Updated: Sep 29
I will save you from having to read the entire article. The difference is in the scope of full end-to-end revenue cycle management (RCM) verses revenue cycle solutions that solve for one area. If you scour the internet, you will find numerous companies with all the options you could ever want to solve for your RCM needs. How you build or select your revenue cycle matters. If you are seeking a revenue cycle vendor, you will want to search for one that provides end-to-end management. This usually is supported by service functions of enrollment, analytics, payor contracting, legal, and provider education, etc. These full scope RCM companies often provide their services as point solution packages as well.
On the other side of RCM sales are the point solution-only companies. I mainly see these to be to support coding, analytics, AR management, denials management, cash reconciliation, and patient billing. I imagine you can chop up any component of RCM and turn it into a point solution. In my experience, the patient billing space is the most broadly sold point solution, because it crosses many industries outside of healthcare. This means that the same platform can be used to target various types of populations. The rest of the point solution spaces are more healthcare specific.
For example, you do not have to think about denial CARC code trending and appeals in clothing sales, or general sales of any large purchases, but you do in healthcare. However, in both of these sales, a re-occurring payment, or payment plan could be used to capture an individual's responsibility and allow them to set up monthly installments through the same base platform and IVR system. So, what is the value in a full end-to-end management verses point solutions along the entire revenue cycle? It is all about business structure and long-term goals of the company. If you want to find the best price out in the market, often point solutions win here. For long term goals it does pose some risks. With point solutions, you often loose the end-to-end data compatibility; the data may not link together correctly. Additionally, you may increase turn times of inventory and processes due to transfers in and out of systems where work is being done. If the company is structured to have high caliber data transformation and analytics support, then the various point solutions may not be an issue.
There is likely always going to be a blend in any healthcare organization. Most often I see the core business being RCM companies, and then those companies bringing in point solutions where they can flex. This flexing of internal and outsourced work is usually in the space of coding, which is a very common practice in healthcare. The other more often outsourced space in healthcare is IT/IS management. All those different data connections and the system infrastructure need to be managed, and smaller companies may not be able to fully support this, or maybe it just does not yet make sense for them to invest in this space. In any case, you'll have to choose the framework that works best for you and your company's goals. Keep in mind, these goals may change as the industry and company does. Be flexible with evaluating your opportunities to fit those future growth goals.
Do you want to be the best at coding?
Do you want to be the set the industry standards in customer service/patient billing?
Do you want to have the shortest AR turn?
Do you want to have the most dynamic analytics?
Do you want to provide robust provider education?
Questions like these will shape the type of RCM company you need to engage, or want to grow into yourself. Sometimes shopping for the best immediate deal will get your company up and running, while paying higher prices for full scope services may allow you to grow faster in the future when business is knocking on your door.
In either case, I hope this provided some insight to the difference between these two areas of RCM sales and support. There is no right or wrong selection, it changes, it usually is a mix. No matter the choice, you will likely have to evaluate and potentially flip or mix-up your model in a few years anyway. So just stay flexible.