It’s an often-debated topic within health care organizations: whether or not to outsource components of their revenue cycle. As much as you might like to manage all aspects of the revenue cycle in-house, you may be seeing signs that are nudging you toward outsourcing.

Key drivers behind an organization’s decision to outsource include increasingly complex payer rules and coding procedures as well as the continued decline in reimbursement from payers.

Industry experts advise that if you find yourself asking some of the following questions, it might be time for you to consider outsourcing:

In a perfect world, your claims would leave your business office “clean” and be paid promptly.

No denials, no delays, and no reductions in payment. But the world of health care providers and payers is not perfect; nor is it simple.

Increasing the number of claims that get paid on the first submission takes time, effort, and quality control. It is possible, however, to apply strategies that help reduce avoidable claim denials – those that could be prevented by your organization – and take a critical step toward improving revenue cycle management.

As a revenue cycle consultant for Zimmerman & Associates in the early 90s, I served as an analyst for the HARA report. For those of you who started your career after it was in circulation or don’t recognize the name, HARA stood for Hospital Accounts Receivable Analysis. At the time, it was the industry-leading publication that discussed healthcare billing best practices and trended major KPIs. Which brings me to my reason for this article - the GDRO benchmark (Gross Days Receivable Outstanding) for a superior performing hospital at the time was anyone reporting 60 days or less.