Tag: business process outsourcing

Solving The Challenges of Provider Database Management

By Priya Sabharwal, practice leader, network operations, HGS.

Priya Sabharwal
Priya Sabharwal

Imagine a scenario: A patient looking for a new doctor searches her insurer’s online network directory to find a provider her plan will cover. She selects what seems to be the perfect doctor based on her criteria, which could include gender, office location, languages spoken or other qualifications, in addition to being in-network with her health plan.

But there’s a plot twist: The patient eventually learns the doctor she found is not, in fact, the right option for her – but it took her scheduling and arriving at the appointment for her to realize this. It turned out the entry in her insurer’s directory was outdated, and her doctor had moved offices.

This scenario is hardly out of the ordinary. A 2019 Health and Human Services survey uncovered errors in half of the listings in Medicare plans alone. These significant inaccuracies cause issues not just for patients, but for payers and providers, too:

So what are some steps payers and health plans can take to create a solid provider data foundation? It starts with fundamentally changing the way we think about, use, enter and maintain data.

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How BPO Has Exploded In The Healthcare Industry

Guest post by Jennifer Smith, director, Digital Documents, LLC.

Jennifer Smith
Jennifer Smith

Even with electronic decision-support technology and responsive, knowledge-based medical software built into modern electronic health care record (EHR) systems, it is critical for physicians and clinicians to recognize the primary focus is still treating the patient. In an effort to survive escalating costs of care and declining reimbursements, modern health care delivery models shifted from a patient-centric care model toward a financially motivated business model.

With the push toward value-based reimbursements and rigorous quality measurement reporting mandates, hospitals and medical organizations today must balance the need to remain financially solvent with improving patient outcomes and experiences throughout the health care journey.

Business Process Outsourcing: Revenue Cycle Management (RCM) and Value-Based Care

End-to-end RCM in the healthcare industry explores cost per transaction beyond salaries and benefit packages. Administrators examine productivity volumes, idle time, workforce utilization ratios and patient flow as key factors that directly influence revenue potential.

Business process outsourcing (BPO) has gained popularity in recent years as a way for hospitals and practices to control operating costs without compromising patient care or satisfaction levels. It is a win-win proposition for all stakeholders. The RCM software and services market, which includes BPO, now garners more than $12 million, annually. There are many reasons to consider BPO, including streamlining internal efficiency, expediting third-party payer reimbursements, and reducing data entry errors that stifle cash flow and frustrate consumers.

Analytics, Document Management and BPO

Improving document management is critical. Leading technology enables collecting vast amounts of data, data that can be used to improve patient outcomes, and financial performance. However, data is only valuable if it can be rapidly accessed, analyzed, organized and converted into actionable information. Digital Documents, which is a company that provides outsourced document management services, says document processing services essentially convert information to digital assets.

Those assets may translate into higher profit margins. One study showed hospitals that outsourced most of their RCM operations in 2014 saw an average revenue increase of 5 percent to slightly more than 6 percent. Revenue increases are expected to continue to grow over the next few years, especially in the health IT outsourcing area, which according to Reportstack should see an annual compounded growth rate of almost 9 percent through 2019.

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