HAP Radiology Billing and Coding Blog

How to Choose a Radiology Revenue Cycle Management Vendor - Part 2

Posted: By HAP USA on September 30, 2016

Our first article in this series provided a list of questions to ask when evaluating a professional services Revenue Cycle Management (RCM) vendor for your radiology practice.  If your current RCM vendor cannot answer all of them positively, it’s time to look for a new vendor.  With a large number of RCM companies available in the market, how should you decide which one to choose?


Your colleagues in the same specialty should be happy to tell you about their own experience with their RCM vendor, and several names will quickly rise to the top of the list of answers. Some might quickly fall to the bottom of the list as well! And don’t be surprised if you hear vendor names that are unfamiliar from colleagues who have taken up practice far away from your office.  Many of them may have trusted relationships with billing companies that are well-established but more regionally known.  


Similarly, a vendor that is nationally recognized is not necessary unless you happen to be in a multi-state practice. Working with a vendor that is familiar with the reimbursement trends of the payers in your state is always a plus.  However, don’t discount the benefit of new perspectives that a vendor from outside of your region can potentially bring to your practice.  It’s possible that a state-specific payer issue that your practice is dealing with now could be one that a vendor from outside the region has already addressed.


In narrowing down the field, look for vendors that have expertise in your specialty and practice configuration. If you are in a large group, find out if the vendor has experience with large group practices, including all of the imaging modalities and sub-specialties your practice includes.  Interventional radiology and radiation oncology present their own unique challenges, so be sure the vendor has the depth of experience in these areas if your practice requires them.


Radiology is different from other clinical specialties when it comes to the process of data collection, coding and billing. Whereas many physicians provide their own coding for office visits and procedures, radiology derives much of its coding indirectly through data capture systems and behind-the-scenes coders examining the consultation reports.  A radiology practice that is solely hospital-based will have different needs from those of an imaging center.  A thorough understanding of billing for a variety of radiology practice configurations is a must for the RCM vendor to do a good job. 


Once you have narrowed the field to those vendors with the experience you need for your practice, our list of questions is a good resource to use to start the detailed evaluation process. Develop a checklist that will allow you to compare the responses across the vendors you select to interview.  Some will stack up better than others, allowing you to eliminate those with poorer responses.


As part of the interview process, vendors should offer to review your current practice billing statistics and offer comparisons to industry benchmarks so you can evaluate where your practice stands. They should also be able to provide a range of statistics that they think are attainable for your practice’s unique situation.  Find out how they will be able to improve your practice’s results.  Ask them to be specific about potential gaps and how they would fix them.


With the advent of the Merit-based Incentive Payment System (MIPS) for Medicare, a vendor that understands how to accomplish all of the tasks required under this program is essential for your practice to maximize Medicare reimbursement. This is another area where radiology has its own special needs.  A RCM vendor that has successfully reported its clients’ data under the Physician Quality Reporting System (PQRS) will most likely be in a good position to help you achieve success with MIPS reporting as well.  Seek out vendors that use a report card approach to keep your practice apprised of its quality reporting progress throughout the year, so there are no surprises at the reporting deadline.  There may be other value-added consulting services the vendor can provide, such as assistance with compliance plans, strategic planning and other practice management services.


Certainly a major factor in the decision to hire one RCM vendor over another will be the cost of the services. Most often this is quoted as a percentage of net collections, which means that the vendor has the same incentive as the practice in performing its services.  The more revenue they collect, the better off both parties are.  When considering a change of vendors, it will be important to analyze what the expected increase in collections will be based on the improved processes the new vendor will bring to the practice, and consider this in comparison to what might be a higher cost for those services. There should still be a net benefit to the practice.  Be sure to ascertain what is included in the basic fee and which services might carry an extra charge when comparing vendors.


The process of identifying, interviewing and selecting a Revenue Cycle Management vendor for your practice can be a fairly long and complex undertaking. Form a team within the practice that is willing to be committed to the task and possesses the level of detailed understanding that will be required to conduct the RCM vendor evaluation.  If the practice has staff members who are responsible for management or revenue, it would be a good idea to include them along with one or two physicians who are knowledgeable about these matters.  A smaller group will be most effective at keeping the process moving forward.


Remember our story in Part 1 about the RCM vendor who took the extra steps to analyze the data and solve a problem that benefitted everyone involved?  The right RCM vendor will become this type of valued partner whose interests and goals are aligned with those of your practice. 


Related articles:
How to Choose a Radiology Revenue Cycle Management Vendor – Part 1

Why Outsource Revenue Cycle Management?


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Topics: radiology reimbursement, radiology billing, radiology coding

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