Outsourcing Medical Billing and Coding: Streamlining Healthcare Reimbursements

Patients need high-quality healthcare services, especially during emergencies. Medical providers optimize their human and technological resources to meet this demand. However, what if medical reimbursement is the only factor that hinders them from achieving their goal?

Healthcare business process outsourcing (BPO) offers a cost-effective solution to address the gap. Service providers employ skilled professionals and modern tools to handle medical coding and billing. This enhanced function helps streamline the payment process. 

Are you looking to maximize similar benefits? Let us first explore how medical BPO boosts your healthcare reimbursements.

How medical BPO enhances healthcare reimbursements

Healthcare reimbursements involve repetitive processes ranging from claims filing to payment. Each procedure is interconnected and requires absolute accuracy. Timeliness in this function also helps businesses ensure financial sustainability. 

The need to focus on delivering quality patient care while streamlining reimbursements influences healthcare organizations to outsource. But besides affordable access to a large talent pool and advanced infrastructure, what can BPO providers contribute to your healthcare company? 

Below, we explore how medical BPO providers harness these scalable resources to improve your reimbursement processing and ensure on-time payments for services you render.

Leverage robust technologies

BPO providers simplify healthcare reimbursement using artificial intelligence (AI), cloud computing, and automation tools. These technologies help increase efficiency and minimize errors while handling large volumes of medical data. Providers also utilize the following:

• Practice management software is an all-in-one platform for streamlining healthcare operations. It automates functions from appointment scheduling and medical claims processing to coding and billing.
• Electronic health records (EHR) systems make patient data easily accessible to healthcare providers and BPO vendors for accurate reimbursements. 
• Revenue cycle management (RCM) platforms assist medical BPO companies in optimizing cash flow and reducing revenue leakage.
• Claim scrubbing software allows providers to review insurance claims for inconsistencies before submission. The results guide them in tracking and mitigating issues, reducing the likelihood of rejections.
• Health information exchange (HIE) systems facilitate secure patient data sharing among healthcare providers, payers, and BPO companies.
• Telehealth platforms facilitate remote healthcare services, such as virtual consultations. BPO firms use telehealth platforms to track online patient encounters and ensure precise documentation for billing purposes.
• Document management systems (DMS) enable BPO teams to organize and share electronic medical records and billing files required for the reimbursement process.
• Analytics and reporting tools automatically collect and provide insights into critical financial metrics. They help BPO firms monitor reimbursement trends and identify areas for improvement.

Enhance patient registration and eligibility verification

Based on AKASA’s latest survey, nearly half of medical providers have experienced a year-over-year increase in initial payer denial rates. They cited errors in patient registration and eligibility as the top causes of this issue. 

Service providers help address such gaps by employing robust strategies and technologies. They improve patient registration and eligibility verification to set the tone for your RCM. Medical BPO companies apply the following techniques to enhance this function:

• Implement online registration portals. These web-based platforms have self-service features. Patients can fill out registration forms, update their insurance details, and validate eligibility online. This capability minimizes employee manual data entry. 
• Use AI-based software to automate eligibility validation. The application speeds up the verification of patient qualifications against payer databases. It can perform the process in batches, saving time and validating numerous patients. 
• Enforce standardized and automated data entry practices. This process ensures consistency and accuracy of patient information during and after registration. 
• Integrate registration platforms with client DMS and EHR systems. By unifying these systems, BPO firms achieve a seamless flow of medical records. This simplifies access to important data for faster healthcare reimbursements. 

Boost medical coding and billing

Expect improved medical coding and billing when adopting healthcare BPO services. Service providers invest in AI-powered tools to automate these tasks and minimize billing errors. They also deploy medical coders and billers who know these numeric and alphanumeric codes used in patient records:

• The Healthcare Common Procedure Coding System (HCPCS) represents medical procedures, supplies, products, and services in the United States. It facilitates the billing of Medicare and Medicaid claims.
• The International Classification of Diseases (ICD) is a set of alphanumeric codes used worldwide to categorize various health conditions. The World Health Organization (WHO) maintains this standardized system. 
• The American Medical Association (AMA) uses the Current Procedural Terminology (CPT) to describe medical, surgical, and diagnostic services in the U.S. 

Ensure data security and legal compliance

The U.S. Department of Health and Human Services (HHS) reported more than 133 million patient record breaches in 2023. According to the HHS, patients were directly contacted and threatened for sensitive health data exposure during ransomware attacks. 

Similar cases might occur when acquiring medical BPO services because they involve online transactions. Hackers can steal and expose sensitive personal health information (PHI) if BPO providers and clients let their guard down. 

Healthcare BPO companies execute robust measures to avoid such costly issues. They implement the practices below to strengthen medical data security and regulatory compliance when handling reimbursements:

• Familiarize and train staff on the Health Insurance Portability and Accountability Act (HIPAA).
• Use encrypted communication channels and virtual private networks (VPNs) for data exchange.
• Enable role-based access to confidential PHI and medical records.
• Apply multifactor authentication to ensure only authorized personnel can use critical systems and files.
• Deploy secure storage and backup systems to prevent data loss, especially during emergencies and calamities. 
• Perform regular compliance audits and vulnerability assessments to immediately identify and mitigate security flaws.
• Maintain comprehensive audit logs that monitor system user activities for compliance and security purposes.
• Develop and implement well-structured incident response plans to proactively address potential security threats.

Improve customer service

According to The Harris Poll’s recent research, 64% of adults want healthcare providers to spend more time understanding them. Another 54% stated their condition would improve if these organizations guided them in learning about the healthcare system.

BPO call centers employ customer support teams trained in healthcare reimbursement processes to meet such needs. These agents possess in-depth knowledge of medical billing and coding. This insight lets them answer patient inquiries while allowing your in-house team to focus on more pressing matters. 

Service providers use omnichannel solutions to enable seamless, real-time communication across multiple channels. These tools enhance customer experiences by allowing patients and healthcare providers to reach out through their preferred medium.

The outsourced customer service unit also conducts the following tasks to advance medical reimbursements:

• Provide clarification on billing statements and charges.
• Address billing discrepancies and payment-related concerns.
• Regularly update healthcare providers on the status of reimbursement claims.
• Perform root cause analysis as part of managing reimbursement rejections.
• Help prepare and submit appeals for denied claims.
• Collect feedback from healthcare businesses and patients to improve customer service.

How streamlined coding and billing impact patient satisfaction

Smooth healthcare reimbursement processes prevent missing data and reduce errors in coding and billing statements. They also ensure accuracy in charges and insurance coverage details. Patients then encounter fewer discrepancies and avoid hidden fees. 

Additionally, patients value prompt and accurate information about their claims. Strategic outsourcing can help streamline coding and billing, resulting in faster claims processing and reimbursement.

Most importantly, BPO companies emphasize transparent communication regarding billing and reimbursement processes. They help healthcare businesses relay precise details about insurance coverage, deductible information, and out-of-pocket expenses to patients.

These insights give patients a better sense of control over their healthcare finances. The advantage also fosters trust between medical providers and patients, boosting the revenue cycle and bottom line.

The bottom line

As the need for a superior patient experience increases, healthcare organizations rely on medical BPO providers to streamline reimbursement processes. Third-party experts and technologies help them navigate the complexities of coding and billing cost-effectively.

Service providers use these scalable resources to optimize the revenue cycle, from patient registration to customer service. They deliver significant benefits, including reduced errors, faster reimbursement turnaround, and improved patient satisfaction. 

Are you looking to enhance your medical reimbursements? Let’s connect and negotiate a possible deal. Unity Communications has medical coders and billers to help you achieve smooth payment and claims processing.