Blog

Factors for Successful Offshoring of Revenue Cycle Management Services

By Ashish Kumar Aggarwal

March 29, 2023

Those considering offshoring their RCM may have questions about setting their teams up for success. The right partner will ease any concerns and instill confidence in your team by leveraging commonly used project management tools and engaging in open, honest communication.

When considering the life cycle of the engagement, here are some best practices you should watch for. Once you’ve decided to outsource, you and your outsourcing partner should work together to:

  • Clearly Define the Scope of Work in the RFP: Defining the scope of work helps to eliminate any ambiguity. For example, with A/R, what range would the RCM team work? When considering the services you expect from your RCM partner, what's in scope? Who is responsible on the customer and vendor sides? This is also a great time to define volumes so both teams can staff appropriately.
  • Define and Document RCM Partner Capabilities: During contracting discussions, it is essential to fully assess and document the capabilities of your selected RCM vendor. If this step is overlooked, it can lead to confusion and disruptions down the road.
  • Be Transparent About Cultural Differences: You must understand cultural differences and what to expect. For example, in India, people are generally taught from childhood to respect and be agreeable to their elders despite differences in opinion. This can translate to a need for more comfort with questioning or pushing back. In the U.S., people are commonly taught from a young age to question things. We are empowered to ‘do things in new ways.’ When selecting a partner with an offshore team, it’s important to familiarize yourself with cultural differences.

    At AGS Health, project managers based in India receive additional training on cultural differences. They are encouraged to ask questions and offer guidance to customers. AGS is committed to creating a more consultative team so customers can understand what systems, processes, etc., are working for other healthcare organizations. And they have a team that is empowered to engage in and guide those discussions.
  • Customer-Side Support Must Be Present: RCM is complex, and with each healthcare organization doing its RCM differently, it isn’t a ‘lift and shift’ operation. Teams on both sides must support the transition and be actively engaged throughout the project – especially during the first 18 months when processes and systems are being established.
  • Clearly Define Success Factors: What does success look like? Are these factors shared with all the appropriate team members? Aligning on success not only unites team members but also gets them working toward a shared goal and helps to keep them on track.
  • Set Clear Expectations for Measurement: It’s hard to measure progress when the teams are clear about the metrics (from the customer and vendor sides). To determine metrics, it’s important to review historical performance when setting targets.  This not only helps to ensure goals are realistic, but it aligns team members from both companies.
  • Define Productivity Expectations: Using historical performance data and feedback from the RCM Vendor, what are realistic expectations for productivity? Productivity expectations must be documented and provided in a shared location where all teams can access the information.
  • Understanding Gaps: One element of risk mitigation involves understanding gaps. For example, cracks can occur when there are cultural differences or when the next steps aren’t clearly defined at the close of a meeting. How many times have you been in a forum when everyone walks away with a different understanding of what transpired? To control these gaps, it’s helpful to have detailed documentation, including meeting notes that are shared and signed off on by both organizations. Again, the goal is to ensure that all team members are aligned.
  • During the Transition, Perform a Soft Launch: It’s essential that RCM outsourcing isn’t viewed as a ‘lift and shift’ project. Teams from both organizations need to be involved, motivated, and participating. For the first few weeks, your team needs to review the RCM partner’s work to ensure it meets your expectations. Your team members must make time for this critical step. Auditing the work for the first few weeks allows you to provide feedback and allows your vendor to make adjustments. RCM workflows are very different from organization to organization, so this is an excellent opportunity for the teams to get the project off to a great start.
  • Quality: You and your RCM Vendor need a clear and documented understanding of how quality will be scored and measured, as well as the frequency of quality reviews. Quality delivery is critical. This will help to ensure the teams have a shared view and understanding.

Collaboration is Critical

While all the above are essential for successful offshoring, other activities are equally important. These activities require both teams to work together and have open and honest dialogue.

Process documentation to capture customer workflows and how the customer's revenue cycle works is essential. Documenting Standard Operating Procedures (commonly known as SOPs) also helps to ensure full transparency for all involved. If these documents aren’t readily available, you and your vendor will need to work together to build these documents and have them approved by both parties before work begins. These types of records help ensure that, from an operational perspective, both teams are fully informed.

Factors for Successful Offshoring of Revenue Cycle Management Services

Other Critical Success Factors

When offshoring, your organization should expect to have the following team members assigned by your RCM partner:

  • Customer Success Representative
  • Project Managers
  • Transition Manager

The absence of any of these roles should raise alarms. These individuals are critical for a successful engagement.

Additionally, any new transition requires calibration. This allows the team to identify any further gaps. RCM is complex and each healthcare organization has unique team compositions and operating procedures. A commitment to continuous improvement through periodic evaluations helps the team align, address potential issues, and recommit to the goals.

Open, Honest Communication

In many instances, when people offshore, they may replace team members that possess 15-20 years of coding experience with outsourced team members who are relatively fresh in their career journey. As such, the RCM partner should perform some basic activities to ensure quality output, such as:

  • Conducting regular audits to ensure vital coding accuracy – and putting plans in place for team members who don’t hit their quality baseline.
  • Providing ongoing, rigorous training for coders to ensure they are familiar with coding changes and updates.

Day-to-Day Support

It’s essential to keep staff (on both sides) motivated and engaged. One way to do this is to tie the project’s success to individual performance reviews. If people know their merit increases depend on the success of the RCM transition, they are more likely to be motivated and actively participate. Tying team performance metrics to the project is a great way to ensure the project remains a priority.

Additionally, for RCM vendors, it’s essential that project managers be clear about the importance of customer satisfaction.

Having a value mindset needs to be top of mind for everyone involved in the project.

The Value of Meetings

Regular meetings help teams discuss progress, address challenges, remove barriers, review metrics, and share concerns. Engagement in all aspects of the project, beyond the metrics, is essential. This is a great time to review processes, KPIs, and leading indicators.

Monthly business reviews provide opportunities to review performance data and discuss how the past month’s performance is measured against expectations.

Strategic quarterly meetings that involve leaders of both companies are also critical. During these meetings, it’s critical to discuss:

  • Industry trends
  • Any changes to your organizational strategy
  • Organizational changes that could have a significant impact on the work being done
  • Priorities

Conclusion 

With all these elements in place, you can rest assured that your team and your RCM partner will be on a path to success. The most important element that everyone must agree on is having a team mindset. Don’t treat your outsourced partner as a vendor. Best results are often delivered when vendors are treated as an extension of your team. A team mindset will help everyone stay motivated and view the project as a priority.

Ashish Kumar Aggarwal

Author

Senior Vice President – Operations and Process Excellence