The Benefits of Outsourcing Your RCM

Big shifts are happening in the healthcare industry, and particularly in the business of revenue cycle management (RCM). New technology, evolving regulations, and a historical labor shortage are straining practices and providers. As practices begin to recover financially from the ongoing Covid pandemic, many are experiencing a lack of billing professionals, increasing overhead costs, and low revenue performance which directly impacts the financial health of the practice.

In-house RCM operations are complicated and expensive. Fortunately, outsourcing RCM can help eliminate this burden. By collaborating with a trusted partner to manage their RCM, practice managers and practitioners can return their focus to where it’s most needed: exceptional patient care.


Inefficient billing processes can wreak havoc on your practices’ financial well-being. Billing errors denied claims, and compliance challenges all arise from inefficient and disorganized processes. The increase in the number of days in A/R alone can erode profitability and ultimately patient care. For every dollar spent, 30 cents will never be collected by the healthcare provider. Furthermore, errors in coding and insurance requirements contribute to 20% of unallocated funds. Billing mishaps are not only stressful for your staff, but they also upset patients and hurt your practice’s reputation through a negative patient financial experience.

Here are a few important statistics to consider when trying to decide whether to outsource healthcare RCM. Denial rates drop up to 3.5%, days cash on hand increases by 30-40 days, and blended encounter rates for third party payers improve by 20%. Improving RCM can increase a practice’s financial stability. With this improvement, the practice is able to focus on other important aspects of healthcare operations.


Coding and compliance guidelines are constantly changing. It is difficult to keep up with the regular stream of updates coming from CMS and regulatory agencies. Inaccurate coding leads to documentation errors and greatly increases the risk of a claim denial. These issues can compound and ultimately lead to an external audit by a third party such as an insurance company or the federal Office of Audit Services (OAS).

Outsourcing coding, compliance, and clinical documentation can solve these problems. RCM companies are up-to-date on the frequent changes to billing guidelines. They are experts in Medicare, Medicaid, and the ACA. In addition, they have an extensive knowledge base that includes ICD-10 and CPT Codes. Instead of having to train employees, hiring an RCM provider guarantees that experienced professionals are handling revenue cycles. They invest in the best technology tools for managing revenue as well.

They will also be HIPAA and DPA20212 compliant, which guarantees patient confidentiality and consent.


Physicians need to direct as much attention to patients as possible. They commonly disconnect from the financial realm of their medical practice, because patient treatment is their priority. Administrative and financial employees are then tasked with cost reductions and increasing collections, but doctors lose touch with these background processes.

One lesser-known benefit of outsourcing RCM is that it can improve communication between doctors and financial staff. Without having to put enormous effort into staying up-to-date on the latest industry information, physicians can get a better view of what is happening behind the scenes at their practice.


Outsourcing RCM to a trusted partner is one of the best strategic decisions a practice can make today. Having a trusted partner manage your coding, compliance, communications, and billing processes will make your life easier. It will free up vital staff resources that can be allocated towards improving patient care outcomes. Additionally, it will maximize your ability to serve patients and capture revenue from each of those interactions.


We are Revenue Cycle experts. RCM is our only business and it’s something we are passionate about. If you are thinking about outsourcing, think about PRL. We handle the end-to-end revenue cycle management for practices and large hospitalist organizations that offer a different approach to RCM outsourcing. PRL is not just another plug-in vendor, we become part of your team, working with you every day to improve your financial health. Give us a call and talk to us about our RevCycle Ecosystem approach, chances are we’ll collect a lot more money for you, and save you money as well.

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