Health care is one of the most bureaucratic, overly regulated industries. Not only do government regulators have a number of rules and guidelines, but private insurance companies have tremendously complicated billing procedures. They are seeking any possible excuse to deny a claim and have created a byzantine billing system to reduce claims and make the process as complicated as possible. For that reason, more and more firms are choosing to go with a Healthcare Business Process Outsourcing firm to expedite their processes and improve the business. There are several things to look for and a few key benefits of using a BPO firm.
Efficiency and Cost Reduction
The most obvious reason to choose a BPO firm is the cost of creating an internal division versus outsourcing it to an expert firm with a team to tackle the task. The BPO firm has perfected their process and will cost less to perform it. They have invested in the technology and personnel who know how to work extremely efficiently to process a large volume of work in a short amount of time with a relatively low cost. While they take some profit for themselves, the total will still be less than for a company to set up their own unit. Those units require expensive managers, staff, office space, benefits and technology. Unless it is a giant chain of hospitals, the internal unit will not be able to achieve the scale that a BPO provider could. For that reason, the efficiency and cost reduction gains will be massive.
The chosen BPO firm must have the necessary knowledge to complete all of the tasks assigned. The regulations around health care are changing constantly due to updated HHS regulations. Additionally, the Affordable Care Act set in motion a whole new set of industry dynamics around electronic health records, reimbursements and payment plans. BPO firms must be aware of these issues so that they can rapidly adjust to any issues that arise.
Critically, these firms must know the billing codes perfectly. Mistakes in billing entry could result in denied claims or much delayed claims processing. This is a huge issue for the health facility's cash flow and the patient's ongoing care. BPO firms will be more accurate at billing because they are focused 100% on the task. That means there will be fewer errors and a lower denial rate. That results in more revenue and profits for the health care provider.
Importantly, any BPO firm that you would work with must be 100% HIPAA compliant. Violating these laws results in a heavy fine and additional monitoring by the government. HIPAA regulations are extremely tight concerning how information is handled so it is crucial that firms have the appropriate security, data handling and data access protocols in place.
More importantly, violating HIPAA means loss of trust in the marketplace. It will be hard to retain clients and regain the faith of market participants. BPO firms are expert at keeping these records private due to their expertise with large volumes of information. They have mastered HIPPA regulations as well.
Transparency and Claims Management
A BPO provider applies complete transparency to the work that they do. They post their work onto an internal dashboard when it is complete so that the client firm knows what has been done. They post all of the processing that has been completed into an easily searchable database. If a claim is denied, the firm will manage the process and post status updates all along the way. This makes it easy to follow and understand for the client. That creates peace of mind and a predictable business model.
Overall, choosing the right BPO provider has never been more important. Firms are making this choice to reduce costs, improve efficiency, improve revenue and keep documents private.
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