In this episode of “Med Practice Made Perfect”, host Tom Maher dissects the insourcing-versus-outsourcing dilemma in revenue cycle management (RCM) for medical practices. Maher explores the contrasting viewpoints on control, oversight, and cost-effectiveness associated with each approach. If you’re debating whether to keep your healthcare billing and coding internal or outsource it with an RCM vendor, this is a great place to start.

Tom introduces the industry debate by outlining the opposing perspectives on insourcing and outsourcing RCM services. Insourcing offers control and oversight, while outsourcing provides relief from administrative burdens and access to specialized expertise. There are challenges inherent in RCM, such as staying updated on regulations and managing talent shortages. However, he also underscores the opportunities presented by both insourcing and outsourcing, including scalability and access to advanced technologies.

There are major financial considerations involved in insourcing versus outsourcing RCM services. While insourcing may initially seem financially advantageous, hidden costs like employee turnover can impact the bottom line. Conversely, outsourcing costs vary based on fee structures and service quality. Selecting the right outsourcing partner is crucial. Trusted referrals and clear contractual agreements are essential.

Understanding your RCM partner's expertise and technological capabilities is paramount for long-term success because effective RCM requires insightful analysis. Data analytics enable practices to identify trends and optimize revenue streams. From monitoring insurance distribution to tracking referral patterns, data-driven insights empower informed decision-making.

It’s critically important to align with RCM partners who share your practice's vision. Whether opting for insourcing or outsourcing RCM services, practices must weigh the advantages, challenges, and costs. By leveraging expertise and technology, practices can navigate the complexities of revenue cycle management and drive growth in healthcare management.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Welcome to MedPractice Made Perfect, brought to you by Practicefirst Medical Management Solutions. In this episode, host Tom Maher will delve into a pressing issue affecting many medical practices: termination letters for RCM services from Optum.

Understanding the Situation

Optum recently acquired a significant portion of business from ChangeHealthcare. As part of the integration process, Optum has begun terminating contracts with practices having fewer than 16 providers. These termination notices typically provide a 90-day window for practices to find alternative solutions.

Considering Insourcing vs. Outsourcing

Some practices may consider insourcing their revenue cycle management (RCM) processes as an alternative to outsourcing. However, there are crucial factors to consider. Assessing the size of your practice and the availability of qualified staff is essential. In today's market, there's a shortage of experienced billers, making it challenging to maintain an in-house RCM team, especially for smaller practices.

Transitioning to New Platforms

Many affected practices are using the Medent platform, tied to Optum's license. Transitioning to a new Medent license, particularly the cloud-based option, may be necessary. While this transition might come with additional costs, it offers advantages such as enhanced security, centralized claims processing, and access to advanced tools.

Other Considerations

It's important to note that Optum is not the only entity divesting smaller clients. Other providers may face similar situations in the future. For practices seeking support during this transition, companies like Practicefirst offer comprehensive RCM solutions backed by decades of experience.

Support from Practicefirst

Practicefirst, with 64 years of service in the New York area and a presence in multiple states, specializes in billing, coding, and credentialing across various specialties and carriers. While we have a minimum fee for billing services, we cater to practices of varying sizes and offer flexible solutions tailored to individual needs.

Conclusion

If you find yourself grappling with an Optum termination letter for RCM services or similar challenges, don't hesitate to reach out to Practicefirst. We can provide guidance and support to ensure a smooth transition and uninterrupted revenue flow for your practice.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Starting a medical practice is a process rife with potential landmines. If caught off guard, hopeful practice owners may find themselves dealing with major delays, incurring fines, or experiencing significant revenue cycle issues down the road. 

In this insightful podcast episode, we delve into some of the key intricacies of launching a successful medical practice while giving a broad overview of the process. Host Tom Maher shares his valuable insights on the logistical planning, legal considerations, and financial aspects involved in starting a medical practice. From navigating regulatory hurdles to building a strong foundation for patient communications, this episode offers a helpful guide for aspiring medical practitioners looking to embark on their entrepreneurial journey.

Tom addresses key topics such as choosing and setting up a business entity, establishing effective patient communication strategies, and operational considerations such as office space and the hiring process. Whether you're a recent medical graduate or an experienced practitioner contemplating the shift to private practice, this podcast serves as an invaluable resource, offering actionable tips to empower healthcare professionals in realizing their goal of launching a thriving medical practice while avoiding common mistakes.

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About Tom Maher

As President and CEO of a growing organization in a complex industry, Tom Maher focuses on people: Practicefirst employees and clients. “You can’t have one without the other, and Practicefirst is successful because we take care of both.” He oversees a diverse and talented team of experienced professionals; whose collective mission is to maximize the value of their clients’ medical practices, so they can focus on the health and well-being of their patients.

Follow Tom on LinkedIn - https://www.linkedin.com/in/tom-maher-090569a/

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.