Posted by HGS Senior Vice President, Provider Healthcare Daniel A. Schulte, MBA, CHFP
Hospital financial managers face new risks and opportunities ranging from compliance modifications; movement from volume to value; and renewed efforts to build alliances between and among hospitals, payers, clinicians, the government, and employers. Navigating this new landscape means seizing opportunity without unduly increasing the risks.
Healthcare organizations need to understand these risk issues, and take the appropriate steps to manage processes accordingly. Some of the high-risk factors include:
- Regulatory pressures from new governmental programs and statutes, including ARRA, HITECH, PPACA, PCI, FDCPA, and other consumer-protection and healthcare initiatives
- ICD-10 preparedness and potential for wider claim denials due to misunderstood coding processes
- The Hospital Value-Based Purchasing Program and other reimbursement reform efforts, and their impact on Medicare/Medicaid reimbursement (soon to include a growing list of commercial payers)
- Merger and acquisition activity, MSSP and ACO efforts, physician alliances, and further care consolidation
As pressures grow, healthcare organizations may wish to investigate and select business partners with the experience, tools, and goal-driven processes that will help providers meet their internal and external objectives. Business Process Outsourcing (BPO) and Contact Center Outsourcing (CCO) partnerships will give the healthcare provider the skills they need to optimize their own contact management strategies, improve internal policy and process maps, and ensure the best levels of compliance in an increasingly complex environment. A successful BPO / CCO partnership returns value beyond the terms of the Statement of Work between provider and vendor, which allows the healthcare provider to focus on their mission and service to the community.
According to Market Research Reports, Inc., the global healthcare RCM outsourcing market is projected to grow at a CAGR of 17.55 percent over 2014–2019. BPOs are unlocking significant outcomes that improve patient quality of care, positively affect population health, and mitigate both cost and risk.
When evaluating BPO or CCO partners, providers should keep in mind that these eight core competencies are integral to effective healthcare receivables:
- Compliance with federal and state privacy and security guidelines—In this post-reform environment, healthcare stakeholders are bolstering compliance, and many are turning to outside experts to provide the creation or management of more stringent programs.
- Enhancing or improving methodologies—New strategies and insights are required to deliver on new demands like ICD-10 implementation, value-based reimbursement reforms, revenue cycle, and patient marketplace shifts.
- Increasing productivity internally, and obtaining increased productivity within the BPO or CCO—For one of the largest home health providers in the U.S., HGS insurance eligibility and authorization services support drove near-100 percent financial clearance rates, with internal quality scores above 96 percent.
- Quantifiable savings—From denials reversals to bad debt collections, BPOs that specialize in RCM strategy can deliver significant cost-containment outcomes.
- Solid governance documentation—Master Service Agreement, Statements of Work, Service Level Agreements, timely operational reporting requirements all are mandatory elements of a good relationship.
- Advanced analytics--To take advantage of the increased focus on data and customer experience (CX), BPO partners are offering analytics-as-a-service technologies.
- Improved end-customer focus-- BPOs can sharpen the consumerism focus with service excellence, smart processes, and a fresh perspective on CX—and the expertise required to deliver it.
- Effective IT infrastructure capable of managing operational, regulatory, and client-driven needs—From proprietary, web-based tools for claims and denial workflow to automation, BPOs help keep providers solvent and focused on next-generation solutions.
These 8 habits are the foundation of a strong BPO/CCO partnership. How to begin on the journey? Choose a partner with these virtues as part of their own corporate DNA.
Healthcare organizations often need additional skilled leadership to help manage the many projects, processes, and people involved in the delivery of healthcare business process management. Healthcare providers aren’t looking to pass off every business operation to a third party, but rather parts of a much larger core-competency process. Typical examples include:
- Pre-registration and client onboarding support
- Coding, billing and A/R management
- Case management and care coordination
- Claims denial resolution.
Each of these service lines has unique statutory restrictions, policies and process maps, workflows, and best practices.