Why Outsourcing Medical Claims Processing Boosts Efficiency
In a world where change and speed define the healthcare market, efficiency is no longer a target that one aims for, it is now a requirement. Healthcare providers everywhere operate under pressures to lower operating expenses while providing patients with high-quality care. One major area that consumes time and resources is medical claims processing. Because of this, numerous healthcare organizations are considering medical claims processing companies to help boost operations, improve accuracy, and, in the end, efficiency.
But what really makes outsourcing a viable option in this area? This article will examine the underlying reasons for outsourcing medical claims processing and the positive impact it can have on the general efficiency of healthcare practices.
Understanding Medical Claims Processing
The medical claims process encompasses the creation, submission, and follow-up of claims with health insurance companies to receive reimbursement for services rendered as a healthcare provider. Although that may not sound too difficult, it is much more complicated than it sounds. The medical claims process has multiple steps, including patient data entry, insurance verification, coding, claims creation, claims submission, claims follow-up, denied claim management, and finally posting payments.
If there is an error at any point in the process, then you risk the claim being denied, delayed reimbursement, and/or lost revenue, which are all a critical aspect of medical claims and very complicated. It is this level of complexity that makes a significant amount of providers look to support from a company that specializes in outsourcing the medical claims process.
The Growing Need for Efficiency in Healthcare
Healthcare efficiency is no longer a choice. The industry is filled with growing patient volumes, increasing administrative burdens, and shifting regulations that require sharper workflows. Medical billing and coding errors collectively cost the healthcare industry billions of dollars each year. This enormous loss proves that healthcare organizations require a method for accurate, dependable, and timely claims processing.
In-house billing teams are frequently overstressed and have insufficient resources. Developing and training employees, keeping abreast of rapidly changing coding updates (such as ICD-10 or CPT changes), and being compliant with insurance rules and regulations all cost time and valuable knowledge. All of these challenges leave opportunities for the cost benefits that outsourcing can bring.
Benefits of Outsourcing Medical Claims Processing
1. Reduced Operational Costs
It can be costly to hire, train, and retain skilled billing talent. By outsourcing, you do not have to pay for costly software systems and infrastructure. A reputable outsourcing firm will already have the technology, systems, and trained staff in place to process claims more efficiently and at a lower cost.
2. Access to Expert Knowledge
It can be expensive to recruit, train, and keep skilled billing talent. By outsourcing, you are not paying for expensive technology systems and infrastructures. A reputable outsourcing provider has the technology, systems, people, and processes in place to process claims more efficiently and at a lesser cost.
3. Improved Claim Accuracy and Fewer Denials
Outsourcing partners have sophisticated claim-scrubbing tools and methods that help them eliminate errors that lead to claim denials before submission through thorough audit methods. Accurate coding and billing can improve the probability of acceptance by insurance payers on the first pass.
4. Faster Turnaround Time
Outsourcing companies work round-the-clock which allows for faster claims submissions and quicker reimbursements. Faster submission improves cash flow and consistency with revenues, and this is extremely important to any health care organization.
5. Scalability and Flexibility
As your healthcare practice expands, your medical claims volume will also expand. Outsourcing allows healthcare providers to scale and enhance their practice while incurring none of the financial costs, time, and effort of hiring and training staff. When faced with a sudden temporary increase in patient volume for a multitude of reasons, or spikes typical of seasonality, outsourcing provides a constant stream of care.
The Role of Medical Call Centers in Support Operations
In addition to claims processing, outsourcing offers value to many other support functions, including patient communication. One of the most hired services of medical call centers is their management of appointment scheduling, reminders, insurance verifications, patient questions, and follow-ups. Their services add to the patient experience while supporting healthcare providers completing their primary role as healthcare providers.
Call centers can also function as an extension of your front desk. They provide support for managing incoming calls that your internal teams could manage to alleviate administrative burden and increase their productivity.
If patients were to call to learn about the status of their claim requests or insurance limitations, then trained call center agents can field those requests without involving your in-house staff. This creates a seamless workflow towards answering common questions and provides a faster resolution time.
Compliance and Data Safety
Health-related outsourcing companies understand HIPAA (Health Insurance Portability and Accountability Act) and are experts in dealing with regulations. They do everything they can to protect the data security, privacy, and confidentiality of patient data. They do this by utilizing secure file transfer systems, encrypted communication, and an all-around level of care that complies with international compliance standards for the handling of data.
When healthcare providers work with a trusted outsourcing partner, they are assured that the outsourcing company will take on all of the legal and reputational liability associated with the risk of protecting sensitive patient information.
Impacts in the Real World: Case Study
Let’s look at an example of a medium-sized medical practice that had experienced slow payments and a high level of claim rejections before outsourcing their medical claims processing. After they did this, they were able to:
• Increase claim acceptance by 25%;
• Decrease payment turnaround time by 30%;
• Decrease administrative costs by 40%; and
• Allow legitimate staff to focus on patient satisfaction.
The tangible benefits provided not only more financial return, but also a significant enhancement to patient satisfaction with better query response times and an improved billing experience overall.
Final Thoughts
The healthcare industry is complex and an efficient revenue cycle is key for sustainability. Outsourcing of medical claims processing offers healthcare providers the potential for accuracy, cost reduction, and faster reimbursement while also remaining focused on patient care.
When combined with medical call centers outsourcing is an advantage that will drive operational and clinical efficiencies. In a competitive healthcare environment, outsourcing is much more than a mechanism for savings, outsourcing is the best way to create a more sustainable, flexible, and efficient healthcare system.
If you are looking to increase the efficiency and financial performance of your practice, working with an experienced outsourcing company may be the best option.
