Revenue Cycle Expertise Gaps Might Require Looking Externally

Revenue cycle management has grown to an unmatched level of complexity in recent years. For most organizations, this has meant increased needs for training and improved hiring processes – but is it possible there’s a limit to the effectiveness of these tactics?

If you take a close look at the requirements of many revenue cycle roles, you’ll likely find something interesting. A select few are so complex, that they require looking outside the organization for expertise to access a higher level of performance in revenue cycle management services. These are typically positions that have one or more of the following characteristics: 

• Inherent hyper-complexity and regular, significant disruption 
• Nuances that reflect influences from all phases of the revenue cycle
• Requiring in-depth foresight and proactive responses

This includes roles like denials management, prior authorization, and medical coding, especially risk adjustment coding. These roles require extensive subject matter expertise and while these can be developed and maintained in-house, it’s worth considering a different approach. 

For example, look at the positions in your revenue cycle that require the most subject matter expertise and reframe them – automatically classifying them as having higher potential for success through leveraging outsourced revenue cycle management services. By taking this perspective, you’ll start from a position that allows you to focus your resources on simpler, easier-to-maintain roles, and pass off hiring and training responsibilities to a revenue cycle management company. 

This is an especially pressing issue as confusion emerges as a result of payers changing processes and requirements. In the ambulatory space in particular, providers are experiencing increases in A/R days, denials, appeal processing time, and effort getting payer guidance on coverage. A recent KLAS report has revealed that providers are facing increased pressure to manage claim cycles in the midst of staffing shortages on both the payer and provider sides. Two out of three respondents to the survey indicated this dynamic has influenced their decision to outsource revenue cycle services [1]. 

As we close out 2023, and challenges around staffing, remote work, and training and education continue to increase, I encourage all revenue cycle leaders to take the time to identify expertise-intensive roles. Now is a time to start short listing partners to avoid the knowledge and competence deficits that can crop up when you default to taking on the most investment-intensive revenue cycle roles on in house. 

You might find that the specific roles that are the most challenging are particular to your organization, but regardless, you can see a new level of success by approaching this from an “outsource first” perspective that you might not have considered in the past.