Physician with calculator and laptop

The New Ambulatory RCM Space

Historically, KLAS has had the ambulatory RCM segment open only to core technology vendors. This year, we opened up the segment to focused services vendors like R1 RCM and Bolder Healthcare, who don't create EMRs or PM systems. This adjustment revealed some very interesting insights and aha moments.

In allowing those vendors into the category, we didn’t necessarily expect a performance disruption, but that is exactly what those vendors brought to the space. They set a new bar for performance and delivery of RCM services. This change and other changes to the segment have been compiled into KLAS’ newly published Ambulatory RCM Services 2020 report.

Raising the Bar

These incoming vendors are very focused on delivering services. They are coming from the acute space, so they also do acute billing. They are taking that expertise and moving it into the ambulatory space, which makes sense. It is notable that they can deliver at such a high level for ambulatory because there are some distinct differences. A very focused revenue cycle delivery model has probably been the biggest factor in their success.
strength of partnership vs overall score

Missing the Bar

One of the biggest trends we are seeing in the broad market is inconsistency. Ambulatory RCM services is a tricky space that involves delivering billing services across multiple specialties. There are geographical nuances and variances in specialties. How do you submit claims correctly? How do you maximize revenue? If a model isn’t dialed in, there will be inconsistency.

We also see a lot of gaps created by turnover of knowledgeable staff members, which in turn creates inconsistency in delivery. There is also inconsistency generated from offshore support. A lot of service is going to India and other countries where it is simply cheaper to outsource. Moving offshore, however, often creates language barriers, training issues, and knowledge issues. It's very common for vendors to struggle with inconsistency in that area.

The Current Space

Because of the changes in the space, providers can use the report to see who is still offering RCM services. There have been some acquisitions and some divestments. Not all the players around last time are around this time; some vendors are getting in, and some vendors are getting out.

Who are the vendors? How are they performing? Who is delivering consistently? Who is delivering key pieces for RCM? And what mergers and acquisitions have taken place that have shifted the space? We highlight this information in the report.

If you are losing money each month, if you feel that your vendor is throwing everything back on you and that you are doing all the work, or if you feel that you just don’t have the partnership for success that you expect, now might be a good time to look at what new vendors or new solutions the space has to offer by reading the full report.

     Photo Credit: Adobe Stock, thicha