Alex Stockdale and Jim Rinker specialize in navigating rapidly changing regulatory requirements, competitive positioning, and operational efficiency. This month’s column explores how the strategic outsourcing of select operational functions can improve workflow efficiency, reduce staffing-related costs, and improve overall performance while minimizing operational complexity at organizations ranging in size from small solo practices to large group practices.

Tracy J. Kenniff, MBA, OCS

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Declining CMS reimbursement and other economic pressures are compelling ophthalmology practices and management services organizations (MSOs) to reduce costs while accommodating higher patient volumes. Revenue cycle management outsourcing can strengthen net collection performance.

THE BENEFITS OF OUTSOURCING

Outsourcing can reduce operating costs by shifting key tasks to a trusted partner, lowering overhead, improving workflow efficiency, and allowing the organization to focus on patient care. This strategy also enables scalable staffing aligned with demand and provides access to specialized compliance expertise.

EXAMPLES

A Small Practice

A little more than 3 years ago, a Northeast ophthalmology practice specializing in retina care began evaluating revenue cycle management outsourcing to support its growth. The group ultimately connected with Visionary Reimbursement Solutions (VRS), which, unlike traditional percentage based outsourcing models, offers a dedicated full time equivalent (FTE) staffing approach. The practice also required that all coding and billing personnel be AAPC certified, a standard met by VRS.

The practice partnered with VRS and currently employs two dedicated FTEs as part of its team.

A Large MSO

Revenue cycle management outsourcing can benefit large MSOs as well as small practices. In 2022, a Northeast MSO within a private equity portfolio hired VRS to manage components of the MSO’s revenue cycle and call center operations. Key outsourced functions included credentialing, preauthorizations, high-cost retina drug management, and other related tasks.

The MSO’s call center had struggled with persistent staffing shortages. By adopting an FTE-based outsourcing model, the organization gained reliable coverage 24 hours per day, 365 days per year, supported by trained backup staff who ensure continuity when team members are unavailable.

The ability to scale staffing in response to volume removed the operational burden of managing these fluctuations internally. The MSO demonstrated the value of scalable staffing by expanding from 15 FTEs 4 years ago to 98 FTEs today.

THE ROLE OF AI

AI’s role in the revenue cycle is expanding. Although many VRS clients have adopted AI tools that streamline certain tasks, the overall financial effect has remained neutral because AI expenses often offset staffing reductions.

AI can serve as an enhancement to but not a replacement for experienced professionals. The technology excels at routine, repeatable work (eg, financial analysis, meeting documentation, drafting appeals and communications), but complex issues require the judgment of skilled, trained personnel.

CONCLUSION

By shifting key functions to an external partner, organizations can reduce expenses associated with salaries, benefits, training, and office space. This approach can also provide access to trained and certified professionals, eliminating the need for internal hiring and ongoing staff development.

External experts handle operational tasks, allowing internal teams to focus on core priorities such as patient care. Organizations can quickly scale support up or down based on demand without the burden of recruiting, onboarding, or reducing staff. This flexibility can help manage growth and volume fluctuations.