GeBBS Healthcare RCM Blog

Sobering Statistics about Growing Patient Self-Pay Amounts

Posted on Mon, Dec 14, 2015 @ 10:00 AM

With the growing number of high deductible insurance plans and the Affordable Care Act (ACA), patients are now responsible for up to 35 percent of their healthcare delivery costs. Here are some staggering facts from MGMA and McKinsey & Company:

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 - Patient A/R growing to $660 billion in 2015
 - $65 billion in bad debt projected
 - Annual family deductibles average now up to $5,000
 - Some ACA plans can approach $12,000
 - 30% of patients walk out the door without paying anything
 - 3.3 billing statements will be sent before a patient’s balance is paid in full
 - Only $15.77 of every $100 owed is recovered once turned over to collections

With patient self-pay amounts growing, are you prepared to collect these large deductible amounts at the point of care?

This new A/R environment requires new procedures and new thinking to deal with this new world of large self-pay amounts. You must be prepared to implement new technologies, and an end-to-end, outsourced, comprehensive revenue cycle management solution that includes complete billing and collections services with call center follow-up support which includes compassionate collection methods used by highly trained professionals.

Make sure your outsourcing partner has expertise in multi-specialty collections and billing, and is well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. It is also important that your outsource partner has a staff that is highly trained in compassionate collection techniques that do not employ “strong arm” tactics which can upset your patients.

In the high deductible insurance world, insurance policy and eligibility amount verifications are absolutely critical. Identifying the patient’s responsibility upfront, prior to delivery of services, is critical in managing your receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, nonpayment and bad debt.

An outsourced, end-to-end, back office solution can provide the services you need to help you survive in this new world of high deductible insurance plans.

Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

The New World of High Insurance Deductibles Requires New Solutions

Posted on Mon, Dec 07, 2015 @ 11:00 AM

The amounts for insurance deductibles continue to grow each year and there is no end in sight to these increases. With more and more patients opting for high deductible, low premium commercial health insurance policies, and the growing usage from the Affordable Care Act (ACA), providers must seek ways to collect these large deductible amounts at the point of care, using an integrated approach that includes call centers and comprehensive end-to-end revenue cycle management, coupled with compassionate collection training.

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As patient financial obligation rise, so does bad debt.

The surge in these high-deductible health plans has also highlighted the fact that as financial obligations increase, the propensity for patients to pay any portion of that obligation decreases -- for all patients, at all income levels. One report from McKinsey states that 30 percent of patients walk out of treatment facilities without paying anything. How can you be prepared to deal with these high deductible patient insurance plans?

You and your team must adjust your procedures and your thinking to deal with this new world of large self-pay amounts. Even patients are uncertain about how much they owe for their care. By updating your point of care collections procedures and investing in technology that allows your staff to openly engage with patients about their financial obligation, you can be equipped to minimize your bad debt levels.

The next step is to implement an end-to-end, comprehensive revenue cycle management solution that includes complete billing and collections services with professional call center follow-up support. Make sure your outsourcing partner has expertise in multi-specialty collections and billing, and is well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. It is also important that your outsource partner has a staff that is trained in compassionate collection techniques that do not employ “strong arm” tactics which can upset your patients.

With high deductible commercial insurance claims and the ACA, insurance and eligibility verification are absolutely critical. Identifying the patient’s responsibility upfront, prior to the visit is critical in managing your receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, nonpayment and bad debt. An end-to-end, outsourced back office solution can provide the answers you need, and help you survive in this new world of high deductibles.

Tags: Business Process Outsourcing (BPO), Accounts Receivable (A/R), Knowledge Process Outsourcing (KPO), Best Practices, Offshore Medical Billing, Self-Pay Collections

Patient Choice Is Driving Growth in Urgent Care Centers and Free Standing Emergency Departments

Posted on Wed, Dec 02, 2015 @ 06:00 AM

By Nitin Thakor, GeBBS President & CEO

The way patients want to receive their medical treatment is creating significant growth in two types of healthcare delivery facilities: Urgent Care Centers and Free Standing Emergency Departments.

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Urgent care centers have been around for some time and deliver ambulatory care that is performed outside of an emergency room setting, primarily on a walk-in basis. They typically serve patients whose medical needs may not be severe enough for an emergency room visit. Today, modern urgent care providers are well equipped to care for this patient population at a fraction of the time and cost, generating significant savings to the overall healthcare ecosystem.

The healthcare industry’s growing emphasis on patient convenience and customer service has led to the rapid emergence of free-standing EDs in many areas as an alternative to hospital-based EDs.

With shorter wait times than hospital EDs and more sophisticated facilities than urgent care centers, free-standing EDs are becoming increasingly attractive to many patients as preferred sites for receiving emergency care. The most important benefit of free-standing EDs is that they can provide access to emergency services to patients in areas where hospital-based ED services are unavailable, and are less expensive to build and operate than an entire hospital.

One way in which all free-standing EDs are alike from a regulatory standpoint is with respect to compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA states that hospitals accepting government-insured patients must provide emergency medical treatment to any presenting patient, regardless of ability to pay. Because many free-standing EDs are affiliated with hospital systems, they must accept all patients. Free-standing EDs are staffed by board certified emergency physicians and are usually open 24X7.

Urgent care centers can handle a variety of medical conditions that need to be treated right away, but are not emergencies. These facilities are usually staffed by primary care physicians and are open daily and on the weekends, but not on a 24X7 basis. They expect payment at time of service and may not accept many types of insurance.

Convenience, choice and insurance plans -- or lack of insurance -- are driving growth in these two types of healthcare facilities. One of the major differences between freestanding EDs and urgent care centers is the acuity level of the treatment being sought by patients. Patients can now triage themselves.

Tags: Business Process Outsourcing (BPO), Knowledge Process Outsourcing (KPO), Best Practices

All is Not Well in the Small Hospital World When It Comes to the ICD-10 Transition

Posted on Fri, Nov 06, 2015 @ 07:00 AM

By Nitin Thakor, GeBBS President & CEO

So far small hospitals and small health systems are not faring as well as large hospitals and health systems during the ICD-10 transition. The press is full of reports about how well the transition is going for large hospitals, but that is not the case for smaller community hospitals.

Offshore Medical Coding ICD-10 Outsourcing

There are several reasons for this.  Many smaller hospitals were not as well prepared as the large hospitals. They just didn’t have the budget to conduct intensive preparation campaigns. Also, the lack of clinical documentation improvements (CDI) by their physicians seems to be an issue, and for some their greatest challenge.

Many physicians have taken little or no advantage of ICD-10 training. This has led to a lack of knowledge on the documentation of procedures and diagnoses to meet the specificity requirements of ICD-10.

An even more common problem seems to be that many small hospitals, typically under 300 beds, have offered very little training to their physicians, either because of opposition by hospital physician staff, or ICD-10 transition teams did not understand the importance of upgraded documentation.

These small hospitals are working hard to catch up by adopting programs to help them meet the challenges of ICD-10.  In getting a late start to cope with ICD-10, many small hospitals are considering using an outsourcing medical coding and outsourcing medical billing partner, who has been diligently preparing for the ICD-10 transition for several years. An experienced outsourcing partner can provide immediate expertise to ensure small hospitals’ revenue risks are minimized. 

Working with a knowledgeable outsource partner can also reduce costs and overhead complexity. Expertise is available and there is no need to face the transition alone. Select an outsourcing partner on the basis of their coding and billing experience and knowledge. All of their coders will have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Most will be certified RHIT, RHIA, CCS, CCS-P, CPC or CPC-H.

An outsourcing partner can also provide targeted training programs to help physicians with CDI and to help hospitals retain their most experienced medical coders - those who will be the most valuable during the next year or so of the ICD-10 transition.

Finally, small hospitals need to take advantage of new technology that has dramatically changed the medical coding process within health information management.  Computer-assisted coding or CAC is a cutting edge technology that automatically derives medical codes within clinical documentation. CAC technology is an enterprise-wide coding solution that improves and enhances the overall coding process. It combines expert workflow technologies, rules-based automation, and certified coders to guarantee accuracy rates of over 95%.

Getting a late start does not mean you cannot win the ICD-10 race; it just means you have to work a little harder and smarter!

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Offshore Medical Coding

Survey Shows About 80 Percent of Hospital CFO's Consider Outsourcing RCM to be the Best Stop-Gap Measure

Posted on Mon, Oct 19, 2015 @ 08:00 AM

By Nitin Thakor, GeBBS President & CEO

offshore medical codingAccording to a recent survey reported in Healthcare Finance, 83 percent of hospitals now outsource some accounts receivable and collections, 58 percent of hospitals outsource some contract management, 55 percent of hospitals outsource some denials management and 68 percent of physician groups with more than 10 practitioners now outsource some combination of collections and claims management.

The expected impact of ICD-10 on the revenue cycle will prompt providers to outsource even more of their revenue cycle functions the article states. Larger health systems are even more bullish on the trend. The survey found 93 percent of larger hospitals (more than 200 beds) anticipate supplementing their existing revenue cycle software with outsourcing services in the first quarter of 2016 as fallout from ICD-10 likely affects cash flow and more value-based reimbursement opportunities are presented.

Outsourcing RCM: Onshore and Offshore Medical Coding and Billing

This trend is nothing new to GeBBS Healthcare Solutions. We have always promoted outsourcing as a means to cut through the complexity of revenue cycle management with proven expertise, operational excellence, and a sophisticated approach to business processes. Outsourcing providers have experienced, ready-to-deploy remote medical coding, denial management, and medical billing resources available immediately to ameliorate the effects of ICD-10.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, Offshore Revenue Cycle Management, Healthcare BPO Companies, Medical Coding Outsourcing, Remote Medical Coding

The Benefits of Outsourcing Chronic Care Management

Posted on Tue, Oct 13, 2015 @ 12:00 PM

 

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There are many benefits of outsourcing the chronic care management (CCM) activities for physicians who want to take advantage of the new Centers for Medicare & Medicaid Services (CMS) initiative that pays doctors for delivering non-face-to-face care to their Medicare patients who have two or more chronic conditions.

Primary, of course, is the ability to create a new, significant revenue stream for the practice. This is entirely possible, even for smaller practices, when the chronic care management coordination is outsourced to a healthcare organization that specializes in this type of activity.

Outsourcing overcomes the time-intensive CCM challenge for many physicians who do not have the professional staff bandwidth to provide this ongoing chronic care management. The new CMS initiative works well with outsourcing.

The billing physician creates a specific healthcare plan for his patients and then turns that plan over to the outsource organization who is responsible for the daily or weekly contact with the patient to monitor his or her progress, provide health coaching according to the physician’s care plan, ensure the patient is being compliant with the plan and report this progress to the physician.

This allows the physician to extend his chronic care management to a greater number of patients by giving him the added professional staff bandwidth he needs.

By outsourcing the daily care management activities physicians can combine technology, clinical services and analytics that yield improved patient interactions between actual office visits, with almost no impact on their current professional staff.

Outsourcing will allow the physician to increase and maximize his patient enrollment in the program, improve patient compliance and provide CCM documentation requirements, while minimizing additional workload.

Outsourcing care management provides an end-to-end solution that will improve outcomes and provide increased revenue for the physician.

The communication between the outsourced organization’s professional staff and the patient is an extension of the physician’s practice and qualifies as physician interaction under the new CMS initiative. Additionally, ongoing interactions through personalized messaging motivates and supports patient’s to reach predetermined health goals set for them by their physician.

As a result, engaged patients are more likely to participate, adopt healthier behaviors and follow their physician’s care plan. The end result is higher quality of patient engagement, increased compliance, better outcomes, lower costs – and increased revenue for the physician.

Tags: Business Process Outsourcing (BPO), Knowledge Process Outsourcing (KPO)

Trends in Healthcare Billing: Healthcare Revenue Cycle Management and Global Offshore Medical Billing

Posted on Wed, May 29, 2013 @ 01:02 PM

Today’s healthcare delivery system is at the center of many political and social debates. The ongoing focus of these debates is often how the healthcare financial process is handled, and it is one of the many problems frustrating professionals in the billing department of hospitals and medical facilities.

Each year, $350 million is spent to submit and process claims in the healthcare industry, according to Dell, and that number is only expected to climb. Equally disheartening, HMFA stated in a late 2011 report that trends in A/R reserved for write-off and collectible A/R indicate that “the net revenues billed by hospitals are getting harder to collect.”

Healthcare facilities are facing a host of issues that complicate billing, including changes in healthcare records keeping, increasing out-of-pocket costs for patients, changing healthcare laws, changing Medicare and Medicaid policies, and the looming possibility of the Affordable Healthcare Act. Because of increasing operating costs in the medical industries, healthcare facilities cannot afford to let their A/R go unchecked.

A/R must be carefully managed, and the most effective way to do that is with improved healthcare revenue cycle management (RCM). Many healthcare facilities are looking to streamline and reduce costs by outsourcing, offshore, critical parts of their billing cycle, principally to India, a country with proven expertise in all facets of U.S. RCM.

Healthcare Revenue Cycle Management

What is revenue cycle management?

True revenue cycle management begins before the patient even visits the facility. It begins with eligibility and benefits verification including pre-authorization and enrollment. This allows healthcare providers to verify coverage in advance for every patient and also give the patient his or her out-of-pocket costs before the procedure. The second phase of revenue cycle management is implemented in the coding process. Coders can have as little as eight months of training (no high school degree necessary) to be certified. In order to increased efficiency, coders should be prescreened and required to be proficient in all the following code sets and usage guidelines: CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS. The next phase of revenue cycle management is in the billing phase; more specifically, in charge capture and payment posting. The more efficiently billing is done, the first time, the more likely payments are to be collected. Fourthly, payments must be posted correctly and quickly to the right patient, for the right services. The final phase in revenue cycle management is receivables follow-up, a step that often gets neglected if procedures are not in place to ensure it.  In this stage, claims must be continually worked, resubmitted and processed until payment is received.

Global Offshore Medical Billing

When billing is outsourced as part of a healthcare revenue cycle management transition, compliance and cost savings both are possible. Again, coders have minimal requirements to start in the medical field. However, a diligent RCM provider can source talented and certified coders from India to produce the most accurate coding and billing support team. This will increase the accuracy and speed of processing, create costs reductions of up to 40 percent in some cases and increase compliance.

Both of the aforementioned initiatives, healthcare revenue cycle management and offshore medical billing, provide not only cost savings but increased compliance, so essential in the current regulatory environment. Audits are intensive in the healthcare industry, HIPAA compliance is non-negotiable and ADRs are on the rise. Healthcare providers cannot afford to maintain inaccurate or outdated records, billing or coding systems any longer. Healthcare revenue cycle management may be the present trend of the decade, but it has longevity because it is a solution that works and is critical to a healthcare provider’s financial well-being.

 

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO)

The Rise of Knowledge Business Process Outsourcing (KBPO)

Posted on Fri, May 10, 2013 @ 09:39 AM

The state of our economy is on everyone’s mind today. Our business leaders understand that job creation and company growth is an increasingly global proposition, especially with the growth of outsourcing over the past two decades. Outsourcing began small, focused on finding cheaper manpower for labor-intensive jobs such as telemarketing and data entry at the beginning of the millennium. However, the paradigm is changing. Leading business organizations, including those in the healthcare industry, are outsourcing even their “core competencies” to gain a competitive edge with Knowledge Business Process Outsourcing.

            Business process outsourcing has been a reality for many larger corporations for the past decade, and smaller businesses have been gradually engaging as well because of the changing process. Initially, smaller businesses were hesitant because the headaches of managing employees even in a central office; the idea of managing  a work force overseas was just too much. However, outsourcing is now much simpler. Instead of worrying about each individual contractor, companies simply work with a business that specializes in outsourcing that particular talent pool, and their provider hires and manages the workers abroad. In the same way, KBPO will free managers from many of the mundane details of having employees and allow them to focus simply on the deliverables. Talent is vetted and managed from abroad -- all business managers have to worry about is the product and payment. 

Advantages of the Knowledge Business Process Outsourcing for Healthcare

The transition to Knowledge Business Process Outsourcing is occurring in healthcare, as in every other industry. Examples of healthcare KBPO currently available include:

  • Financial Research
  • Insurance Research
  • Market Research
  • Data Analytics
  • Content Research Services
  • Medical Content Services
  • Reconciliation Services
  • Billing and Invoicing Services

In healthcare, it began with outsourcing services such as social network analysis and business process outsourcing for health insurance strategic services. As of July 2010, a wide range of services was available to healthcare facilities, and all were in various stages of mainstream adoption. According to a study by Gartner, KBPO for the healthcare industry has reached the necessary “plateau of productivity” and will see increasing adoption in the next few years. Some of the benefits of KBPO for healthcare include:

Collaboration across and beyond the enterprise. Automatic work routing and notifications across groups, partners, and customers reduces the time, errors and complexity of executing processes.

Straight-through processing. Business rules in processes can help automate the routing and processing of tasks — often reducing the amount of human intervention needed by over 80%.

Real-time visibility and control over processes. Managers can view real-time process performance and proactively manage bottlenecks.

Value and life of core systems extension. Leverage existing applications by reading and posting transactions while introducing more efficient Web-based forms and interfaces.

Process consistency. Ensure that the process documented is the process executed. Process models that actually run the process provide consistency, adherence and audit trails to ensure compliance with regulations like Sarbanes-Oxley.

Faster response to change. Revise processes to respond to organization or regulatory changes — in days, if necessary.

Potential for cloud. Cloud is the next iteration of outsourcing, adding to the beneficial economics many companies already experience. Unlike traditional BPO, which often requires the service provider to take over an existing software installation, the process cloud uses a common, one-to-many platform to automate highly standardized processes. It differs from application clouds in that it provides end-to-end process support, covering not just software but also people processes such as contact centers.

Over the next two to five years, the majority of KBPO will be widely adopted in the healthcare industry. Healthcare companies and providers cannot afford to overlook the advantages and benefits of this growing trend. 

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Knowledge Process Outsourcing (KPO)

The Impact of Accountable Care on Your Revenue Cycle

Posted on Thu, Apr 11, 2013 @ 04:27 PM

Becoming an accountable care organization (ACO) requires that your facility adopt a completely new point of view when it comes to revenue cycle management. The goal of an ACO is to reduce costs by improving the quality of care provided to patients. Providers are encouraged to and boost preventative efforts that may ultimately reduce the future need for high-cost medical services such as hospital stays. As a reward for the collaborative efforts of the ACO, participating insurers such as Medicare will generally offer financial rewards for lowering costs and meeting quality care goals for their patients. On the down side, this also means that ACO providers are accountable to Medicare and may risk losing money if their costs run higher than expected. Costs will no longer just affect overall profitability; for example, they will be evaluated in conjunction with efficiency to determine reimbursement parameters. Healthcare organizations need to be able to collect the correct financial and quality data, compile accurate reports and run predictive analytics in order to meet ACO objectives of better care at lower costs.

Due to its many tenets, it is difficult for many healthcare organizations to fully understand the total ramifications of becoming an ACO, and how to adequately assess the risks and benefits of ACO participation to their revenue cycles. The assessment involves a careful analysis of data capture methods, revenue cycle infrastructure, and available clinical and financial analytical tools to help maximize efficiency during the transition.

One effective strategy to assess the risks and benefits of becoming an ACO is to engage an experienced RCM outsourcing partner who understands the ramifications of becoming an ACO. They can educate you on the various pro’s and con’s and assist in deciding whether or not it would be beneficial to establish an ACO or join an ACO. The decision will vary greatly among provider types, geography, local health care environment, and organizational preparedness. Those considering the ACO concept must first figure out how much risk their organization is willing and able to take.

One of the biggest misconceptions about joining an ACO is that the revenue cycle will be easier to manage. In fact, just the opposite will most likely be true. The reality is that the complexity simply shifts. Payers demand more specific data about the management and outcomes of patient populations and providers and organizations need more sophisticated cost and performance information to negotiate contracts. These cost controls are more crucial under risk-based contracts; therefore organizations need to rely more on integrated data systems and predictive analytics. Healthcare providers will require the use of  advanced analytics, measured by accurate and applicable data, to manage costs and quality of care provided to patients.

A knowledgeable RCM partner can help your organization identify and capture the critical data you need for ACO participation. Before your facility can perform a risk-benefit analysis, you must have the most effective technology to capture the correct information. Your technology must be configured correctly to capture meaningful information and workflows to support the changes expected by this new business model.

Today’s EHR systems make the discrete capture of large amounts of patient data possible. By applying the appropriate analytical tools to this discrete data, your organization can measure and monitor the costs and outcomes that directly impact compensation within the ACO. An experienced RCM partner can leverage a higher degree of analytics to ensure seamless coordination among healthcare providers and accurate attribution models. Likewise, when fully integrated with a practice or enterprise management system, organizations can pinpoint and predict how much it costs to treat certain patient populations and how resources should be utilized. It is this broad, population-based analysis that is necessary to put organizations in a better position to evaluate ACO opportunities and performance.

 

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Evaluation and Management (E&M) Requirements, GeBBS Healthcare Solutions, Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO), Accountable Care Organizations (ACOs), Affordable Care Act

Advantages of the Knowledge Process Outsourcing for Healthcare

Posted on Tue, Dec 04, 2012 @ 05:32 PM

This election season, the economy was on everyone’s mind. Americans were evaluating the candidates on the likelihood that they will be able to improve the economy and get more jobs. However, this simplistic view of the economy does not penetrate the business world.

Leaders understand that job creation/company growth is an increasingly global proposition, especially, with the growth of outsourcing over the past two decades. Outsourcing began small, focused on finding cheaper manpower for labor-intensive jobs such as telemarketing and data entry at the beginning of the millennium. However, the paradigm is changing. Leading businesses, including those in the healthcare industry, are outsourcing even their “core competencies” to gain a competitive edge with the Knowledge Process Outsourcing Model.              

The outsourcing of core processes that require competitive knowledge and higher specialized skills is known as Knowledge Process Outsourcing or KPO.

Business process outsourcing has been a reality for many larger corporations for the past decade and smaller businesses have been gradually engaging as well because of the changing process. Initially, smaller businesses were hesitant because the headache of managing even employees in a central office—the idea of managing overseas was too much. However, outsourcing now is simpler. Instead of worrying about each individual contractor, companies simply work with a business that specializes in outsourcing that particular talent pool, and their provider hires and manages the workers abroad. In the same way, the Knowledge Process Outsourcing Model will free managers from many of the mundane details of having employees and allow them to focus simply on the deliverables.

Talent is vetted and managed from abroad—all businesses have to worry about is the product and payment.


Advantages of the Knowledge Process Outsourcing Model for Healthcare


The transition to the Knowledge Process Outsourcing (KPO) Model  is occurring gradually, as in every other industry.

Examples of KPO currently available include:

  • Financial Research

  • Insurance Research

  • Market Research

  • Data Analytics

  • Content Research Services

  • Medical Content Services

  • Reconciliation Services

  • Billing and Invoicing Services


In healthcare, it began with outsourcing services such as social network analysis and business process outsourcing for health insurance strategic services. As of July 2010, a wide array of services was available to healthcare facilities and all were in various stages of mainstream adoption. According to a study by Gartner, the KPO for the healthcare industry has reached the “plateau of productivity” and will see increasing adoption in the next few years.

Some of the benefits of KPO for healthcare include:

  • Collaboration across and beyond the enterprise. Automatic work routing and notifications across groups, partners, and customers reduces the time, errors and complexity of executing processes.

  • Straight-through processing. Business rules in processes can help automate the routing and processing of tasks — often reducing the amount of human intervention needed by over 80%.
    Real-time visibility and control over processes. Managers can view real-time process performance and proactively manage bottlenecks.

  • Value and life of core systems extension. Leverage existing applications by reading and posting transactions while introducing more efficient Web-based forms and interfaces.

  • Process consistency. Ensure that the process documented is the process executed. Process models that actually run the process provide consistency, adherence and audit trails to ensure compliance with regulations like Sarbanes-Oxley.

  • Faster response to change. Revise processes to respond to organization or regulatory changes — in days, if necessary.


To increase the probability of success, organizations must use a structured approach to managing the KPO opportunity. One such structured approach is depicted in the diagram below.

KPO

Source: Ivey Business Journal

 

  • Potential for cloud. Cloud is the next iteration of outsourcing, adding to the beneficial economics many companies already experience. Unlike traditional Business Process Outsourcing, which often requires the service provider to take over an existing software installation, the process cloud uses a common, one-to-many platform to automate highly standardized processes. It differs from application clouds in that it provides end-to-end process support, covering not just software but also people processes such as contact centers.


In conlclusion, over the next two to five years, the majority of KPO will be established and widely adopted in the healthcare industry. Companies can no longer afford to stay behind this growing trend.

Tags: Business Process Outsourcing (BPO), Knowledge Process Outsourcing (KPO)