Should you manage coding and billing in-house, outsource it completely to a third-party vendor, or just have them help you with overflow? Whatever decision you make, you’ll want to ensure it’s the right one for your agency. That’s where rightsourcing comes in. Let’s examine what it is and why it’s important.
What is Rightsourcing?
Your coding and billing operations can sometimes be met best by insourcing, which means managing it in-house. Your needs may also be best met by outsourcing all or part of your RCM to a third-party vendor. The careful judgement and execution of this decision is called rightsourcing.
Essentially, rightsourcing means taking a sensible and thoughtful approach when determining how to manage coding and billing operations. It also covers considerations for selecting an RCM partner. Some factors that are often addressed when righstourcing include:
- Availability of talent
- Financial goals
Why is Rightsourcing Important for Coding and Billing Operations?
As long as we can remember, organizations have had to make choices about what tasks to perform in-house and what should be outsourced to others. That’s why most of us don’t manufacture our own cars or build our own houses!
When it comes to coding and billing, you should always take a rightsourcing-focused approach. This doesn’t mean that you should automatically outsource. It does mean that you should consider a variety of factors when determining what’s best for your agency. Consider the following:
- Are you having trouble keeping up with changing regulations?
- Are you seeing higher than usual denials or takebacks?
- Do you have difficulty recruiting and retaining qualified coding and billing staff?
- Do you spend a lot of time managing your coding and billing teams?
- Are claims being rejected on the first pass, causing a bottle neck in cashflow?
- Do you have complete insight into your RCM operations and key performance indicators?
- Do you know what changes need to be made to improve your RCM and do you have a plan?
These may be tough topics to address. But for effective rightsourcing, you must take a non-biased view of your coding and billing processes. The ultimate goal is to determine what makes the most business sense for your agency.
What Options Do You Have?
When it comes to rightsourcing your revenue cycle management, there are typically three things you can do. You can choose to manage it in-house, partner with an RCM vendor to manage it entirely, or partner with a vendor to help you manage overflow.
Manage RCM Operations In-House
Once you’ve gone through the exercise of evaluating your coding and billing operations, you may determine that managing it in-house is the best option. If you’re able to successfully manage your RCM with a high level of accuracy and speed, then this is a great choice for your agency.
Outsource to a Third-Party Vendor
Following your RCM review, you may find that you’re seeing problems with your coding and billing operations that you simply don’t have the time and/or resources to resolve. If this is the case, you should consider outsourcing your RCM to a third-party vendor like HealthRev Partners. This will help you get back on track, ensuring that your agency submits accurate, timely claims for maximum reimbursement.
Outsource Overflow to a Third-Party Vendor
Maybe your biggest challenge is keeping up with volume. If you don’t want to, or need to, go “all in” with a third-party vendor, that’s great! You can work with a RCM vendor to help you manage coding and billing overflow or on a PRN basis. This allows you to keep your coding and billing operations in-house but gives you the flexibility to get the help you need, when you need it.
How HealthRev Partners Can Help
We’re passionate about securing the success of home health and hospice agencies nationwide. We’d love to consult with you about your coding and billing challenges, needs, and objectives. We can help guide you through the rightsourcing process to determine how you can best accomplish your goals and achieve success.