Outsourcing is a growing trend that has become a staple in many industries.
From banking and insurance, customer services, and legal firms to travel agencies and real estate, the business process outsourcing (BPO) industry can cater to just about any sector.
Today, even highly personalized services like healthcare can benefit from outsourcing.
Outsourcing healthcare services help healthcare providers have more streamlined processes and maximize results.
They’re able to do this through cheaper labor, better infrastructure, and other advantages afforded by BPO firms.
Read on below to learn more about outsourcing health services, including how it helps health and ambulatory care providers.
Outsourcing health services: How it works
Outsourcing health services – or healthcare outsourcing – is the process of entrusting a healthcare provider’s services to a third-party BPO provider.
These processes are often back-office roles (e.g., data entry, billing, and payroll) that support the revenue-generating aspect of a healthcare organization.
However, healthcare businesses can also outsource client-facing roles, such as customer services, teleconsultation, and appointment scheduling.
These BPO providers can be located within the same country as the healthcare organization (onshore), in a neighboring country (nearshore), or even from another distant country (offshore).
Which health services can you outsource?
Naturally, outsourcing health services doesn’t cover every aspect and function of healthcare.
There are health services that require in-hospital care, like inpatient procedures (e.g., surgery, medical assessment, and drug tests).
However, processes that aren’t inherently medical – but still provide critical support for medical processes – can be outsourced to BPOs.
Below are some of the healthcare services that providers can outsource to BPOs:
Medical data entry and processing
Medical data entry and processing involve encoding medical information into a computer system.
This medical information includes patient records, insurance claims, billing codes, drug databases, and other sources.
Medical data entry and processing is also referred to as health data entry or healthcare data entry.
This process contains the following steps:
- Data verification
- Formatting and cleaning up raw data
- Entry into the database system
- Verification against coding standards and service specifications
Medical data entry and processing is the first step in the workflow that leads to the creation of medical records.
It is also used as an internal tool by healthcare organizations for various purposes, including clinical research and quality assurance.
Medical coding and billing
Medical coding and billing is the process of converting healthcare information into codes and numbers.
These converted data are then used by payers, providers, and clearinghouses to process healthcare transactions.
Medical coders analyze patient information, such as age, diagnosis, and procedure codes, to assign codes that accurately reflect the services provided.
They use this information to ensure that all claims are processed correctly by the payer.
In addition to coding, medical billers also process claims from providers for reimbursement from insurers or other payers.
They ensure that the correct amount is paid for services rendered and that any applicable insurance deductibles are met before any payments are made on behalf of patients.
Claims processing
Medical claims processing involves collecting and analyzing information about medical services provided to patients. It covers paying the healthcare providers who provide those services, and ensuring that the provider is paid correctly.
This process follows several steps, including:
- Receiving claims from patients or their insurance companies.
- Checking the claim to ensure that all the necessary information has been provided.
- Approving payment for claims that meet certain criteria.
- Issuing a check if payment is approved or sending a bill if it isn’t approved.
Medical claims processors are responsible for ensuring that all claims are processed in accordance with company policy and regulatory guidelines.
In addition, they must also be able to verify patient eligibility, determine whether or not services were necessary, and complete payment correctly when appropriate.
Electronic health records and data management
Electronic health records (EHR) are digital versions of a patient’s medical history.
They include information like test results, prescriptions, allergies, immunizations, and more.
EHRs are typically managed by registered health information administrators (RHIAs). These professionals oversee the data management systems of healthcare organizations.RHIAs often work closely with registered health information technicians (RHITs) to ensure that a healthcare facility’s EHR management is both efficient and effective.
What will you gain by outsourcing health services?
Outsourcing health services can help healthcare providers in various ways.
From costs savings to better results, the advantages of outsourcing health services are what makes it appealing to business owners in the sector.
Below are some of the benefits you’ll reap from outsourcing health services:
Costs reduction
BPO firms often have operations in developing countries (e.g., the Philippines) where labor is significantly cheaper than in developed countries, such as the US and Canada.
Outsourcing health services to BPOs in these countries gives businesses access to a labor market where talents can be hired for as much as 70% lower salaries.
BPOs also shoulder associated overhead expenses for outsourced health services providers, such as training, recruitment, and equipment costs.
Improved focus
Outsourcing health services that are more administrative than medical lets healthcare businesses focus on the health aspect.
This lets them dedicate more of their time and resources to improving the revenue-generating aspects of their business – healthcare services.
Access to diverse global talents
Outsourcing health services lets businesses connect to the larger global labor market through BPOs. This gives them more freedom and flexibility in choosing the talents they onboard.
Ensured compliance
Compliance with existing laws and regulations is paramount in the healthcare industry.
Outsourcing health services is one way healthcare providers can ensure their processes comply with federal and state regulations.
As service providers for other businesses, BPOs take great care to remain compliant with existing regulations in various industries, such as HIPAA in healthcare.
