The trend of medical service outsourcing is not new. In fact, many organizations in the healthcare industry have partnered with an outsourcing company to handle many of the back office operations, from medical records to diagnostic services. The impetus behind companies collaborating with third-party service providers is multifaceted, but as the Claims Journal indicated, meeting internal financial benchmarks motivates many organizations. The source indicates the insurance industry is also a major factor in the decision to outsource for healthcare providers. However, instead of taking a holistic approach to collaborating with an outsourcing company, it is far more common for companies to select specific aspects that can be better handled by an outside firm.
Assessing the claims
Kevin Quinley, founder and principal of Quinley Risk Associates, explained organizations should go through their list of claims and itemize each according to a corresponding dollar value. The higher the dollar value for a claim, the greater the risk, meaning the organization would likely benefit from the expertise of an outsourcing company that primarily deals with medical insurance claims. Karlyn Carnahan, principal at insurance research firm Novarica highlighted several aspects of the claims process that an outsourcing partner can accomplish to benefit a small or medium-sized business owner.
Initially, when a customer has a claim inquiry, they expect a very quick response. By outsourcing this function, consumers or businesses can contact the agent at nearly all times of the day to get the information they require. Carnahan also highlights document processing as a commonly outsourced operation, as it is usually outside the core goal of a company, meaning in-house staff can focus on their priorities. Finally, medical bill review is an integral process for any healthcare provider, but it is fairly labor intensive, with staff needing to be continually trained on appropriate medical coding and pricing options to ensure consumers and companies maintain accurate records.
Sourcing top healthcare talent
To perform this duty well, it necessitates a well-educated team. In fact, an outsourcing company has begun recruiting individuals with nursing degrees and other medical graduates to meet the demand for healthcare information management, according to the Sun Star. Jeff Williams, chairman of the Healthcare Information Management Outsourcing Association of the Philippines, explained there is a surplus of unemployed nurses in the country and the industry has demonstrated prodigious growth, raising $460 million in revenue in 2012. He told the newspaper he expects the industry to continue growing, especially if outsourcing enterprises take advantage of such a highly qualified group.
Equipped with robust knowledge of medical operations and terminology, medical professional can be of benefit for both businesses and consumers.