Full-cycle RCM outsourcing (sometimes called ‘full RCM BPO’) transfers all revenue cycle operations to an external vendor. This model works well for smaller hospitals, critical access facilities, or systems undergoing significant operational transitions.
Modular outsourcing — where specific functions are outsourced while others remain in-house — is more common for large health systems. Typical modular outsourcing patterns include:
- Coding augmentation: Using external coders to manage volume spikes, backlogs, or specialty-specific coding (oncology, cardiology) where in-house expertise is limited
- Denial management: Outsourcing the identification, tracking, and appeal of denied claims to a team with deep payer-specific knowledge
- Prior authorization: Outsourcing the submission and follow-up of prior auth requests to reduce administrative burden on clinical staff
- Underpayment recovery: Engaging a specialist team to audit paid claims and recover revenue from payer underpayments — typically on a contingency or project basis
- AR recovery: Engaging an external team to work aged or abandoned AR — particularly accounts that internal staff have flagged as ‘uncollectable’
The advantages of modular outsourcing for health systems: the internal team retains control of day-to-day operations, outsourced functions benefit from specialized expertise, and the relationship can be scaled up or down as volume and staffing conditions change.
Squadyen is structured specifically for modular engagement — health systems can start with one function and expand based on results.