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The RCM RFP – Ask Better Questions to Get Better Vendors

Asking outdated RFP questions related to early out processes places hospitals at risk of ruling-out prospective vendors whose technology and processes surpass legacy/status quo vendors’ abilities. In the early-out world, phrasing questions that do not adequately probe/consider/assess innovation that surpasses the current knowledge/experience base, limits bonafide possibilities to materially improve recoveries and enhance your patients’ billing experience.

 

Today’s best practices require more–they require the science of sophisticated behavioral and statistical analytics at the account level to truly understand individual guarantors’ attributes in a way real enough to determine who will pay, when they will pay, how much they will pay, and how best to elicit that payment.  By asking the wrong questions you are literally limiting your results.

 

If your RFP’s requirements are stuck in the past, you are missing out. Status quo phrasing of questions will render status quo vendors.  Here’s a look at what you are likely asking in your RCM RFPs and what you should be asking.

 

How many letters do you send? The question that should be asked is, “How many contacts with guarantors are made during your process?”. Contacts should include letters, statements, emails, texts, voicemail drops and IVR attempts. Underlying this question should be a request for how the vendor determines the type/appropriate workflow for each guarantor and the type of technology that enables the assessment to determine optimal engagement for each individual guarantor, as well as assures compliance and opt-in/opt-out capability.

 

What monthly reports do you provide? This question harkens to the old days where early-out vendors’ primary service was bad debt and when monthly (frequently late) static reports were mailed or delivered to the client. Live A/R requires live reporting….enabling the client complete transparency into every aspect of the recovery process while outsourced…at any time and in any format. A better question is, “What business intelligence tools are included with the vendor’s service?”.

 

How many accounts are assigned to each representative? This question is reflective of the traditional, old-school collection approach favored by retro-fitted collection agencies engaged in early-out work. With limited technology, the improvised solution is always to throw more bodies to accounts rather than strategy. A better RFP request would be “Explain the types of analytics and workflow automation that are integrated into the vendor’s solution to optimize patient engagement and recovery for each account”.

 

How large is your call center? Bricks and mortar are not a reflection of a vendor’s performance capability. A better question would be, “How does your call center use technology and integrated analytics to optimize patient engagement and recovery?”. Advanced telephony technology and workflow automation reduces the number of employees required to excel in the recovery process. While bull pen call centers and dated telephony require a large staff, the use of cloud-based telephony and a distributed call center allows vendors to hire staff who live in the communities where clients are located. This innovation improves patient satisfaction with the billing process and is a driver of optimal recovery.

 

Do you have a portal?  As phrased, this question fails to adequately differentiate one portal from another…and fails to assess further innovation in electronic patient engagement. Minimally, a vendor should provide a pay portal seamlessly linked to the client’s website/patient portal. But in addition, the portal should be engineered specifically to healthcare and provide a retail-type experience for the patient—access to summary and detailed charges, copies of letters and statements, the ability to establish, modify or cancel a payment arrangement, live chat with a customer representative, offer hospital financial assistance information, and the ability to request documents. A better question would be, “How is your pay portal differentiated from the competition?”.

 

Do you score accounts? This trendy question ignores the most important aspect of early out recovery, which is, how your score drives workflow. Most scoring systems assign a numeric score of 1 -10 and are heavily weighted, if not exclusively weighted, to financial institution scoring. From this information, it is typical to use one of a handful of workflows. For example, a low score may lead to presumptive charity, while a high score may rely on a statement or letter series. A truly innovative vendor will use dozens of demographic guarantor attributes to fine-tune a predictive propensity to pay with algorithms engineered to optimize an automated workflow that dynamically responds to account activity during the period the vendor has control of the account. A better approach is to ask, “How does your scoring drive workflow for each account?”.

 

How much is your fee? This question alone rules out more better-qualified technology-driven vendors than any other question…because it is frequently used as a litmus test by a screening committee who may or may not be qualified/knowledgeable enough to assess a fee. The better question is “What is included in your fee  and how do you assure the greatest net gain to my bottom-line?”? Many advanced vendors integrate processes to streamline efficiencies, improve the patient experience and increase recoveries…these include functions that are required in recovery, whether the client buys bolt-on tools/services or uses multiple vendors to approximate the functionality of an advanced vendor. For example, does the fee include propensity scoring, letter and statement generation/mailing, returned mail processing, skip-tracing, merchant fees, lockbox service, business intelligence analytics, pay portal, implementation, custom programming, etc.? A true fee assessment requires an apples-apples comparison of services, not a simple percentage comparison…failure to perform a cost analysis is very expensive.

 

What other clients do you have in my city/state? Ostensibly, this question is asked to gauge a vendor’s familiarity with the demographics of the community surrounding a facility and experience with any provincial regulatory requirements imposed by the state. An unintended consequence of a vendor’s negative response is that the selection committee may pass on the vendor, who may possess superior technology, but may be a growing company new to the territory. The better question would be, “What technology do you use to identify, remain current on, and assure compliance with local, state, and federal rules and regulations related to billing self-pay recovery?”. An appropriate and differentiating follow-on question is, “How does your company assess service area guarantor demographics?”.  Leading-edge innovative vendors use advanced analytics to assess a hospital’s historical data to draw a true profile of a facility’s service area and its patient base, providing much greater accuracy that the subjectivity derived from having another client in the same city or state.

 

Conclusion

 

Status quo questions deliver status quo vendors which renders status quo results. RFPs are issued to solicit new vendors because next-level results are desired. Don’t be caught asking questions that trap a technology-driven vendor in an old-school mind-set limited to status quo responses.

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