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Table of Contents
Introduction
The healthcare industry requires the highest level of precision and customer service. Patients need support as they navigate personal health issues and complex insurance coverage and healthcare organizations can become overwhelmed handling both patient care and back-end administrative tasks. That’s where healthcare BPO services come in. Let’s explore healthcare BPO services and how your organization can effectively utilize them.
Key takeaways
- The role of healthcare BPO: By handling behind-the-scenes administrative tasks, healthcare business process outsourcing (BPO) can give healthcare organizations the time and focus they need to put patients first, while also improving efficiency and saving money.
- Range of services: Healthcare BPO spans a wide range of services, including (but not limited to) medical coding, billing, telemedicine, claims processing, data entry, medical transcription, and payroll management.
- Best practices: It’s important to partner with a BPO healthcare organization that has extensive experience in the tasks you outsource to them, has high standards for data security and healthcare regulations, and is well-aligned with your organization’s goals and needs.
What is healthcare BPO?
Healthcare business process outsourcing (BPO) is the practice of healthcare organizations hiring outside contractors to cover some or all of their non-clinical duties. Many healthcare facilities (hospitals, clinics, and others) choose to outsource their administrative tasks to a third party, as this allows the facility to focus more attention and care on the medical needs of their patients. Healthcare BPO can also provide major savings on the costs of installing, maintaining, and staffing the same tasks in-house.
How does BPO help to manage healthcare processes?
BPO in healthcare refers to the various outsourced tasks that healthcare organizations hire out, excluding anything involving direct medical care itself since healthcare BPO company providers are not involved with the actual treatment or diagnosis of patients. However, healthcare BPO is often an instrumental part of processing patient health records, transcription, medical coding, appointment scheduling, processing insurance, and billing. By taking these non-core tasks to a third party, healthcare providers are able to benefit greatly from major cost-savings and a boost in efficiency.
What are healthcare BPO services?
Healthcare Business Process Outsourcing services refer to healthcare organizations outsourcing various tasks to external providers. The aim is to enhance efficiency, reduce costs, and improve service quality. Healthcare BPO companies offer clinical and non-clinical services. Let’s look more closely at the different options.
Clinical services
Clinical services are tasks directly related to patient care and medical services. Outsourcing clinical services enhances the quality of care, ensures compliance, and supports healthcare providers in delivering efficient medical services. Clinical services include:
- Medical billing and coding: Outsourcing the process of coding medical services into billable charges and processing insurance claims.
- Telemedicine services: Providing remote clinical services to patients.
- Medical transcription: Converting voice-recorded reports dictated by physicians and other healthcare professionals into text format.
- Pharmacy benefit management: Outsourcing the administration of prescription drug programs to specialized companies.
- Clinical data management: Managing and processing clinical trial data to ensure high-quality and reliable data.
Non-clinical services
Non-clinical services involve tasks that do not directly engage with patient care but are essential to healthcare organizations. These services help reduce overhead costs and improve efficiency.
- Healthcare information management: Managing patient records, entering data, and ensuring the security of health information.
- Customer service: Providing support for appointments, billing inquiries, and other patient needs.
- Finance and accounts: Managing payroll, accounts payable and receivable, and other financial services.
- Human resources: Outsourcing recruitment, training, and HR management functions.
- Supply chain management: Managing inventory and logistics for medical supplies and equipment.
As the healthcare industry continues to evolve, the scope of BPO services will also expand. Many providers now utilize AI and machine learning, develop healthcare mobile apps, and offer more personalized patient care services.
What are the different types of healthcare services?
Healthcare is an extremely broad category that encompasses a wide range of specialized disciplines within the medical field, as well as several auxiliary functions carried out by healthcare providers. Though far from an exhaustive list, some common healthcare services include:
- General practitioners and specialists: These are the one-on-one services where a licensed professional works directly with a patient to treat, diagnose, or examine medical concerns.
- Preventative care: Healthcare services that prevent, screen for, and treat health concerns before they become more serious. These include vaccinations, checkups, tests, and other forms of prevention.
- Hospital care: The various treatments provided to patients within a hospital, either in emergency situations or for severe illnesses and injuries. Patients in hospitals are cared for by a larger team of doctors, specialists, nurses, and others for well-rounded, holistic care.
- Dental care: Any services provided by dentists and their teams to support oral health.
- Laboratory and diagnostics: A variety of tests can be conducted to diagnose related health conditions or diseases by careful examination of a patient’s bodily fluids or tissues.
- Pharmaceuticals: The supplying, portioning, and dispensing of a patient’s prescription drugs.
- Mental health care: The range of services provided to support emotional, mental, and behavioral health, provided by psychiatrists, psychologists, and therapists.
- Physical, speech, and occupational therapy: Care provided to patients who, because of neurological, muscular, or mental conditions, or because of injury are dealing with pain, inflammation, impairment, or general difficulties in daily life. The aim of these therapies is to ease pain, promote healing, and strengthen the patient’s bodily systems, hopefully providing a greater degree of independence and quality of life for the patient.
- Addiction and substance abuse treatment: Provides patients with the tools they need to overcome addictions and physical dependence, as well as preventing or mitigating relapse in the future.
- Medical transport: Physical transportation between medical facilities in emergency situations, usually conducted via land or air ambulance.
Benefits of outsourcing in healthcare
Outsourcing BPO services offers healthcare providers and insurance companies many benefits. Let’s explore some of the key advantages:
- Reduced costs: Outsourcing leads to significant cost savings for healthcare providers. It reduces the need to invest in infrastructure, technology, and staff for non-core functions. BPO providers often offer lower costs due to economies of scale and operational efficiencies, allowing healthcare companies to allocate resources more effectively.
- Focus on core activities: Outsourcing non-core activities allows healthcare organizations to concentrate on their primary mission of providing high-quality patient care. This leads to better patient outcomes and increased satisfaction.
- Access to specialized expertise: Outsourcing partners specialize in their services and have access to skilled professionals and advanced technologies. This expertise ensures that agents accurately handle medical billing, coding, and transcription, and comply with the latest regulations.
- Improved efficiency and productivity: Outsourcing streamlines healthcare operations, reduces turnaround times, and enhances overall productivity. BPO providers use state-of-the-art technology and processes to expedite time-consuming tasks and deliver services efficiently.
- Scalability: Healthcare BPO services offer scalability, allowing organizations to easily adjust their operations based on demand. This is particularly useful for handling fluctuating work volumes, such as increased claims processing during specific periods.
- Enhanced compliance: Compliance with healthcare regulations and standards is critical. BPO providers help healthcare organizations maintain compliance and ensure the privacy and security of patient information.
- Improved patient satisfaction: By outsourcing non-core functions, healthcare providers enhance the patient experience. Agents more efficiently schedule appointments, resolve issues, and answer questions, all of which results in higher patient satisfaction.
- Access to advanced technology: BPO providers invest in the latest technologies, including AI and machine learning. Healthcare organizations then benefit from using such technology without needing to invest in it themselves.
- Risk management: Outsourcing helps spread and manage risk, especially in areas such as data management and regulatory compliance. BPO providers are equipped to manage these risks effectively.
- Innovation and continuous improvement: BPO companies focus on continuous improvement and innovation to stay competitive. Healthcare organizations benefit from these advancements, which improve services and patient care
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Healthcare processes you can outsource
Many of the administrative and behind-the-scenes tasks in the healthcare world can outsourced to third parties. Some of the most common healthcare BPO tasks include:
Medical coding and billing
To properly record the services provided to each patient and make certain that insurance is billed correctly, medical coders need to accurately categorize each service. Healthcare providers can hire third parties to sort through patient records and assign the proper codes to each condition and service according to a standardized coding system like the Healthcare Common Procedure Coding System (HCPCS), the International Classification of Diseases (ICD), and the Current Procedural Terminology (CPT). Properly coded, these records can then inform how the insurance company and patient are billed.
Claims processing
With coded records, healthcare organizations can then submit medical claims to the insurance companies. This is a vital step in the process because without it the healthcare professionals don’t get paid for the work they do.
However, in-house claims processors in many healthcare organizations can easily become overwhelmed by this process, since hundreds, even thousands of claims may cross their desks every day.
For that reason, it can be a game-changer for many providers to turn to healthcare BPO for claims processing since they have a much higher capacity to process large amounts of medical claims.
Data entry
With the sheer amount of medical records that pass through a healthcare provider’s office every day, it can be challenging to handle the myriad of data from lab results to insurance details.
Hiring a trustworthy healthcare BPO company for data entry tasks is an excellent way to make sure that all patient medical records are up to date and that no important information falls through the cracks.
Telehealth
Due to the busy nature of modern life, and accelerated by the isolation of the pandemic, telehealth has become a very popular option for many patients because of its convenience.
Because telehealth is usually constrained to more basic medical concerns, it can be easily outsourced to a third party, giving your physicians the time they need to focus on patients with more complex symptoms.
Medical transcription
Physicians have enough to think about before we even consider taking notes, filling out paperwork, and similar tasks. When healthcare professionals get bogged down by these administrative tasks, that extra time can quickly add up and contribute to longer wait times and more exhausted physicians.
However, healthcare organizations can easily streamline accurate note-taking by having physicians record conversations with patient consent. Those recordings can then be sent to a secure, trusted healthcare BPO service for transcription and categorization, greatly enhancing record-keeping and accessibility.
Payroll management
Managing payroll in-house can be quite costly. A healthcare BPO can be an excellent option to make your payroll process not only more efficient but more accurate and less costly to the business.
Challenges in healthcare BPO and solutions
Outsourcing BPO services, while incredibly beneficial, comes with challenges. Recognizing these challenges and implementing practical solutions is crucial to maximize the benefits of outsourcing. Here are some common challenges and strategies for overcoming them:
Challenge #1: Data privacy and security
Patient data is highly sensitive, so its security is critical. Outsourcing poses risks as data passes through more hands and is potentially transferred outside of secure systems.
Solution: Healthcare providers should partner with BPO providers that comply with privacy laws and have robust security protocols. The BPO provider should do the following:
- Conduct regular security audits
- Insist on data encryption
- Utilize secure access controls
- Have established producers for breach notification
Challenge #2: Regulatory compliance
Healthcare providers are subject to stringent regulatory requirements. Ensuring that outsourced services comply with these regulations can be complex.
Solution: Work with BPO providers that have expertise in the healthcare sector and are familiar with the relevant regulations. Conduct regular training, stay updated on compliance issues, and include compliance clauses in your contracts with BPO partners.
Challenge #3: Forming a successful partnership
Forming a strong and strategic partnership takes time and effort. It requires integrating outsourced services with existing healthcare systems and processes. It also often involves a perceived loss of control over specific processes and decisions. This can be unsettling and challenging for healthcare providers.
Solution: To mitigate this, establish clear communication channels, set precise expectations, and maintain active involvement in decision-making processes. Choose BPO providers that have experience with similar healthcare systems and can demonstrate seamless integration capabilities. Remember to work to build a strategic partnership rather than a transactional relationship.
By addressing these challenges with strategic planning, careful partner selection, and ongoing management, healthcare providers can successfully navigate the complexities of outsourcing BPO services.
Best practices for successful healthcare BPO implementation
Best practices in healthcare BPO are essential for operational efficiency, cost savings, and high-quality patient care. Here are best practices across five key areas to consider:
Best practices for selecting the right partner:
Expertise and experience: Look for BPO providers with a proven track record in the healthcare sector. You want a partner that has successfully worked with similar healthcare companies.
Compliance: Ensure the provider adheres to healthcare regulations such as HIPAA in the U.S. and GDPR in Europe.
Technology capabilities: Evaluate the provider’s investment in technology, including AI, machine learning, and automation tools that can enhance efficiency and accuracy.
Cultural fit: Choose a partner whose corporate culture aligns with yours, facilitating smoother collaboration and communication.
Financial stability: Assess the financial health of the BPO provider to ensure long-term viability and reliability.
Best practices for contract management:
Clear SLAs: Define specific, measurable service level agreements (SLAs) that cover performance metrics, quality standards, and turnaround times.
Flexibility: Include terms that allow for scalability and adjustments based on changing needs. This ensures the partnership can adapt over time.
Data security and privacy: Incorporate stringent data security and privacy clauses to protect patient information and ensure compliance with regulatory standards.
Dispute resolution: Establish clear mechanisms for resolving disputes or performance issues. Detail the escalation process and determine penalties for non-compliance.
Best practices for transition planning:
Detailed roadmap: Develop a comprehensive transition plan. Outline timelines, key milestones, roles and responsibilities, and strategies for risk mitigation.
Communication strategy: Implement a communication plan that keeps all stakeholders informed throughout the transition process.
Data migration: Plan for secure and efficient data migration, including testing and validation to ensure data integrity and accessibility.
Best practices for training agents:
Ongoing training: Ensure the BPO provider offers continuous training on the latest healthcare practices, regulatory updates, and technology.
Patient-centric approach: Establish a culture centered around patient satisfaction. Agents should constantly work to improve patient care and integrate feedback.
Cultural sensitivity training: Training on cultural sensitivity and local healthcare norms is essential for providers serving diverse populations.
Best practices for choosing the location of your call center:
Regulatory compliance: U.S.-based call centers are often more familiar with U.S. healthcare regulations and privacy standards. If you choose an offshore call center, ensure they comply with all regulations.
Language and cultural alignment: Work with a call center that fluently understands the language and culture of your patients. Utilizing U.S.-based centers can improve patient satisfaction. This is because there are fewer language barriers, and agents have a better understanding of cultural nuances.
Local market knowledge: Ensure the call center, wherever it is located, has strong knowledge of your local market. This allows BPO providers to offer insights into local healthcare systems and patient expectations, providing more personalized customer service.
Adhering to these best practices helps healthcare organizations navigate the complexities of outsourcing. It ensures they reap the benefits while maintaining high-quality patient care and compliance with healthcare standards.
Future outlook of healthcare BPO services
The healthcare Business Process Outsourcing (BPO) sector continues to experience significant growth. These shifts focus on enhancing efficiency, reducing costs, improving patient care, and navigating the complexities of healthcare regulations. Key future trends in healthcare BPO services include:
1. Increased adoption of AI and automation
AI and automation will continue transforming healthcare BPO by streamlining operations, reducing manual errors, and improving turnaround times. These technologies automate routine tasks such as patient scheduling, billing, and claims processing. This allows healthcare providers to focus fully on delivering quality patient care.
2. Expansion of telehealth services
The telehealth market has experienced exponential growth since the pandemic. Healthcare BPO services will continue to expand to support telehealth infrastructure. This includes providing back-end support, customer service, and technical assistance.
3. Emphasis on data security and privacy
With the increasing digitization of healthcare data, there will be a heightened focus on data security and privacy. Healthcare BPO providers must invest in advanced cybersecurity measures and comply with global data protection regulations to safeguard sensitive patient information.
4. Integration of blockchain technology
Blockchain technology offers promising solutions for the secure, transparent, and efficient handling of healthcare data. It can facilitate the safe exchange of medical records, streamline billing processes, and ensure the integrity of healthcare transactions.
5. Personalized patient engagement
Leveraging data analytics and AI, healthcare BPO services will focus on personalizing patient care. This includes customized communication, patient education, and support services tailored to individual patient needs.
These trends reflect a broader move toward innovation, efficiency, and patient-centered care in the healthcare BPO sector. As technology continues to evolve, it is more important than ever to choose the right healthcare BPO partner.
Choosing the best BPO company for your healthcare business
Healthcare organizations of all sizes have been able to grow and thrive thanks to the help of healthcare BPO services. As you go about selecting a healthcare BPO, it’s important to first consider the company’s expertise, and compare that to your current needs. What business processes are holding you back? Does a given medical business process outsourcing company adequately cover that need? Do they have a good reputation for doing so? Do they have the necessary tech to get the work done?
Additionally, your decision process should take into account how well the BPO healthcare company communicates. Are the prompt in getting back to you? Do they communicate clearly, adapt to the situation, and keep you in the loop on major decisions? Does their service feel like genuine collaboration?
At Global Response, we are committed to meeting the changing needs of healthcare organizations and patients alike. Our agents use cutting-edge technology and a patient-first approach to provide the highest level of patient care. Get a free quote from Global Response today to learn how our experienced, accurate, and secure BPO healthcare services can enhance your healthcare organization.
FAQs
Healthcare BPO services are divided into clinical and non-clinical services. Clinical services include medical billing and coding, patient care management, and telehealth services. Non-clinical services encompass revenue cycle management, data entry and management, customer service, IT support, and human resources.
Outsourcing can raise concerns about patient privacy and data security. However, reputable BPO providers comply with strict regulations, ensuring patient data is handled securely. Providers implement robust data protection measures, including encryption, access controls, and regular security audits, to safeguard patient information.
Yes, outsourcing can improve the quality of healthcare services. It allows healthcare providers to focus on patient care while BPO providers handle administrative and operational tasks.
