Revenue cycle management (RCM) has long been a critical function for medical groups, but rising operational costs, increased regulatory complexity, and shrinking reimbursement rates are driving many practices in the healthcare industry to reconsider how they manage it. For a growing number of practices, outsourcing all or part of the revenue cycle has become a viable solution — not just to reduce administrative burden, but to improve financial performance and create better patient experiences.
In a recent MGMA Business Solutions Podcast, Chuck Rackley and Marvin Luz of Greenway Health shared their perspectives on how RCM outsourcing is evolving — and what practice leaders should know when considering the shift.
RCM Has Changed — So Should Your Strategy
“It’s no longer just about sending out claims to a partner and hoping someone else handles it,” says Rackley, Vice President of Sales and Revenue Operations at Greenway Health. “What we’re seeing now is a much more strategic partnership that’s expanding rapidly.”
RCM outsourcing today goes beyond task-shifting within the RCM process to improve efficiencies. Vendors are expected to bring scale, technology, and specialized expertise — often in areas like AI, analytics, and regulatory management — to help practices optimize performance across the revenue cycle. For healthcare organizations facing high turnover, persistent denials, or resource limitations, outsourcing offers a way to stabilize operations.
“With a partner, you’re able to tap into that scalable team that can go up and down depending on volume,” Rackley says. “It’s much more efficient, more accurate, and most of the time these partners are better equipped to handle that every day — authorization, eligibility all the way through denial management, and bad debt.”
Start with the Patient Experience
While RCM is often viewed through a financial lens, Marvin Luz, Senior Director of Revenue Consulting, emphasizes the human side of outsourcing — starting with the patient.
“One of the things that drives patient dissatisfaction, in my opinion, is patient statements,” Luz says. “They can be confusing, inaccurate, and not timely. This trifecta not only erodes at patient satisfaction but also it contributes to potential revenue leakage for a practice.”
As high-deductible plans continue to rise, patients are responsible for more of the bill. Ensuring that financial communication is clear and prompt is essential for practices looking to protect both satisfaction and collections.
“When partnering with a revenue cycle management organization, I would recommend fully understanding their patient financial experience,” Luz says. “What are their workflows and processes and what is their philosophy on interacting with your patients?”
What to Look for in a Partner
Rackley outlined four core areas to evaluate when considering RCM outsourcing:
- Expertise: Ensure the partner understands your specialty. “Things like anesthesia and neurosurgery are not the same things as pediatrics in family practice. Just because one vendor does incredibly well with one means zero with how well they will do with the other.”
- Transparency: Avoid situations where a vendor simply sends lengthy reports with no actionable insight. “If someone’s just reporting the news back to you, that’s where deals go to die. You want someone that’s really giving insights to your business and really moving you forward.”
- Technology: Assess how the vendor uses automation, AI, and other tools to improve claim submission, follow-up, and appeal workflows.
- Price and ROI: While cost matters, Rackley warned against making price the only factor. “I can't tell you how many times Marvin and I have lost a deal because of price … It's important to mary price with what the ROI is.”
Maintaining Compliance and Control
One concern many practices have is whether outsourcing means losing visibility or control over billing. Luz acknowledged this as a common misconception.
“At Greenway, we do all our work within our client’s system,” he says. “The client system remains the source of truth for our clients. Documentation on the actions we're taking provide visibility and transparency to our clients.”
Luz also outlined Greenway’s five-step process for managing compliance with payer and regulatory changes:
- Identify changes
- Determine relevance and impact
- Document the actions needed
- Train the appropriate teams
- Follow up with quality checks
“Ensuring that billing stays aligned with payer requirements and regulations is a full-time job for a team,” Luz says.
Measuring Performance After You Outsource
Once a vendor relationship is in place, practices must establish clear metrics to monitor performance. Rackley advised using a “path to cash” framework and tracking the following key performance indicators:
- Cash collections vs. expected revenue
- Clean claim rate – ideally around 95%
- Days in A/R or % over 90 days
- Initial denial rate – typically 7-8% for high-performing practices
The Role of Technology in the Future of RCM
Technology is reshaping RCM operations, especially with the emergence of artificial intelligence and automation.
“With automation and AI, we’re able to take a lot of repetitive work and dump that to a bot,” Rackley says. “We’re seeing AI agents take scheduling from patients. We're seeing, automatic language processors really look at what a denial is and figure out what to pull from the medical record in order to submit an appeal.”
For practices, this can translate into faster payments, fewer denials, and reduced administrative costs — all without sacrificing control.
“Technology is going to continue to transform RCM,” Rackley says. “You’re going to have better control, more visibility, and better financial results — with less workload.”
What Hesitant Practice Leaders Should Know
According to a November 2024 MGMA Stat poll, 36% of medical groups plan to outsource or automate at least part of their revenue cycle in 2025. But many practices remain hesitant.
Luz offers six steps to take when considering outsourcing your practice's RCM:
- Understand your objectives as an organization
- Understand where your organization is in its financial journey
- Vet your potential partners to align goals
- Partner with vendors who understand your system
- Regularly meet with your vendor
- Communicate
RCM outsourcing isn’t a one-size-fits-all solution, but for many practices, it offers a path to financial stability, improved workflows, and stronger patient engagement. The key lies in choosing the right partner, maintaining open communication, and measuring what matters most.
Resources:
- Learn more at the Greenway Health website
- Explore Greenway Revenue Services
- MGMA Stat Poll: Outsourcing and Automating RCM in 2025
- Connect with Chuck Rackley on LinkedIn
- Connect with Marvin Luz on LinkedIn
