How Much Do Healthcare RCM Services Cost?

Revenue Cycle Management (RCM) is an essential component of the medical practice or healthcare organization, and it encompasses the management of financial transactions between patients, providers, and insurance companies. RCM is a complex and time-consuming process that requires expertise and specialized knowledge of the medical specialty. As a result, many medical practices and healthcare organizations outsource their RCM services to third-party service providers.

Typically, for a successfully running solo medical practice these services can cost between $3,000 and $6,000 per month. This cost depends on size of the practice or facility, the type of services rendered, and the number of patients treated. Usually, the RCM cost is a fixed fee calculated as a percentage of net collections generated from the claims adjudicated by the payers.

In this blog, we will explore the vital factors that can impact the cost of healthcare revenue cycle management (RCM) services. Some of these factors include:

Scope of Services

The more comprehensive the RCM services required, the higher the cost is likely to be. For example, if a healthcare provider needs assistance with everything from insurance verification, prior-authorization, to claims management, coding validation, AR follow-up, denial management and financial reporting, the cost will be higher than if they only need help with claims management.

Size of the Healthcare Organization

The size of the healthcare organization plays a significant role in determining the cost. For example, a large hospital system with multiple locations and specialties will likely require more resources than a small physician’s office.

Complexity of the Medical Practice Specialty

The more complex the medical practice specialty, the more time and effort it takes to manage the revenue cycle effectively. For example, a multi-specialty practice with high patient volume and complex billing processes will require more extensive RCM services, resulting in higher costs.

Technology Tools

The use of Electronic Health Record (EHR) and Practice Management (PM) software and related technology tools improves efficiency however they can add to the cost of RCM services. For example, a decent EHR-PM software can cost $500 to $800 per billing provider per month, not including the cost of mailing patient statements and filing paper claims for certain secondary payers.

Staffing

The number and expertise of staff required to manage the revenue cycle can impact the cost of RCM services. For example, if a healthcare provider requires a team of experienced billing specialists and coders, the cost will be higher than if they only need a few entry-level employees.

Outsourcing vs. In-House

The decision to outsource RCM services or manage them in-house can also impact the cost. Outsourcing can be more cost-effective in some cases, as it eliminates the need for hiring and training additional staff and investing in expensive technology and tools.

Quality and Efficiency

The quality and efficiency of RCM services can also impact the cost. High-quality services that result in fewer denied claims and faster collections may come with a higher price tag but can ultimately save the healthcare provider money in the long run.

Overall, healthcare providers should carefully consider these factors when evaluating the cost of RCM services and choose an RCM services company that can offer the best value for their needs.

Although outsourcing RCM tasks may be more expensive than performing them in-house, the increased success rates on insurance claims provided by experts more than offset the higher fees. By outsourcing RCM tasks, medical practices and healthcare organizations can redirect their focus on delivering high-quality patient care, while leaving billing processes in the capable hands of third-party providers.

If you are looking for revenue cycle consulting, contact TriumpHealth. We are a one-stop-solutions company who helps medical practices, labs, facilities, and hospital systems grow by providing comprehensive revenue cycle services. Give us a call today!

How Much Do Healthcare RCM Services Cost?