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The healthcare industry in Phoenix has seen remarkable changes over the years. The city is known as the go-to destination for medical care. Thus, local practices must continuously strive for quality patient care and improvement.
Business process outsourcing (BPO) has emerged as a strategic tool to help facilities in Phoenix streamline healthcare delivery.
If you are curious about the benefits of partnering with a healthcare BPO company in Phoenix, this article is for you. It discusses how outsourcing supports your organization and which tasks you can outsource.
What Is Healthcare Delivery and Why Is It Important?
Healthcare delivery provides individuals with the medical services they need. It is essential for the health and well-being of communities and encompasses all forms of care, such as:
- Preventative care includes annual checkups, vaccinations, medical screenings, and counseling.
- Acute care includes urgent care, surgery, intensive care, and rehabilitation.
- Chronic care management is needed for conditions such as diabetes, cancer, and heart disease.
In Phoenix, inclusive healthcare delivery is particularly significant. It is the fifth most populous city in the United States, with over 1.6 million residents of diverse ethnicities. The city thus needs a wide range of services.
What Is the Role of Outsourcing in Healthcare Delivery?
Healthcare process outsourcing is a highly advantageous strategy for medical facilities of all sizes. Its main objective is to help organizations reduce costs, enhance efficiency, and improve healthcare delivery.
Outsourcing provides these benefits by enabling organizations to delegate non-core functions, mainly administrative tasks, to third-party service providers. Below, we list the most common healthcare BPO services in Phoenix.
Medical Coding and Billing
With healthcare operations, coding and billing always go hand in hand. They are complex processes requiring specially trained professionals who know the following classification systems and codes used in medical invoices:
- The International Classification of Diseases (ICD) is used for illnesses and other health-related problems.
- The Current Procedural Terminology (CPT) is the classification used for medical procedures and services.
- The Healthcare Common Procedure Coding System (HCPCS) is used for medical procedures and services not included in CPT.
- The Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) is used for a wide range of healthcare data, including diagnoses, procedures, medications, and devices.
Healthcare organizations process large volumes of these complex bills and records. Considering the staff shortage in Arizona, errors and delays in medical coding and billing have become more prevalent.
By outsourcing billing and coding tasks, medical facilities in Phoenix can ensure improved accuracy and efficiency in healthcare delivery.
Claims Processing
Processing healthcare insurance claims is an extensive procedure that includes the following steps:
- Submission. The healthcare provider or insured patient electronically or manually submits the claim to the insurance company.
- Registration. The insurance company records the claim, service, and patient information. Then, they assign it a unique identifier.
- Triage. The insurance company determines if the claim needs immediate attention. Such requests include high-cost claims, claims with potential fraud indicators, or claims from patients with urgent medical needs.
- Review. The insurance company reviews the claim to ensure it is complete and accurate. It also verifies the patient’s eligibility for coverage and the provider’s credentials.
- Adjudication. The insurance company determines whether the claim is covered under the patient’s policy and then calculates the due reimbursement amount. Factors that affect adjudication include the patient’s policy benefits, the provider’s fee schedule, and the medical necessity of the services provided.
- Payment. The insurance company reimburses the insured patient or the healthcare practice for their services.
The process is lengthy, and the wait time for adjudication and payment is longer. With the high patient volume in Phoenix, healthcare organizations might be overwhelmed to keep up with this process. Thus, many practices outsource this task.
Medical Answering Services
Outsourcing answering services is common for Phoenix healthcare facilities because it helps improve patient satisfaction, reduce workload, and streamline service delivery. BPO providers typically offer 24/7 coverage, which is vital for any medical practice.
Here are some of the common tasks included in this function:
- Answering patient calls and messages
- Scheduling appointments
- Refilling prescriptions
- Triaging patients
- Providing after-hours support to healthcare providers
An additional benefit of outsourcing this function is the availability of bilingual medical answering services. We will discuss this benefit more in the next section.
Healthcare Information Technology (IT) Support
Healthcare IT is responsible for the medical organizations’s hardware, software, networks, and computer systems, including:
- Electronic health records (EHRs)
- Patient portals
- Telehealth systems
- Medical imaging systems
- Laboratory systems
- Pharmacy systems
- Billing and coding systems
These systems are essential for administrative tasks such as data sorting, data sharing, data analysis, appointment scheduling, and medical billing.
Effective healthcare IT allows medical workers to easily access patient records and tools. It also provides patients with simple methods to manage their medical information. However, installing, maintaining, and troubleshooting different computer systems require an expert support team. Thus, many organizations turn to BPO services for healthcare IT.
Outsourcing IT support helps medical practices in Phoenix ensure data security, regulatory compliance, and efficient healthcare delivery.
Regulatory Compliance
Healthcare organizations in Phoenix follow various statutes that regulate their operations, including:
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Information Technology for Economic and Clinical Health (HITECH) Act
- Centers for Medicare and Medicaid Services (CMS) Requirements
- Emergency Medical Treatment and Labor Act (EMTALA)
- False Claims Act (FCA)
- Stark Law
- Anti-Kickback Statute (AKS)
- Arizona Medical Practice Act (AMPA)
- Arizona Hospital Licensing Act (AHLA)
- Arizona Nursing Home Licensing Act (ANHLA)
- Arizona Health Care Cost Containment System (AHCCCS)
These regulations promote transparency, accountability, and protection of patient information. However, managing compliance requirements has become daunting, with more complex and diverse rules and increasing patient volume in Phoenix.
Healthcare organizations that fail to comply with these regulations will receive penalties. These include financial penalties that range from $100 to over $1 million per violation, suspension or revocation of licenses, and criminal prosecution.
Outsourcing support for regulatory compliance provides medical facilities with the experts and technologies needed to prevent violations and avoid penalties.
What Are the Challenges Faced by Healthcare Facilities in Phoenix?
Phoenix hospitals and clinics face various roadblocks to providing adequate healthcare delivery. These include:
- Patient volumes. As Phoenix becomes more popular as a healthcare destination, more people visit the city for their medical needs. Thus, patient volumes and service demands continue to rise, posing challenges for local organizations.
- Staff shortage. Arizona is facing one of the worst medical staff shortages in the country since the pandemic. Industry professionals work longer hours to keep up with the increasing patient volumes in the city, leading to burnout. This prevents organizations from providing competent healthcare delivery.
- Technological integration. Technology improves healthcare delivery. However, it is an expensive investment, especially for smaller organizations. Organizations need to spend time training staff to use implemented programs. Patients may also hesitate to utilize digital systems, making accessing care much harder.
- Healthcare costs. Medical services have become more expensive with technological integrations, increasing prescription drug prices, and costly insurance plans. This rise in costs makes care less accessible to the public. Patients end up delaying treatment, while workers limit their resources.
- Lack of diversity. Diversity among healthcare facilities is critical to comprehensive care because it provides alternatives that align with different beliefs and cultural practices. Organizational diversity also helps reduce disparities in the service’s quality based on the patient’s background.
- Chronic and seasonal illness. Chronic diseases comprise three of Phoenix’s five leading causes of death. Specifically, these are heart disease, cancer, and chronic lower respiratory disease. Adding to this is the region’s hot and dry environment. These factors make comprehensive healthcare delivery a must for the city.
More practices rely on healthcare BPO to keep up with the challenges in the city’s developing medical landscape. Outsourcing offers a wide range of benefits to organizations in Phoenix. Thus, it has become an increasingly attractive solution for their healthcare delivery needs.
How Outsourcing Improves Phoenix Healthcare Delivery
The projection that the global healthcare BPO market will reach $468.5 billion in 2026 is a testament to the effectiveness of outsourcing. Consider the five ways outsourcing helps medical facilities in Phoenix streamline operations and enhance overall healthcare delivery.
Better Access to Specialized Skills and Technology
Phoenix is part of Arizona’s continuously growing healthcare hub, expected to open around 90,000 medical jobs in the next decade. In the meantime, the region’s industry faces an ongoing staff shortage that started during the pandemic. Hiring third-party providers allows organizations to access expertise and advanced tools without making significant investments.
Healthcare BPO firms have a pool of highly skilled professionals proficient in various fields, reducing errors and operational delays. They are helpful for medical coding and billing, claims processing, healthcare IT, and regulatory compliance.
Outsourcing providers leverage the best technologies and resources, giving healthcare organizations a competitive advantage. These innovations include natural language processing (NLP), machine learning (ML), artificial intelligence (AI), and blockchain.
Flexible and Diverse Workforce
According to the United States Census Bureau, Phoenix has a 42.7% Hispanic and Latino population. Although the residents primarily speak English, some patients might be more comfortable conversing in Spanish.
Outsourcing functions, such as medical answering services, to countries that speak English and Spanish could be beneficial and practical for healthcare practices in Phoenix. Patients and healthcare professionals can communicate better with a bilingual team to cover these functions.
Some Phoenix-based BPO firms, such as Unity Communications, have offices in Mexico. Clients can enjoy the benefits of multilingual teams when they partner with us for their healthcare outsourcing needs.
Additional Support for Medical Staff
Outsourcing helps organizations in Phoenix reduce the administrative workload on staff, thus improving healthcare quality and delivery.
BPO teams also let practices scale operations as needed. This capability is useful during the summer in Phoenix when patient volume is at an all-time high due to increased cases of heat-related complications.
According to the Arizona Department of Health Services (ADHS), hospital visits due to heat-related illnesses totaled 4,177. In Maricopa County alone, reported cases reached a total of 2,546.
Thus, medical professionals need additional resources to provide quality patient care. They rely on third-party service providers for support.
Greater Focus on Core Competencies
With virtual experts to handle repetitive and time-consuming jobs, healthcare workers can focus on tasks essential to the medical practice’s success. These are:
- Patient care. Hospitals and clinics in Phoenix must provide compassionate, safe, and adequate medical care. This encompasses disease and injury diagnosis and treatment, health promotion, patient education and support, and patient’s rights advocacy.
- Research. Access to the latest medical knowledge helps healthcare organizations deliver quality care. Hospitals and clinics can find ways to improve their care methods with research. Better care can be achieved through improvements in their core medical tasks or structure.
- Innovations. By investing in innovations, healthcare facilities can develop new strategies, technologies, and processes for delivering quality care. These innovations can include telehealth and telemedicine as well as treatments and therapies to improve patient’s quality of life.
- Quality improvement. Healthcare practices must be committed to continuous improvement. Thus, they should track and measure patient outcomes, identify areas for improvement, and implement changes accordingly.
- Communication and teamwork. Healthcare practices must communicate effectively with patients, other care providers, and insurance companies. Open communication is essential for ensuring that patients receive the care they need in a timely and coordinated manner.
Global Collaboration and Exchange
Outsourcing to providers in Phoenix offers unique and larger-scale benefits for healthcare delivery. Here are some of the more extensive advantages of the healthcare process in BPO:
- Access to global expertise. Outsourcing healthcare services to local providers with operations worldwide allows organizations to access broader knowledge and skills. A wide pool of experts can be especially beneficial for rare or complex conditions.
- Collaboration on research and innovation. Outsourcing can facilitate collaboration on research and innovation initiatives between parties from different countries. This can lead to the development of new and better treatments and technologies to benefit patients worldwide.
- Exchange of best practices. Outsourcing can also lead to discussions of best practices between organizations in different countries. This can help improve the quality and efficiency of healthcare delivery within the organization.
The Bottom Line
Outsourcing has become a strategic tool in the Phoenix healthcare industry. Delegating non-core functions to external parties reduces costs, provides specialized talent, and improves patient care and healthcare delivery.
Let’s connect if you want to outsource to streamline your Phoenix practice’s healthcare delivery. Unity Communications is a HIPAA-compliant firm with a pool of highly skilled experts, cloud technology integration, and AI-enabled software. We have what it takes to scale your organization to the next level.
