Revenue cycle management solutions provider AGS Health announced the launch of operations in Manila, Philippines. Serving as a strategic growth partner to more than 100 major healthcare providers across the U.S., the expansion will offer AGS Health and its customers increased access to global talent.
Identified as one of the most popular outsourcing destinations in the world, the Philippines is known for the quality of skills offered in the business process outsourcing (BPO) sector. With strong medical backgrounds and voice-based skills, AGS Health aims to focus on supporting end-to-end accounts receivable services. “By augmenting our service line with patient calls, responding to patient queries, and timely patient follow-ups, the addition of our Philippines operations represents an exciting added value to our customers,” said Patrice Wolfe, CEO of AGS Health.
As the company continues to grow, AGS Health is diversifying its global operating locations. The Manila office is the second recent global addition for the company, following the opening of its Jaipur, India office in June 2022. With more than 11,000 employees worldwide, AGS Health combines a global pool of expertly trained, college-educated resources with AI-enabled technology to leverage the latest advancements in modern revenue cycle practices.
The COVID-19 global pandemic and widespread natural disasters have highlighted the importance of business continuity planning. With an already-extensive presence established in India, AGS Health strengthens its infrastructure with this cross-country addition.
“Our expanded footprint reduces the risk of business disruptions to our clients should operations be interrupted in India,” Wolfe said, adding “The Philippines emerged as our top choice for its solid, low-risk infrastructure and its role as a top business center.”
By Priya Sabharwal, practice leader, network operations, HGS.
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.
Poor directories are more than just an inconvenience for a member; they also impede their access to necessary care, and can create unexpected medical costs.
A typical health plan is already regularly contacting providers’ offices for many different types of data requests. When they also call to verify provider directory requests, it can create added pain for both sides of the equation. On the payer side, it can create provider abrasion, which could influence whether the provider keeps doing business with that payer. On the provider side, receptionists and office managers are pulled away from their higher-level tasks whenever they stop to answer the phone, leading to short-term frustration and, potentially, burnout.
Payers risk incurring stiff fines and penalties from federal and financial entities, and/or member lawsuits. For example, as of 2016, CMS regulations now permit the agency to fine health plans up to $25,000 per Medicare beneficiary for errors in Medicare Advantage plan directories, and up to $100 per beneficiary for mistakes in plans sold on the Affordable Care Act exchanges.
Poor provider data management hinders effective patient-provider matching, patient satisfaction, and demand conversion through call centers.
If a health plan’s website does not contain thorough, accurate provider information, or reflect correct provider availability, potential patients may go back to the drawing board and select a provider from a different organization.
A lack of complete and reliable provider data about specialists leads to misdirected referrals, and acts as a barrier to patient retention within networks.
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.
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.