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ROLE OF OUTSOURCING IN HEALTHCARE FIELD

Author: Chetana Menda

ABSTRACT:

Business Process Outsourcing (BPO) is the topmost business across the globe and is aligned to transform businesses with fully-managed expert solutions to provide the trusted independent resource. Health care service providers from all around the world are going to countries like India to outsource their non-core business procedures, making healthcare outsourcing the newest buzzword in the industry. The article’s goal is to briefly explain the function and significance of healthcare outsourcing.

Keywords: Business Process Outsourcing, Global Healthcare, Error-free medical Billing and Healthcare Revenue Cycle Management.

INTRODUCTION:

The word “outsourcing” denotes the use of “external sources”. Outsourcing is defined as an action to provide goods or services capitalizing on external resources.

Healthcare BPO companies refer to the activities where the healthcare organisation contracts its certain business function to an external service provider.

NECESSITY OF OUTSOURCING IN HEALTHCARE:

• Services at low-cost:

There is a difference in wages between western countries and Asia i.e., a cost saving of around 70% by outsourcing the work to India.

• Get focused on the core concepts:

Outsourcing the business processes enable the companies to focus on building their brands, invest in research and development.

• Diversify the workplace:

Outsourcing partner takes the responsibilities of Business processes and hence helps in diversifying or branchout the workplace.

• Focus on patient care:

Outsourcing administrative tasks to BPO companies to enhance the patient experience with particular healthcare facilities.

• Affordable external expertise:

Healthcare BPO companies serve high quality deliverables and deliverables and decrease the lead-time it takes for the services to reach the patients.

• Instant teams – auxiliary and core roles:

The manpower are trained in respective areas and are provided with technically qualified resources.

• Data storage and Recovery:

Healthcare BPO companies secure the storage and provide extra protection against data breaches.

Healthcare outsourcing reduces the upfront investment and operational expenditure to increase profitability. It also reduces the loss of government corporations and government intervention in the economy.

SERVICES OF HEALTHCARE OUTSOURCING IN INDIA:

Healthcare outsourcing in India provide services like:

1. Hospital records:
   Healthcare Outsourcing companies enhance the accuracy and efficiency of hospital information systems in an attractive manner and are drawing the attention of  numbers of hospitals.
2. Medical records:
   Due to privacy issues, electronic medical records utilised by healthcare provider organisations are not truly available online. No one has real random access from any location as a result. These electronic records, however, are set up on secure systems that only authorised medical personnel can access.
   These records could be accessed from home, office, or hospital. This is increasing the efficiency of a physician’s time. It is now possible, through the use of such systems, to check lab values and radiology reports from a remote location. It is also possible to order medication and discharge patients through these systems, consequently accelerating patient care. Additionally, improved continuity of care is made possible by the automation of patient record keeping and the instantaneous access to old records that results from it.
3. Clinical and healthcare records.
4. Medical billing:
   In addition to affecting the doctor/patient relationship and the keeping of medical records, the Internet can change the Medical billing process. It is the first full-service online healthcare provider that links patients, doctors, and the rest of the medical industry. As a result, all interactions and exchanges  i.e., transactions between doctors, patients, and healthcare organisations take place in a single, secure environment.
   There are multiple steps to the medical billing process, whether in the inpatient or outpatient setting. These steps include enrollment verification, pre-approval, billing, reimbursement, and reconciliation.
5. Medical coding:
   The process of converting information from patient medical records into standardized, preset medical codes is known as medical coding or classification.
   Medical coding is used by hospitals and other healthcare facilities to document medical procedures and any related causes or disorders (diagnoses). The financial transactions handled by insurance companies or other organisations that conduct medical reimbursements rely heavily on these operation and diagnosis codes. As a result, medical codes are frequently required by healthcare professionals to categorise current ailments, diseases, and treatments carried out on nearly all patients.
6. Medical data entry role:
   Electronic data capture (EDC) systems, which speed up the data gathering process and ensure data quality with real-time data entry, evaluation, analysis, and verification, emerge as a timely solution that is in high demand with the development of healthcare information technology.
7. Medical claims processing:
   The process used by insurance companies to review claim submissions for sufficient data, validity, reasoning, and authenticity is known as claims processing. The insurance provider may fully or partially reimburse the healthcare provider for the cost of the procedure.
8. Medical accounts receivable.
9. Healthcare revenue cycle management:
   The revenue cycle is a complex process that requires collaboration across multiple areas of the practice. It will address appointment scheduling, registration, coding, charge capture, patient and insurance billing, account follow-up, and collections.
10. Payment posting.
11. Pre-certification and insurance verification.
12. Account and billing details.

Healthcare BPO companies fix these responsibilities carefully and correctly that medical practitioners may not be able to do with full attention.

REASONS WHY OUTSOURCING IS THE  FUTURE OF HEALTHCARE:

1. Effective Data Collection and Analysis: Several healthcare organisations have already outsourced their efficiency and productivity. BPO companies have started outsourcing data management processes for clinical research, billing, health outcomes, and more.
2. Error-Free Medical Billing.
3. Medical Claims Processing.
4. Data Entry Services: They manage information like lab reports, prescriptions, patient insurance details, patient records, and medical information.
5. Clinical and Patient Care Services.
6. Hospital Infrastructure Management.
7. IT Integration: The global healthcare IT outsourcing market is forecast to reach 61 billion USD dollars by 2023.

The global healthcare IT outsourcing industry size is expected to reach 390.7 billion USD by 2024.

OUTLOOK OF HEALTHCARE BPO COMPANIES IN INDIA:

There are numerous Healthcare BPO firms in India that perform services mentioned above:

Indian Healthcare BPO: Indian Healthcare BPO, is a training and education provider in Chennai, providing training & Placement programs in healthcare-related fields such as clinical research, pharmacovigilance, Data Management, Regulatory Affairs, Medical Coding, Medical Billing, Medical writing, Medical scribing, healthcare.

Elico Healthcare Services: Elico Healthcare Services, is a medical coding company in Hyderabad providing services such as Revenue cycle management, Medical record review, Medical coding solutions, EMS Billing Services and Pre Billing Services.

AURA BPO Services: AURA BPO Services, is one of the best BPO companies in Chennai which provides services such as Billing Services, Dental Billing Services, Credentialing Services, and more. Aura BPO Services has a wealth of business process outsourcing experience in Healthcare RCM services and Non-healthcare services.

MiraMed Ajuba: MiraMed Ajuba is a leading global services company in Chennai with complete Revenue Cycle Management. It provides services such as Scheduling and Patient registration, Medical Coding, Accounts receivables and Denial Management, Self pay follow up, Insurance Verification and Eligibility, Demographic Data Entry, and many more.

INOFINITY Solutions: INOFINITY Solutions, is a Healthcare BPO company in Chennai providing services such as Patient Access Management, Billing, Credentialing, Medical Coding, Denial Management and A/R Follow up.

Global Healthcare Service: Global Healthcare Service, is a BPO company in Chennai. Global Healthcare Resource has been a leader in international staffing solutions for over 20 years. It provides services to healthcare such as Medical Billing, Medical Coding, Patient Eligibility, Patient Experience, Provider Credentialing, Risk Adjustment, Medical record services.

Availity: Availity is a BPO company where the healthcare services connect in Bangalore. Availity operates the largest real-time information network in healthcare.

Outsource2India: Outsource2India, is a pioneering outsourcing company in Bangalore provides services such as Medical Billing and Coding, Revenue Cycle Management, Pharmacy Business, EMR Software, Medical Transcription.

Pacific BPO: Pacific BPO company, is a Healthcare Outsourcing company which is a transforming Revenue Cycle Management. It provides services such as Medical Billing, Medical Coding, Transcription Services, Eligibility Verification, and many more.

CHC Healthcare: CHC Healthcare company, is a BPO company in New Delhi which provides services such as Insurance Eligibility Verification, Denial Management, Account Receivable and Payer Followup, Charge Entry, Medical Coding.

Fusion BPO services: Fusion BPO services is an outsourcing company that serves various industries, including healthcare.
Fusion’s medical BPO services are HIPAA-compliant, combining experience in healthcare customer support with its AI-powered outsourcing solutions that provides premium patient care management.
The firm offers appointment management, insurance verification, claim processing, patient communication, and billing and settling invoices.

WNS Global Services: WNS Global is a business processes management (BPM) based in Mumbai, India, serving enterprises worldwide, including the healthcare, life sciences, and insurance industries.
It caters to healthcare providers, payers, telehealth, and utilization management with its digital-first, patient-centric approach.

FinThrive Global Solutions (E4e Healthcare Business Services): Formerly known as nThrive, the firm has rebranded to FinThrive but still functions as revenue cycle management. FinThrive prides itself as the most complete end-to-end revenue management platform provider in healthcare. Among the services, Finthrive offers are revenue integrity, revenue recovery, patient access, and patient finance. Hospitals and healthcare systems are not its only market but also ambulatory and physician practices, payers, partners, and resellers.

Access Healthcare: It is a leading provider of healthcare revenue cycle services and process automation solutions. The company transforms hospitals, healthcare systems, medical groups, and boutique RCM software and services to achieve efficient and market-leading clinical, administrative, and financial outcomes.

Anion Healthcare Services: Anion is an ISO-certified and HIPAA-compliant one-stop solution centre for healthcare providers, IPA, TPA, and all health plans. Anion has provided Back Office data processing (BPO) for physicians, providers, clinics, and payers. Other client processes it offers are medical billing, medical coding, and claim management.

BOSS Healthcare: BOSS Healthcare is a partner in healthcare BPO services that offers cost-reduction techniques and consistent resources of talented and experienced professionals.
Some services BOSS Healthcare offers are medical transcription, coding, billing, denials management, RCM, and accounts receivable analysis.

Mediscript: Mediscript is a medical transcription service in Pune, India, providing various medical transcription and related medical documentation services.

Athenahealth Technologies India: AthenaHealth is the healthcare outsourcing industry.AthenHealth’s medical outsourcing solutions involve RCM, patient engagement, telehealth, care coordination, and patient engagement to yield better clinical and financial outcomes.

 ASIA, THE  GLOBAL LEADER IN BUSINESS PROCESS OUTSOURCING

Asia is one of the world’s top Business Process Outsourcing (BPO) hubs for many different businesses.
Today’s healthcare providers also depend on clinical services that are outsourced, including laboratory results, pharmacy services, radiology, magnetic resonance imaging, mental health services, dialysis, occupational health therapy, and more.

Healthcare IT cloud service outsourcing rose by 11% in the second quarter of 2020.

HEALTHCARE OUTSOURCING IN 2023

According to a 2019 industry assessment, the worldwide healthcare outsourcing market is anticipated to develop at a 12.3 percent compound yearly growth rate to reach 449.6 billion USD by 2023[12].

REFERENCES

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   https://www.sciencedirect.com/science/article/pii/S1532046414000458
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7. https://dl.acm.org/doi/abs/10.1145/1835804.1835831medical
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12. https://www.bgosoftware.com/blog/healthcare-it-outsourcing-everything-you-need-to-know/