Caitlin Clement|7/20/2023|3 min read

The 6 Benefits of Outsourcing Your RCM for Telehealth

On the Fence? Here are six reasons outsourcing your RCM for telehealth is worth it

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Telehealth and its services are very new to the healthcare industry, which means so is the way its coded and billed. So new, in fact, that congress is still debating the permanent telehealth flexibilities that will set industry wide standards and solidify its placement within healthcare. 

In the meantime, virtual care companies and service lines have to navigate and adhere to various state RCM regulations, payer enrollment processes and licensing and credentialing requirements. Without the right revenue cycle management team, you can be faced with more denials and decreased quality of care for patients.

Besides the current, temporary telehealth flexibilities put into place until 2024, telehealth regulations have largely been left up to the states and payers. By outsourcing revenue cycle management solutions, you’ll have access to a team of experts dedicated to the intricacies of telehealth billing. Below are six ways you’ll benefit from outsourcing your telehealth company’s RCM.

1. Proven expertise in telehealth coding and billing

Telehealth billing and coding can be complex, as it involves understanding and applying specific coding guidelines and reimbursement rules. These rules and guidelines can also vary from state to state and payer to payer—making it difficult to expand your patient pool nationally while staying compliant.

Outsourcing your RCM to reimbursement and billing experts with specialized knowledge and experience in telehealth ensures accurate and compliant billing, reducing the risk of claim denials and revenue loss.

2. Intuitive technology infrastructure and integration

Outsourcing RCM for telehealth allows organizations to leverage a third-party vendor’s existing technology infrastructure. This includes telehealth-specific billing software, electronic health record (EHR) integration, and secure payment processing systems. 

It eliminates the need for healthcare organizations to invest in and maintain their own technology infrastructure, which requires a huge allocation of resources. This is especially advantageous for more rural hospitals and clinics where access to RCM experts can be limited. 

They can also identify ways to optimize your RCM technology into a single, end-to-end solution. With much of the digital health space focused on creating more interoperable systems, finding a core solution is going to be key to future scalability. 

3. Up-to-date regulatory compliance

Telehealth billing and RCM must comply with specific state-by-state regulations and payer policies. Outsourcing RCM to third-party experts familiar with telehealth compliance requirements ensures adherence to regulations such as HIPAA, as well as payer-specific guidelines. This helps minimize compliance risks and potential penalties.

4. Cost efficiency and decreased claim denials

Outsourcing RCM for telehealth can result in cost savings for you and your patients. It eliminates the need for healthcare organizations to invest in technology upgrades, staff training and dedicated resources for telehealth billing and RCM. They often operate on a scalable pricing model, allowing organizations to pay for services based on their telehealth volume and needs.

Also, third-party RCMs can analyze medical coding, documentation and billing data to identify potential issues or errors in claims before submission. Using industry leading technology, they can flag missing information, coding discrepancies and potential denials, allowing time to address these issues proactively, reducing abandonment. 

Essentially, outsourced RCM teams have more time and resources to work claim errors, denials and manage appeals. Appeal management includes: 

  • Evaluating why it was denied

  • Sourcing the required information

  • Resubmitting claims within required periods of time

5. Maintained focus on patient care

By outsourcing RCM, healthcare organizations can redirect their resources and attention to patient care and deliver high-quality telehealth services. The administrative burden of billing, claims management and revenue cycle functions is shifted to the third-party vendor, allowing internal staff to focus on patient engagement, clinical operations and improving the telehealth experience.

By opening up resources to focus on higher-quality patient care, telehealth companies can expect to see better quality outcomes as well. Freeing up those resources means providers can focus on their patient, diagnose and treat faster, reduce follow-up visits and see more patients as a result. 

6. Faster billing, payments and revenue generation

Streamlining your RCM process by outsourcing an expert third-party RCM team can lead to faster claims submission, improved denial management and timely payments. This helps optimize revenue generation for telehealth services, improving the organization's financial performance and stability.

Additionally, having a dedicated team of coding and billing experts can bring your claim rate accuracy to nearly 100%. That means bringing in the kind of revenue that allows you to invest in up-to-date health technology and practices, enhancing patient care and health outcomes.

Powering end-to-end RCM solutions for telehealth

If you are looking to maximize your claims and billing efforts, offload your RCM to proven virtual care experts like OpenLoop! Our team of proven experts utilize intuitive telehealth technology customized for your business and reimbursement needs. Our end-to-end RCM service is built to improve workflows, decrease denials and offer complete flexibility from first visit to final payment. We also specialize in telehealth specific billing and coding for your virtual care practice. 

Interested in what we can do for your organization? Get in touch here!

Our full suite of white-labeled Telehealth Support Services include: