Blog

OUTSOURCING IN MEDICAL HEALTHCARE

Author: Raj Priya

Outsourcing itself implies that receiving sources from out, in other words we can says that it is a process of contracting business function to specialized agency. Let’s understand with example specially Outsourcing of canteen facilities in hospitals, colleges, schools etc.

Healthcare outsourcing process used by organisations like hospitals, nursing homes, etc. The global healthcare BPO (Business Process Outsourcing) market is growing due to rapid increase in outsourcing of clinical process and reduction of error in non-essential functions such as finance, accounting and customer service. The benefits of outsourcing healthcare are following –

• Lower cost makes an organisation’s operation efficient and cut down extra
• Provides quality healthcare & saves
• Avoid serious billing mistakes & makes operation

The healthcare BPO market is currently expanding at a compound annual growth rate of about 21.4% cross the globe. BPO in India can integrate programs fragmented across various platform in to a unified healthcare information and exchange. The global healthcare BPO market size is projected to rich USD 468.5 Billions by 2026 growing at a CAGR of 9.6%. Outsourcing of staffing process is full of partial outsourcing of company internal recruiting function to an outside specialist who assumes the role of companies recruiting department. It is also called RPO (Recruitment Process Outsourcing) is a workforce solution in which a business transfers all or parts of its permanent recruitment to an external provider.

• It reduces costs
• Scalability
• Reduce time to
• Improved candidate
• Analysis & reporting

Patient demographics process such as basics identifying information it includes Name, Date of Birth and Address along with insurance information.

It streamlines the medical billing process, improved healthcare quality, enhances communication and bolster cultural competency.

Prior authorization is a health plan cost-control process by which physician and other healthcare provider must obtained advance approval from a health plan before a specific service is a delivered to a patient to qualify for payment coverage.

Various pharmacy billing process following are:

• Receive mail
• Detail verification
• Data Conversion entry
• Medication refill check
• Organizing prescribed medicines
• Order Placement
• Order Tracking
• Billing Management

Medical date entry process is a heath monitoring system involves processing and analysis of data retrieved from smartphones, smart watches, smart bracelets as well as various sensors and wearable devices.

Healthcare Data Entry Services Process We Follow

1. Need Assessment. We evaluate and interpret your needs to understand the volume and data within documents that need to be
2. Data Verification and …
3. Data Entry …
4. Format …
5. Data …
6. Result Transmission.

Pharmacist clinical review process in which a pharmacist is checking to see if medication gives the appropriate interaction dose quantity and indication. The primary aim is assessing the therapeutic. It is a process of consultation between pharmacist and patient about patient health condition and medication prescribed.

Medical coding is a transformation of healthcare diagnosis, proceedings, and equipment in to universal medical alphanumeric codes. Medical coding professionals help ensure the codes are applied correctly during medical billing process which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.

To medical coding process we have to following the given steps –

• Step 1 Abstract the documentation.
• Step 2 Query if necessary.
• Step 3 Code the diagnosis.
• Step 4 Code the procedure.
• Step 5 Confirm the medical necessity.
• Step 6 Double-check your code.

The medical coding used by professionals are ICD-11, ICD-10CM, ICD-10PCS, CPT etc.

After the medical process, there is eligibility and benefits verification to check the received payment for the service. Healthcare providers need to verify each patient eligibility and benefits before patient visits.

The drug assistance program which offers free or low costs medicines. If you don’t have insurance or underinsured and can’t afford medicines, whereas the patient responsibility on drugs is to accept the measures takes by the hospitals to ensure personal privacy and confidentiality of medical record. To attend follow up appointment as requested by doctor.

Long term care pharmacy operation provides prescription processing handle dispensing and delivery.

Offer medication and administration.

Are available to respond emergencies 24/7.

A long-term care pharmacy typically services patients who have chronic ailments and who rely on continuous medications to get the best care for their medical needs, even when several concerns overlap. Unlike a retail pharmacy, a long-term care pharmacy can help patients monitor their health over time.

In India, medical outsourcing is growing at a rate of 150% per year and shows a sign of abating. Healthcare BPO is not still very large in India. The industry is estimated about $300 million now but it has immense potential and very attractive space.

The top healthcare outsourcing companies in India are –

• Fusion BPO service
• WNS global service
• Access healthcare
• Medi Script
• AGS health
• Genpact
• Login service
• Vsynergize

As one of the leading BPO hubs in the world, India edge in the outsourcing industries lie in the costs efficient service and flexible rate. Medical outsourcing has become the next big thing after BPO hits the outsourcing world. Medical outsourcing has been steadily growing in recent year and now large organization in US & UK has been of offshore outsourcing their employee healthcare service.

India become prominent destination for outsourcing in the service sector in the 1990s. Outsourcing to India started with the IT industry which has responded to the changing market requirement by increasing the scale of operation and capability to handle complexity.

RAMAN ROY father of BPO revolution in India.

The reason behind rise in outsourcing increase efficiency for something consuming function that the company may lack resources for.

RCM (Revenue Cycle Management) is a process used by healthcare system in all over the world to track revenue from patient to their initial appointment or encounter with the healthcare system to their final payment.

The revenue cycle begins when the patient makes an appointment and end with a successful payment collection however, there are many steps in between that must be accurately and efficiently completed to ensure timely payment.

The factors that affect RCM:

. The provider has little control over the payment from the claimed review and denial process. Long walls for the billing and claims to be processed for providers payment may result from claim denied due to insurance eligibility issues and the increasing efforts to combat healthcare fraud and abuse.

Benefits of RCM system is saving time by automating duties like appointment and payment remainder and reaching out to ensures regarding claim denials.

• Providing insights on why a claim was denied.
• Ensuring proper reimbursement for medical patients.
• Opportunities to review revenue short falls.

At last, but not the least outsourcing in the healthcare business is growing day by day, the healthcare staffs and services in demand now by saving resources, money, time etc.