GeBBS Healthcare Blog

Outsourcing as a Solution for Revenue Cycle Management (RCM) Continues to Grow at a Rapid Pace

Posted on Wed, Feb 22, 2017 @ 06:00 AM

Facing lower reimbursements and shrinking margins, hospitals are exploring ways to capture more revenue. This has led an increasing number of hospitals across the nation to outsource their revenue cycle management to professional outsourcing companies. This trend was identified in a recent Black Book™ survey, which included responses from 1,309 hospital CFOs and business office leaders. The surveyed revealed that 39.8 percent of U.S. hospitals outsourced their complex claims and revenue cycle management to specialized vendors. That is up from 20.4 percent of hospitals in 2013.

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Hospital billing and collections staffs typically do not have the experience in handling complex revenue cycle management challenges, causing a significant number of claims to be written-off.

Many hospitals are turning to outsourcing to reduce those write-offs and give their organizations a financial boost. According to the Black Book survey, 49 percent of hospital CFOs said outsourcing, including offshoring, is becoming an extremely viable option in 2017 for their organization’s revenue cycle management. Black Book projects the market for outsourced revenue cycle management will grow at a compound annual growth rate of 26.5 percent over the next two years, with the market reaching a value of $9.7 billion by 2018.

The next challenge for hospital financial managers is to choose the right outsourcing partner. CFOs should select an outsourcing partner that has a national recognition as a provider of RCM and HIM solutions. They should choose a company that has an in-depth healthcare industry knowledge and has the expertise to provide innovative, end-to-end solutions that will successfully resolve their complex RCM challenges, while enhancing their overall business operations.

This kind of outsourcing partner can leverage deep industry knowledge and expertise, and provide a partnership approach with comprehensive service offerings. They will deliver highly skilled professionals, robust processes, proprietary workflow engines, and world-class infrastructure to reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity.

This week, the IAOP® has named GeBBS Healthcare Solutions to its 2017 Global 100 Outsourcing List, an annual listing of the world’s best outsourcing service providers. We were recognized as an industry leader in healthcare revenue cycle optimization outsourcing solutions for the second year in a row that was judged in five main categories: size and growth, customer references, awards and certifications, programs for innovation, and corporate social responsibility.

It extends GeBBS’ long history of awards.  Modern Healthcare has listed us as one of the nation’s top 15 largest revenue-cycle management companies for 2016 and we’ve been recognized as one of the top 20 outsourcing providers for revenue cycle management for hospitals 100 beds and up, according to Black Book Market Research.

As hospitals are forced to do more with less, outsourcing provides the scale necessary to optimize revenue from complex claims collections to end-to-end revenue cycle management. Be sure to select an outsourcing partner that fully understands your healthcare RCM needs.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Offshore Medical Billing, outsourced medical billing, Outsource Coding, outsourced coding, coding outsourcing, Business Process Outsourcing (BPO), Offshore Medical Coding, Offshore Revenue Cycle Management

CMS and AHIP Move to Improve Healthcare Quality Measures

Posted on Thu, Apr 28, 2016 @ 04:00 AM

The Obama administration and health insurers took steps recently to standardize and improve the measures that are intended to gauge the quality of healthcare. The CMS and trade group America's Health Insurance Plans (AHIP) have announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. This is a good move!

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Nobody benefits when doctors spend time collecting different data for multiple insurers instead of using those resources to improve the quality of patient care. This agreement to standardize quality measures can accelerate development of capturing data that patients care about most – how fast they recover from any illness or treatment.

The most important aspect of this new quality program will be how it deploys superb clinical documentation and expert medical coders to identify and codify these new quality measures.

Medical coding is the lifeblood of a revenue cycle, regardless of whether or not it is used in pay-for-performance contracts. Accurate and efficient coding is crucial to meet financial and compliance goals. Medical coding can be complex yet time sensitive, where being down even a single coder can impact revenue. Healthcare providers need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient coding.

An expert HIM company can provide immediate, experienced coding professionals to help healthcare providers capture these new quality measures. Whether the medical coders work on-site or remote, U.S. or global, their knowledge and training is top notch. They know the most current coding regulations and keep up to date with the latest in patient care in the clinical and hospital setting. Strict enforcement of coding compliance guidelines, ongoing reviews, and a commitment to continuing education promotes coding accuracy, data integrity, and proper claims submission.

These new quality measures are also making accurate clinical documentation more important than ever. RAC, Medical Necessity, ICD-10, pay-for-performance, and the growth in volumes resulting from the ACA are all impacting healthcare organizations. The ability to get reimbursed is directly dependent on the quality of clinical documentation. Missing, poor, or non-specific clinical documentation will result in lost revenue.

Outsourcing can help you comply with the new quality measures and get you paid faster by improving your clinical documentation. Outsourced CDI specialists are professionals of the highest caliber. They are credentialed, experienced, and they are passionate about getting even the smallest details right. Whether the CDI professionals are assessing your program or supplementing your staff, they can help you develop, improve, and maintain your clinical documentation to meet the new CMS and AHIP quality measures.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding, Offshore Medical Coding, Outsource Coding, Medical Coding BPO

CMS Chronic Care Management (CCM) Initiative Can Help Improve Bottom Line for Physicians

Posted on Fri, Mar 18, 2016 @ 05:00 AM

In today’s healthcare delivery environment, physicians are constantly looking for new ways to earn and increase their bottom lines. For example, the 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT code 99490 -- Chronic Care Management (CCM), which reimburses practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients.

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The good news is that chronic care management, as well as the medical coding for these services, can be fulfilled by professional outsourced companies. This is a critical element of the CMS initiative.

Traditionally, physicians have not had the staff bandwidth to support intensive Chronic Care Management; however, this initiative allows doctors to outsource much of the hands-on, daily care coordination to healthcare organizations who are staffed with experienced care management and medical coding professionals. These outsourced coding companies can work hand in hand with a medical practice’s CCM to provide end-to-end professional services. 

It’s not a coincidence that more than 80% of practices who want to offer CCM services to their patients ultimately end up outsourcing their CCM service and their medical coding. 

The billing physicians are still responsible for creating their critically-ill patients’ care plans and directing the efforts of their professional outsourced staff. 

CMS allows physicians who bill for the 99490 code to delegate this non-face-to-face time, and provide only general supervision on the CCM work they do. This critical change allows physicians with smaller professional staffs to extend the medical coding and care management of chronic diseases to their patients who need it the most and at the same time create a new revenue stream.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO

Medical Coding Outsourcing is More Than Staffing

Posted on Thu, Feb 18, 2016 @ 06:00 AM

Outsourced medical coding's traditional approach has been staff augmentation. It has been typically used to meet short-term gap needs due to turnover, extended absences, or electronic medical record (EMR) changes. In other words, it has been used when a healthcare provider needed temporary additional resources to supplement its existing resources. However, from our experience, this traditional staff augmentation model is not keeping up with the rapidly changing needs in the healthcare industry.

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There is a growing demand for healthcare services to meet the needs of an aging population and the burgeoning impact from newly-insured patients resulting from the Affordable Care Act. The effect is a trickle down that has increased staffing needs all along the revenue cycle from coding to accounts receivables to collections. With the industry’s transition to ICD-10 with its new codes and processes, and computer-assisted coding (CAC), providers have been challenged to keep up with this evolution.  There is a need for coders -- not just new coders, but also current coders who have been trained to work in today's new coding world.

As a result, there are some healthcare providers who have spread their outsourcing needs across multiple vendors to meet this demand. Invariable, the quality can suffer with inconsistencies among different vendor processes and management. Further, the vendor has limited economic incentive to make meaningful investments to ensure success due to the limited or unknown contract length. Short-term traditional approach engagements face ramp-up challenges, since even experienced coders may need 45 or more days to reach full efficiency. Coders working in these environments may not capitalize on the values of synergy in processes and technology that using outsourcing professionals from a single vendor offers.  

GeBBS, which was recently selected to this year's IAOP Global 100 Outsourcing List, has seen this trend with its long-term investment and delivery of end-to-end revenue cycle management (RCM) solutions. These solutions provide not only coders, but also HIM technology platforms for coding and audits to improve coding efficiency, accuracy and control. This combination of coders and a comprehensive audit and management capability creates transparency for higher coding performance that meets client standards. The byproduct from higher coding performance is the reduced number of claim denials, which ultimately improves the provider’s revenue flow.  This long-term investment is just as true with accounts receivable and patient access, where the strength of GeBBS’ outsourced RCM is not just outsourcing staffing, but also the infrastructure backbone supporting the staffing. The net impact that healthcare providers are seeing include cohesive outsourcing benefits across all of the elements of people, processes and technology.  So when you think of outsourcing, realize the important value that outsourcing can provide is not only people, but also the processes and technology to support those people.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO, Coding Accuracy

New Year's Resolutions Can Be Achieved If You Have a Plan

Posted on Thu, Jan 14, 2016 @ 07:00 AM

A new year presents a fresh opportunity to set annual goals and create a plan to achieve them.  Many people make New Year’s resolutions where they strive to do better than they have in the past.  Often the most successfully attained resolutions are the ones that are documented and backed-up with a plan to achieve them. 

NewYearsRes-600x400.jpgNew Year’s resolutions are not limited to self-improvement in your personal life, but can also impact your business life.  What are the New Year resolutions for your job?  They can range from simply being more efficient, or to being more resourceful and proactive by planning ahead instead of always working in a crisis mode.

If the foregoing resolutions seem viable to you, what steps can you take to achieve them?  If it is about being more efficient -- are you being more technology savvy?  Are you working smarter and using your time more efficiently? Are you planning to add more internal resources, or do you plan to outsource some of your workload and have best practices available to you immediately? Maybe you are planning to use a combination of all three. 

For healthcare providers, 2016 goals may include becoming fully ICD-10 compliant. This resolution can be achieved immediately by outsourcing this work to a professional firm who can extend their expertise and best practices to your workflow, while simultaneously improving your patient satisfaction with higher quality service.  For example, your practice may be dealing with paper EOBs, but that doesn’t mean you cannot be more efficient by using an outsource service to transfer paper documents to an electronic format that will expedite your charge entries.

It’s not too late to make 2016 the year where your goals are set and actually achieved.

Tags: Business Process Outsourcing (BPO), Explanations Of Benefits (EOBs), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, Offshore Revenue Cycle Management, Medical Coding Outsourcing

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.

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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

Top 10 Reasons Why You Should Outsource Your Revenue Cycle Activities

Posted on Thu, Mar 19, 2015 @ 12:12 PM

In today’s healthcare environment of shrinking reimbursements, due to governmental mandates and Medicare policy changes, the importance of maintaining a healthy revenue cycle is second only to providing the best patient care possible. Without an adequate margin there can be no medical mission.

One way to ensure your revenue cycle remains as healthy as possible is to enlist the help of a healthcare BPO company to assist with -- or handle completely -- your revenue cyclegebbs outsourcing medical billing activities. These organizations are expert at keeping your revenue cycle fine-tuned and optimized to its maximum performance level, much like a highly-trained
mechanic can do for your automobile. There are literally dozens of advantages that third party revenue cycle companies can provide, such as onshore and offshore medical coding and offshore medical billing. Here, in my opinion, are the top 10 reasons why healthcare financial professionals should consider outsourcing.

  1. You will see an increase in your reimbursements and collections.

  2. Your labor costs for revenue cycle maintenance will be reduced.

  3. Requires no capital investment.

  4. You get immediate access to highly-skilled and expert personnel that will mitigate risks from frequently changing governmental regulations.

  5. Staff members will be freed up to work on other critical financial issues.

  6. You will receive daily, detailed financial reports upon which you can take immediate action.

  7. Your revenue cycle will be easier to track and manage.

  8. It’s an uncomplicated solution that works from day 1 of implementation.

  9. No additional staff, training or office spaces are required.

  10. You get immediate peace of mind that you are doing everything you can to maximize your revenue cycle.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Medical Coding, Affordable Care Act, Insurance Billing Solutions, Offshore Medical Billing, Offshore Medical Coding, Medical Billing BPO, Offshore Revenue Cycle Management, Remote Medical Coding, Medical Coding BPO