Choosing a Revenue Cycle Management (RCM) company is one of the most critical decisions a medical practice can make. Your RCM partner directly impacts your cash flow, patient satisfaction, and overall financial health. Yet, many providers find themselves in long-term contracts with companies that overpromise and underdeliver.
This guide provides actionable insights into how to select an RCM company, including key questions to ask and red flags to watch for. Whether you’re a practice manager, physician, or executive, this is your roadmap to making an informed decision.
What Does a Good RCM Company Look Like?
A great RCM company should:
Improve Cash Flow: Streamline billing processes and maximize collections.
Enhance Transparency: Provide clear, real-time reports on financial performance.
Offer Proactive Support: Address claim denials, compliance issues, and inefficiencies before they become problems.
Understand Your Specialty: Tailor solutions to your practice’s specific needs.
Critical Questions to Ask an RCM Company
Before signing a contract, ask these questions to gauge their fit for your practice:
1. What is Your Approach to Denial Management?
Denial rates are one of the most telling metrics of an RCM company's effectiveness. An experienced company should have:
A denial rate below 5%.
A defined, proactive process for resolving denials.
Real-time tracking and regular reporting on trends.
Red Flag: If they don’t track denials or provide vague answers, you may be looking at future cash flow issues.
At Sloan Medical, We…
Maintain an average denial rate of less than 4% through a proactive approach to denial management.
Monitor and analyze trends in real time using advanced analytics tools, identifying root causes of denials to prevent them from recurring. Track and group denial reason codes, create resources for payer specific billing rules and provide continuous education to our billing team and providers.
Ensure all denied claims are followed up within 24–48 hours, maximizing recovery rates and minimizing revenue leakage.
2. How Do You Ensure Transparency?
Transparency builds trust. Your RCM company should provide:
Regular reports on KPIs like days in A/R, collection rates, and denial percentages.
Access to billing data in real time through a user-friendly dashboard
Red Flag: If they provide reports only on request or lack a centralized platform for tracking performance, you may struggle to hold them accountable.
At Sloan Medical, We…
Provide detailed, real-time dashboards where you can track KPIs like days in A/R, collection rates, and denial trends at any time.
Schedule monthly or quarterly review meetings to discuss your performance and opportunities for improvement.
Customize reports to match your practice’s unique needs, so you always have actionable insights at your fingertips.
3. How Do You Handle Patient Billing and Communication?
Patient billing is often a pain point. Ask how they:
Communicate billing information to patients.
Follow up on unpaid balances while maintaining patient satisfaction.
Offer modern solutions like online payment portals and installment plans.
Red Flag: Poor patient communication or outdated technology can hurt your reputation and delay collections.
At Sloan Medical, We…
Use patient-friendly billing solutions, including clear, easy-to-understand statements and online payment options in addition to live instant messaging and live phone support during business hours.
Offer multiple payment methods and flexible installment plans to make it easier for patients to pay.
Follow up with automated reminders via email, SMS, or phone, ensuring patients are aware of balances without overwhelming them.
4. What Support Do You Offer for Coding and Compliance?
Coding errors are a leading cause of claim rejections. Ask about:
Their process for ensuring coding accuracy.
Support for regulatory compliance (e.g., HIPAA, payer-specific rules).
Experience with your specialty’s specific coding challenges.
Red Flag: If they don’t offer detailed coding support, you could face increased denial rates and compliance risks in addition to offering staff that are extensivly educated in your specialty.
At Sloan Medical, We…
Employ certified coding experts (CPCs) who are additionally certified in your specialty, ensuring a deep understanding of the procedural and anatomical complexities of your specialty
We conduct regular audits to identify coding errors and provide actionable feedback to prevent future mistakes. In the rare event of an error, we take full responsibility, promptly correct it, and implement robust procedures to ensure it does not happen again.
Stay up to date with regulatory changes, including payer-specific rules, so your claims are always compliant.
5. How Do You Charge for Services?
RCM companies typically charge a percentage of collections or a flat fee. Ask for:
A breakdown of their fees and what’s included.
Whether they charge for extras like credentialing, training, authorizations or analytics.
Any hidden fees in the contract.
Red Flag: Avoid companies that refuse to disclose all fees upfront or offer contracts that lock you in without performance guarantees.
At Sloan Medical, We…
Offer clear, transparent pricing with no hidden fees, an all inclusive price model is our most common option.
Provide flexible fee structures, including percentage-based models and flat rates, to fit your practice’s needs.
Include key services like reporting, training and onboarding in our standard packages—so you’re never surprised by additional charges.
Shortfalls to Watch For
While many RCM companies deliver great results, some fall short in these areas:
1. Lack of Specialization
If the company doesn’t understand your specialty, they may miss opportunities to optimize coding or payer reimbursements.
2. Poor Technology Integration
Outdated systems that don’t integrate with your EHR or billing software can lead to inefficiencies and reporting delays.
3. Lack of Accountability
RCM companies should be partners, not just vendors. If they avoid accountability for poor performance, it’s time to walk away.
4. Inadequate Follow-Up on Claims
Slow or insufficient follow-up on denied claims can severely impact your revenue.
How to Identify Shortfalls During the Selection Process
Request Case Studies or References: Speak with practices similar to yours that have worked with the company.
Review Their Track Record: Look for data on their average denial rate, days in A/R, and collection rates.
Audit Their Technology: Ensure their systems integrate seamlessly with your existing tools.
Ask About Onboarding: How long does it take to get up and running? Will they provide training for your staff?
Making the Final Decision
Selecting the right RCM company is about finding a partner who will work collaboratively to improve your practice’s financial health. Keep these principles in mind:
Transparency is Non-Negotiable: If they can’t provide clear, real-time data, move on.
Tailored Solutions Win: Choose a company that understands your practice’s unique needs. A one size fits all solution is no solution at all.
Accountability is Key: Look for a partner who takes ownership of challenges and provides measurable results.
Final Thoughts
Your RCM company is the backbone of your revenue cycle, and choosing the right one can make or break your financial performance. While the idea of making a change can be daunting, and you may experience some growing pains during the transition, it’s much like a medical treatment: it might slow things down temporarily, but it creates better outcomes and quality of life in the long run. Staying with a poorly performing company, however, will cause far greater damage to your practice over time. By asking the right questions, staying alert to red flags, and demanding transparency, you can find a partner who aligns with your practice’s goals and ensures long-term success.
Comments