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Why your agency should outsource RCM

As Medicare and Medicaid Advantage plans, VBID and EVV continue to increase in the market, they’re also bringing new billing requirements for payor setup. And while Medicaid Advantage plans are skyrocketing in patient utilization, many home health and hospice agencies lack the in-depth know-how to accurately bill for them. This knowledge gap in billing requirements can stall growth, but outsourcing revenue cycle management (RCM) can change that through:

  • Increased cash flow
  • Responsibility for staff training
  • Business continuity
  • Ability to scale quickly
  • Advanced training
  • Payor familiarity
  • Compliance management
  • Assistance with identifying and resolving EHR set-up issues
  • Industry knowledge
  • No direct management responsibility

With so many benefits, why do agencies choose not to outsource RCM?

Many home health and hospice agencies are hesitant to give up control to a third party, maybe due to previous negative experiences with outsourcing solutions. They also underestimate the true costs of RCM staffing and training since the functions are spread across multiple team members and represent only a portion of the staff’s daily work hours.

This inability to justify the return on investment of outsourcing RCM can keep agencies from scaling. They must consider the financial losses caused by poor performance such as aged AR, write-offs from unresolved denials and late NOEs and NOAs, unsupported contractual adjustments and underpaid claims — and how outsourced RCM can help.

Who can benefit from outsourced RCM?

According to Grand View Research, the US medical billing outsourcing market size was $5.2 billion in 2022 and is expected to grow at a compound annual growth rate of 11.56% from 2023 to 2030.

The market for outsourced RCM is clearly on the rise, but who benefits? Home health and hospice agencies that are experiencing:

  • Staffing turnover in skilled, certified positions
    Many small to mid-sized agencies do not typically have back-up staff with the necessary training and knowledge.
  • Payor audits and regulatory compliance concerns
  • New leadership mindset from those with previous positive outsourcing experiences
  • Cash flow issues
  • A new EHR or lack of system knowledge

Connect with us to learn how we can help you accelerate reimbursement and maximize cash flow.

See what MatrixCare can do for you

Jeremy Crow

Jeremy has been employed as the Director of Revenue Cycle Services since January 2020. He possesses extensive expertise in the Healthcare Information Technology field, specifically in Home Health and Hospice, spanning over 25 years. Throughout his career, Jeremy has collaborated with Fortune 20 and private equity companies, specializing in project management, training, consulting, custom technical services, and overall professional services operations. He has successfully overseen multinational teams, introduced new services, and facilitated the integration of acquisitions. Jeremy holds an MBA from Washington University in St. Louis and has been PMP certified since 2004.

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