumes of claims, billing, and patient data. Ensure they can maintain efficiency and accuracy even during periods of rapid growth.
  • Evaluate if the vendor offers flexible pricing models that can adapt to changes in your organization's size or billing complexity.
  • Assess the vendor's use of advanced technologies like AI and automation, which can enhance scalability by automating tasks, reducing errors, and improving efficiency.

By conducting a thorough self-assessment, healthcare organizations can identify these unique needs and requirements, ensuring that they select an RCM vendor that aligns with their specific operational, financial, and technological goals. 

Job #4: Showtime! Bring this RCM vendor evaluation question list to the demo

Take control. Use these questions to determine vendors' strengths and weaknesses, as well as its fit with your organization.

You RCM vendor evaluation of MD Clarity may surprise you

When evaluating RCM vendors, organizations should focus on scalability, technology integration, compliance, and customer support. By asking the right questions during vendor demos, such as those related to integration, scalability, and denial management, healthcare organizations can select an RCM solution that aligns with their operational needs and supports long-term financial stability. This proactive approach ensures that the chosen RCM software optimizes financial performance, enhances patient satisfaction, and positions the organization for success.

MD Clarity's RevFind contract management solution has won customer service and product awards from G2.com. Its comprehensive contract management capabilities meticulously evaluate payer payments against established contractual terms, automatically identifying and alerting staff to discrepancies. The system not only equips users with critical insights for proactive contract negotiations, but it also facilitates the recovery process for underpayments. Furthermore, it assists in pinpointing root causes of payment issues, helping prevent future revenue leakage. Its revenue modeling capabilities assess the financial impact of proposed payer rate adjustments. Provider teams model their own changes as well, generating unlimited scenarios to simulate the revenue implications of rate and term changes and combinations. The insights gained from these models strengthen the team's negotiating position and help prevent unfavorable contract modifications.

Get a demo to see how RevFind aims to be the RCM vendor that improves your revenue and lifts burdens from RCM staff. 

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