In or Out

If community feathers will be ruffled. Despite receiving significant ROI after outsourcing DCH's self-pay collection, Winfrey says he is hesitant to outsource any more of the revenue cycle for fear of bad press.

"In a community the size of Tuscaloosa, outsourcing is somewhat frowned upon," he says. "We are a community hospital system and we like to say we keep as many jobs as we possibly can here versus outsourcing elsewhere."

Public relations is also a concern for Crouse's Boynton, but for a different reason. Four years ago, the hospital was receiving a great deal of complaints about the national self-pay collection service it was using. It turned out that out-of-state call center workers were upsetting Syracuse locals.

"Because [the workers] were located so far from our community, they weren't even pronouncing our hospital's name correctly," she says. "When we switched vendors about four years ago, the complaints dropped drastically."

If you have internal talent. While scenarios vary, there is one revenue cycle outsourcing constant: Don't send out work if you've got the talent.

"When you have experienced, well-qualified individuals to run your revenue cycle, I think it's a bad idea to outsource because accounts receivable is your largest, most liquid asset," Winfrey says.

Boynton utilized Crouse's internal talent by creating a revenue cycle improvement group. Seven years on, AR is at 40 to 43 days, down from 60 to 65 days. The percentage of AR over 90 days is also down significantly and stays below 20% consistently. "If you have the talent within your facility and you have a working group that handles the revenue cycle from beginning to end and when there's a glitch in that cycle they can go in and attack and fix it, there just isn't the need to outsource," she says.

—Marianne Aiello