In the light of the pandemic, many policyholders are utilizing their insurance. Therefore, the best time to outsource a team of Claims Specialists is now.

Because more people are taking advantage of the benefits of their insurance, this may lead to high number of denials if not managed properly and can ultimately lead to revenue loss.  On the other hand, high workload can contribute to high claims processing time because of lack of manpower resulting in unpaid claims.

To overcome this, outsourcing a team of Claims Specialists is a must for healthcare businesses to fortify their business operations despite the demands caused by the current pandemic and any future health crisis thereof. Outsourcing can help save on operational cost and secure optimal business operations. To help you more appreciate the contributions of a team of outsourced Claims Specialists, check the list below:

1. Increase Overall Productivity

Claims Specialists can free up your core-healthcare team on taking care of claims concerns. Productivity is given a boost by channeling resources to their core activities. Claims processing in healthcare is time-consuming, so it is crucial to identify and resolve errors as soon as possible. For this reason, many businesses prefer to outsource claims processing functions for speed and efficiency, leaving decision-makers to focus on their core business.

2. Faster Claims Processing

The volume of claims submitted run into hundreds of thousands a day and taking up this activity with your healthcare team will leave no room for them to concentrate on core activities and can pose errors in claims processing which can be the reason for revenue loss. By outsourcing a team of Claims Specialists, can quickly adjudicate and settle claims (within 45 days). The right partner can also build you a great team of certified coders and billers, speedy and efficient resolutions, and transparency to your business – speeding up your claim processing time.

In addition, despite the faster claims processing, data privacy and protection should be prioritized and secured. The right outsourcing partner can ensure information security. 

3. Cost Savings

In any business, cost savings is important because you can leverage your resources and invest them in plans and processes that can help you achieve your business goals and adapt to the economic changes caused by the pandemic. Outsourcing a team of Claims Specialists can help you save up to 70% on operational cost versus building an in-house team. The right partner has access to world-class talent and has an A+ recruitment process that can build you great, high-performing teams at the most cost effective way. In times of crisis, cost savings is always a smart move for all business owners.

Pro Tip

When considering for a potential healthcare outsourcing partner, you must consider a Net Promoter Score (NPS) of >60.

Why?

Net Promoter Score helps businesses gauge the quality of the customer service offered by outsourcing companies. Organisations can use NPS to assess which outsourcing service is best to partner with because this score shows loyalty trends and growth revenue outputs.

In a way, NPS represents the primary way customers survey their experience because it means that their clients are happy which results in customer loyalty and retention, making this a critical trait a BPO company should have. When used correctly, NPS (of at least 60%) can tell you how well the BPO is performing, how often they resolve issues, and if their clients are satisfied with their experience.

Outsourcing with the right partner is the most efficient solution to manage insurance claims needs. A dedicated team Claims Specialist with other RCM teams can be a game-changer for your business and enhance your healthcare team performance with or without crisis.

With this out of way, your business can focus on the patients, and they can handle all the clerical and administrative tasks. The right outsourcing partner not only ensure building a great and high-performing RCM team mentioned above but also ensure:

• Operational excellence
• Build a dedicated team of Claims Specialists and RCM team
• Operational savings of up to 70%
• Clinical Documentation Improvement (CDI) and efficient process
• Information Security
• 95% coding, billing and documentation accuracy
• 1 hour turnaround time
• 90% increase in revenue
• Improved denial management rate
• HIPAA and DPA-20212 compliance
• Net Promoter Score: Sense of security and peace of mind

Partnerships with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Provider Management Services

• Claims Specialists
• Medical Coders
• Medical Billers
• Enrollment Processors
• Denial Management Specialist

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Let’s work together to build a great RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

Just like any other industry, uncollected debt and outstanding payments can result in cash flow problems and later on, financial losses for medical providers. Healthcare business consultant agency, Sage Growth Partners, conducted a survey among 100 hospital executives in 2018 and found that about 36% of responding executives said their health systems faced more than $10 million in bad debt. 

When it comes to patients, a 2016 survey by Kaiser Family Foundation and New York Times showed that one out of five insured working-age Americans faced problems when it comes to paying their medical bills in the past year and among those without insurance, 53% dealt with the same problems. With all these findings, medical providers should really consider investing in a good collections team that is experienced in the laborious process of debt collection.

Training your in-house staff for this task can be an option, but it is best to outsource your collections specialists so you can steer away from spending extra resources and time and ensure that your staff remains focused on taking care of patients rather than paperwork and phone calls. An outsourced team of collections specialists will thoroughly review and process billing information, debt, and unpaid insurance claims to yield the best results for your company. 

Here are 4 more reasons why you should choose to outsource your collections team:

1. Save 95% on Resources and Time

As mentioned above, hiring an in-house collections team can be taxing on the budget. Since recovering delinquent funds is no easy task, and the laws and regulations when it comes to debt collection are ever-evolving, the staff will need constant training and monitoring, which you will not need to handle when you partner with a reputable outsourcing company.

Moreover, by outsourcing your collection specialists, you free your staff from unnecessary stress and they can focus more on their tasks and taking care of patients, resulting in better employee morale and patient satisfaction.

2. Access to Specialists and Professional Tools

Outsourcing gives you access to a talent pool of experienced collections specialists who are not only knowledgeable about billing procedures, collection techniques, laws related to debt collection, and other related topics, but are also well-versed when it comes to dealing with patients and their concerns when it comes to medical debts They exhibit compassion and courtesy while still being transparent and professional to patients so they can help them settle their balances through payment plans that fit with their budgets.

At the same time, they also have professional tools and third-party sources at their disposal that can be used to contact clients who do not pick up the phone or those who left town in an attempt to escape payment.

3. Collect Debts from Delinquent Clients

Equipped with ample knowledge on collections law and years of experience on the job, collections specialists are more assertive when it comes to delinquent clients or those who failed to make a required payment or action in a given period of time. They are consistent and patient in following up to these kinds of clients so that delinquent accounts can be resolved as quickly as possible and be avoided from occurring again moving forward.

4. Improved Cash Flow

Effective debt collection is important in revenue cycle management (RCM). With your outsourced collections team working round the clock to make sure that accounts are up-to-date and the collections cycle is shorter, it will ultimately improve your cash flow and increase your bottom line.

Look for a trusted outsourcing company that can help you build a dedicated collections team who has:

• Access to world-class talent
• A+ recruitment process that can hire and on-board new teams within 30-45 days
• Most specially, a high Net Promoter Score of at least 60. Why?

High Net Promoter Score

Net Promoter Score helps businesses gauge the quality of the customer service offered by outsourcing companies. Organisations can use NPS to assess which outsourcing service is best to partner with because this score shows loyalty trends and growth revenue outputs.

In a way, NPS represents the primary way customers survey their experience because it means that their clients are happy which results in customer loyalty and retention, making this a critical trait an outsourcing company should have. When used correctly, NPS (of at least 60%) can tell you how well the BPO is performing, how often they resolve issues, and if their clients are satisfied with their experience.

With the right partner,  you are guaranteed with: 

• Operational excellence
• Build a dedicated team of collection specialists and RCM team that can help you properly manage claim denials
• Operational cost savings of up to 70%
• 95% coding, billing and documentation accuracy
• 90% ROI in correct claims processing
• Improved denial management rate
• ISO 27001 and 9001 certified, GDPR, HIPAA compliant
• Net Promoter Score: Sense of security and peace of mind

Connect to a world-class pool of talent all the while saving up to 70% operational cost without compromising quality of work and maintaining operational excellence by finding the right partner. The right partner also has an established Information Security in place to ensure patient data confidentiality regardless if working on site or remotely. 

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Collections and Other RCM team composed of:

Collections Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Let’s work together to build a great Collections Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

Medical claim denials are one of the most common barriers to effective revenue cycle management (RCM) as inadequate management of these can lead to revenue loss, additional costs, and slowing down cash flow. According to a report by the American Academy of Financial Physicians (AAFC), the average denial rate across the healthcare industry is between 5 to 10 percent with below 5% being the more desirable rate indicating that a provider has healthy cash flow.

The Center for Medicare and Medicaid Services has stated that 30% of claims are either denied, lost, or ignored. This is where denial management specialists come into picture. They are the ones who have the duty to review and resolve denied patient insurance claims and appeal for possible reimbursement. Building an in-house denial management team can be quite taxing especially to resources and time, which is why outsourcing is highly recommended due to its multiple advantages that can help your business especially in times of crisis:

Access to World-class Talent

Outsourcing denials management means you have access to a pool of trained professionals who have extensive experience and insight on important subjects such as claims submission and appeals, standard coding rules, and NCD and LCD policies that determine which healthcare services will be covered by Medicare on a national and local level, respectively. This does not only prevent denials but also help you avoid getting into the same situation in the future.

Since these professionals already have the knowledge needed, you are guaranteed that they can do their jobs properly without the need for training or orientation which contributes in cutting costs while still delivering quality service. With this, you and the rest of your staff can focus on providing care to patients.

Their access to world-class talent coupled with their A+ recruitment process can build you a dedicated team of Denial Management Specialists and Revenue Cycle Managers (RCM) in only 30-45 days from hiring to on-boarding.

Limit Denial and Claims Errors

Incorrect coding, whether it’s using a mismatched ICD or outdated CPT code or entering incorrect patient information, is considered to be one of the common reasons for denied claims according to the 2013 MGMA Health Insurer report card. By having a dedicated team of denial management specialists to thoroughly filter claims, these errors can be fixed and prevented, saving you the trouble and high costs of dealing with initial denial or rejected appeal. 

Just to provide a better picture on why reducing errors is important, a study by the American Medical Association (AMA) found that practices spend approximately $15,000 every year on reworking claims, including phone calls, investigative work, and claim appeals.

Improved Cash Flow

Ultimately, strategic denial management is the key to a healthy cash flow. You can achieve this by opting to outsource a team that will focus on tracking and processing claims and identifying common causes of denied claims in your business. Through this, you will be able to avoid revenue loss, make guided business decisions that can prevent future denials and lower your denial rate.

Sense of security and peace of mind from a Net Promoter Score of >60

Operational excellence is measured by a Net Promoter Score of >60. This is a result from a survey answered by their clients on how much they are willing to promote their outsourcing partner. If the score is >60, it means that they were able to receive outstanding quality service and the level of satisfaction they have with the partnership. To put it simply, if you partner with an outsourcing company with an NPS of >60, you have a sense of security that the services they are providing responds to your unique needs and pain points which in return give you peace of mind to allow you in focusing on achieving your business goals as they focus on denial management.

Look for a trusted outsourcing company that can help you build a dedicated denial management team. In return, you are guaranteed with: 

• Operational excellence
• Build a dedicated team of denial management specialists and RCM team that can help you properly manage claim denials
• Operational cost savings of up to 70%
• 95% coding, billing and documentation accuracy
• 90% ROI through accurate claims
• Improved denial management rate
• ISO 27001 and 9001 certified, GDPR, HIPAA compliant
• Net Promoter Score: Sense of security and peace of mind

Connect to a world-class pool of talent all the while saving up to 70% operational cost without compromising quality of work and maintaining operational excellence by finding the right partner. The right partner also has an established Information Security in place to ensure patient data confidentiality regardless if working on site or remotely. 

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Denial Management team composed of:

• Denial Management Specialist
• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors

Let’s work together to build a great  Denial Management Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

For a free business consultation, you can schedule an appointment here.

Today, business owners recognize the surge in healthcare demand can impose risks in health and business because this overburdened the healthcare system. It also means that if a patient’s inquiries are not managed well, it results in increased frustration and ultimately making them unsatisfied with the healthcare service they’re receiving from your company. Lastly, financial stress can surface and lost productivity from your healthcare team creates even greater chaos.

But like all high-achievers business owners who are forward-thinker, and solution-oriented, they recognize that one of the most productive solution is to outsource a team of Revenue Cycle Management (RCM) such as a team patient concierge to address specifically surge in patient inquiries during a surge of healthcare demand. To fully appreciate their support in this type of business challenge, here are the 3 major roles:

1. Decrease Patient Wait Time

With limited staff and long queues, wait times are alway inevitable. The traditional system’s way to counter this is increasing in-house staff numbers to accommodate the surge which poses  an enormous and expensive operational expense for healthcare organizations. But by outsourcing a relatively low-cost team of patient concierge with a trusted partner, you can get better results for significantly less cost – freeing up funds for use elsewhere.

An outsourced team of patient concierge allows your core healthcare members to focus on patient and treatment related responsibilities because calls, emails, and other forms of inquiries will be addressed by this dedicated team, lessening your patient’s wait time because someone will respond solely for their concerns. This also allows a smooth patient flow because they can book appointments in their own time and get updates without leaving the comfort of their own home. An outsourced patient concierge team is also available 24 hours a day and requires minimal interaction. Just a few taps of a phone and an appointment is booked.

2. Encourages patient-centered care

As mentioned above, having a dedicated team of patient concierge during surge of healthcare demand enables your medical staff to focus on patient-centered duties. No healthcare experience will be positive if the actual treatment and care your team member is providing is only half-focused efforts. With a dedicated patient concierge team, medical staff are kept informed of not only appointments but all relevant information they need to know before a patient arrives or visits your hospital. They will be well guided through all necessary information throughout the patient’s journey resulting in patients feeling well taken cared and heard. Outsourcing your patient concierge team makes every appointment more efficient and encourages building a better patient relationship.

3. Ensures Patient Satisfaction

Patient concierges work strategically by targeting critical areas that affect overall patient satisfaction. Decreasing wait time and allowing medical team members to focus on patient care ensures increased patient satisfaction. In a survey, it states that 99% of patients agree that their satisfaction increased because of the hospital’s concierge service. 

And since a team of patient concierges manage the non-clinical responsibilities to primarily focus on patient concerns prior, during and after the course of treatment, the benefits are four-fold; high patient satisfaction, streamlined patient flow, clinical efficiency and decrease in clinician burnout.

It has been identified that 20-30% of dollars spent in the US healthcare system is sent to waste due to unnecessary spending, building a team of patient concierge is best done with a trusted outsourcing partner. They usually have A+ recruitment process that can hire and on-board your team within 30-45 days, have access to world-class talent at a more cost efficient labor cost allowing a projected savings of up to 70%, and a Net Promoter Score of >60 as your insurance of the quality of service as well as the operational excellence they can provide to your company. All of these best traits yield to:

• Operational excellence
• Building a great, high-performing Patient Concierge and RCM team
• Operational cost savings of up to 70%
• Information and data security thru ISO 27001 and 9001 certification, GDPR, HIPAA compliance
• 100% overall patient satisfaction
• 95% first call resolution
• Net Promoter Score: Sense of security and peace of mind

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Provider Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

For a free business consultation, you can schedule an appointment here.

Since there are different comprehensive health plans available like individual policies, employer-sponsored or exchange plans, policyholders often call their insurance providers to inquire about coverage, cancellation, extension or simply clarification about their plan. But in today’s healthcare climate where there is a rise in chronic illnesses coupled with the existing pandemic, many people are apprehensive with their health insurance plans.

And because each policyholder has unique insurance plans, the change in the health economy and the rise of distinct situations brought by health crises, these can cause some degree of confusion to policyholders which in return can trigger them to seek clarifications to their insurers resulting in a surge of inquiries through call, chat and email. To overcome this, here are 2 best ways to effectively deal with surge insurance inquiries and claims.

1. Employ a great customer service team

Having a great customer service team that can address and respond to these surge of queries helps lighten the load of health insurance companies all the while giving utmost assurance and clarity to policyholders amidst the era of uncertainty. Because with the difference of cost-sharing among plans, it makes sense that people will call their insurance company to find out exactly what is and isn’t being covered. And it is crucial to answer these queries efficiently and effectively especially that there is a significant decrease of policies due to insurance cancellations. This is one way for insurers to retain their existing clients.

To address this, try incorporating several dimensions of your healthcare business supply chain through outsourcing from vendors that have been aiding healthcare companies in the telehealth and health insurance fields. Partnering with third parties like outsourcing companies for patient concierge, medical review specialists and other patient inquiry-related concerns can support production capacity by freeing clinicians from answering phone calls and responding to appointment inquiries. They can also help oversee the day to day peer review process from acceptance of medical cases for review, facilitating first level screening if applicable and preparation of case review documents to be endorsed to doctors, nurses and other healthcare providers. A team of dedicated customer service can focus on answering questions and making sure that these inquiries are responded accordingly.

2. Incorporate a Dedicated Revenue Cycle Management Team

Increase in inquiries can also result in an increased number of claims or the inquiries are an outcome of some denials. Therefore, having a dedicated RCM team in your business is one sure way to address surge in inquiries and claims.  Your RCM team are experts on diagnosis and procedure codes, you are assured that they are to make accurate claims submission that can positively impact revenue cycle. To capture diagnosis codes for billing purposes, the industry uses the  International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Hence, make sure that your RCM team should have expert knowledge on ICD-10 and CPT coding to yield accurate claims.

Outsourcing your customer service team and dedicated RCM experts ensures that surge in inquiries will be taken care of and any potential issues in claims will be addressed. These teams can also work remotely with the following workout results:

• Patient satisfaction
• 95% coding, billing and documentation accuracy
• 1 hour turnaround time
• Improved denial management rate
• HIPAA and DPA-20212 compliance

The right outsourcing partner not only ensure building a great and high-performing Customer service and RCM, it also ensures:

• Operational savings of up to 70%
• Clinical Documentation Improvement (CDI) and efficient process
• Information Security
• Maximize revenue
• NPS >60

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Provider Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Let’s work together to build a great  RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

Healthcare business process outsourcing, or simply Healthcare BPO is an outsourced business activity or process that provides support and administrative functions to healthcare providers and organizations. One example is Revenue cycle management (RCM) services such as medical coding and billing, and transcription which are some of the most commonly outsourced.

Through the years, changes in the healthcare landscape coupled with growing patient expectations have led to the resurgence of the BPO trend in the industry. The enactment of the Affordable Care Act, implementation of ICD-10, and shift toward value-based healthcare are just some of these changes that left hospital staff working harder than ever to keep up with the boost in complex claims and comply with conflicting mandates for improved quality and reduced costs.

With this, a report by MarketsandMarkets projected that the global healthcare BPO market will reach USD 312.43 billion by 2023, at a CAGR of 10.2% during the forecast period (2017-2022). The primary attribute to this growth is the “rising focus on reducing operational cost and availing outside expertise to ensure performance efficiency and improvement.”

Indeed, outsourcing healthcare services for RCM has a lot of advantages. For one, it helps healthcare providers solely focus on what they do best and that is providing holistic care to their patients. It is also very cost-effective since outsourcing generates a pool of professionals on behalf of the company, thereby saving you cost in acquiring and training additional staff. Finally, the process reduces billing errors with highly skilled and trained professionals in your team, which in turn maximizes feedback assistance on reimbursements and future assets

Now, if you are interested to partner with a healthcare outsourcing company for your business or organization, here are five traits that you should look for:

1. Industry Experience and Expertise

There is no substitute for experience in outsourcing, so make sure that before choosing a partner, check for a proof of positive track record of industry & domain expertise, number of years they have been offering these services, and client partnership tenure and company reputation & success rates such as Net Promoter Score (NPS). In line with this, they should also have the right expertise and knowledge when it comes to such a sensitive sector that is healthcare in order to render services effectively. As an example, Medicare claims processing is something that can be difficult to build internally, but is the exact skill that an outsourcing provider specializing in medical billing excels at. This can result in significant increase in collections.

2. Range of Services and Quality of Talent

Another thing to factor in when choosing an healthcare BPO is its range of services, From billing, coding, clinical documentation, telehealth services, and more, it would be best if you go for a one-stop provider as this will save you from the trouble of working with different providers for different services. At the same time, dealing with one company enhances overall efficiency and accuracy.

Good providers also insist on building a dedicated team of highly-experienced healthcare professionals who can deliver quality results. You may want to look for one that houses talents with the skill and experience necessary to adapt the current technology you are using and be able to continuously improve on it. Usually, a great partner has A+ recruitment team and process who has access to world-class talent despite the competitive talent pool.

3. Compliant to International Standards on Data Management

Since you will be dealing with personal health information of patients, your healthcare solutions partner must be one that is ISO certified and HIPAA compliant. ISO, also known as International Organization for Standardization, is the certification for any business to deliver a consistent level of quality to its customers by having well-defined and regularly checked processes. HIPAA, on the other hand, stands for Health Insurance Portability and Accountability Act, which develops standards and rules that protect the security and privacy of personal health information. 

4. Tech-Forward

Keeping up with the fast-paced digital world can only be done through the use of top-notch technology. When selecting your healthcare solutions partner, see to it that they use the necessary software and a well-maintained infrastructure preferably with both back-up power and storage to secure the compiling and storing of patients’ data.

Additionally, you may opt for a provider that is technology-agnostic or one that has the flexibility to adapt to your healthcare organization’s current technology and enhance it further. With a technology agnostic healthcare solutions provider, the enhancement of your current technology will not be based off of any pre-existing models; rather, it will be customized and tailor-made to cater to your business solutions. This will ensure that your technology is humanized in such a way that it solves the bigger picture problems while allowing your healthcare business to hit its goals.

PRO TIP: High Net Promoter Score

Net promoter score helps businesses gauge the quality of the customer service offered by outsourcing companies. Organisations can use NPS to assess which outsourcing service is best to partner with because this score shows loyalty trends and growth revenue outputs.

In a way, NPS represents the primary way customers survey their experience because it means that their clients are happy which results in customer loyalty and retention, making this a critical trait a BPO company should have. When used correctly, NPS (of at least 60%) can tell you how well the BPO is performing, how often they resolve issues, and if their clients are satisfied with their experience.

All these qualities and more can be found with the right outsourcing partner who can provide a customized, high quality healthcare business solutions that can promise for the following:

• Operational excellence
• Build a great healthcare & RCM team specifically designed for your unique needs
• Operational cost savings of up to 70%
• Information and data security
• Sense of security and peace of mind

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Provider Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

Clinical documentation is an integral part of patient care. With this, a thorough record of the diagnoses made, symptoms observed, and services provided on a patient is created. In short, this is the foundation of a patient’s medical record. When done precisely, it can be used to submit valid claims for reimbursement, but on the flip side, incomplete and inaccurate documentation on patient care or those that do not support the billing codes may result in denial of claims. 

To prevent this from happening, Clinical Documentation Improvement (CDI) must be done to ensure that the events of the patient encounter are captured accurately and the electronic health record (EHR) properly reflects the services that were provided.

Ultimately, it is focused on two things:

1. improving the quality and value of clinical documentation to improve patient care

2. maximizing revenue and reducing medical coding and billing errors

When it comes to conducting CDI, it is beneficial to have a dedicated team of Revenue Cycle Management (RCM) specialists on your operations.

This team consists of:

• Medical coders and billers – who have the role of translating a patient encounter into the languages used from claims submission and reimbursement

• Clinical documentation specialists – who review medical records, ensure medical codes have been inputted correctly

Below are 4 reasons how a great team of RCM experts improves your Clinical Documentation process:

1. They have expert knowledge on ICD-10 and CPT coding

Diagnosis codes play an important part in clinical documentation. These are used to describe a patient’s condition or injury, as well as social determinants of health and other patient characteristics. To capture diagnosis codes for billing purposes, the industry uses the  International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

Procedure codes, on the other hand, complement diagnosis codes by indicating what providers did during an encounter. The two main procedure coding systems are the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS). 

The Center for Medicare and Medicaid Services (CMS) determines the ICD-10 coding guidelines that affect the reimbursement rate for health systems, which have the tendency to change every year. Outsourced medical coders and billers, especially those who are certified by accredited organizations, have extensive and current knowledge of these codes given that they have to undergo an annual recertification exam to keep their credentials. This is especially useful in the process of improving clinical documentation.

2. They submit accurate claims that improve revenue

Given that your RCM team are experts on diagnosis and procedure codes, you are assured that they are to make accurate claims submission that can positively impact revenue cycle. It has been proven that through CDI, revenue can be maximized. To support this, a 2016 Black Book Market Research survey found that nearly 90 percent of hospitals that used CDI solutions earned at least $1.5 million more in healthcare revenue and claims reimbursement.

RevCyle Intelligence, a leading online resource for the latest news and product information about the healthcare revenue cycle, claims reimbursement, and medical billing for providers, also reported that the Summit Healthcare Regional Medical Center in Arizona achieved a 20 percent increase in its case mix index after implementing a CDI program. Altogether, the case mix index improvement resulted in nearly $560,000 in additional revenue in less than a year.

3. They allow physicians to focus on patient care

A 2016 AMA study reports that only 27% of their work time is spent on the patient, while 49% is consumed just for EHR documentation. In addition to more time being spent on records alone, they input an additional average of two hours after their work time for EHR data entry. Doctors spend more time inputting the information rather than observing the proper approach and discussing the treatment with the patients.

4. They are certified with data privacy compliance

Because clinical documentation is often scanned into an electronic system and often interactive and viewed by simultaneously different healthcare providers, it is vital that patient’s records are kept safe and secured.

Although a patient’s record and chart belongs to the facility or healthcare organization, according to the Office of the National Coordinator for Health Information Technology the health record is “not just a collection of data that you are guarding—it’s a life”. Hence, there are three major ethical priorities for electronic health records: privacy and confidentiality, security, and data integrity and availability.

A great team of RCM are often HIPAA and DPA20212 compliant because they value privacy and confidentiality and understand that patient information should be released to others only with the patient’s permission or as allowed by law despite having all access to these records for the clinical documentation process.

With an outsourced team of RCM experts, clinical physicians will have more time in their hands to spend on patient interaction rather than on EHR and clinical documentation. Your RCM team can also work remotely with the following workout results:

• 95% coding, billing and documentation accuracy
• 1 hour turnaround time
• Improved denial management rate
• ISO 27001 and 9001, GDPR, HIPAA and DPA-20212 compliant

The right outsourcing partner not only ensure building a great and high-performing RCM team mentioned above but also ensure:

• Operational savings of up to 70%
• Clinical Documentation Improvement (CDI) and efficient process
• Information Security
• Maximize revenue

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Provider Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Let’s work together to build a great  RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.

On a daily basis, an average healthcare professional is loaded with core tasks such as assessing the patient, plan treatment course, execute tests and diagnostic procedures all the while documenting every step provided and performed to the patient. Simply put, their workload is never light. When administrative tasks such as coding, billing, patient concierge and claims processing add to their existing work, it may distract them from their core responsibilities.

And with the increase in workload demands and a significant decrease in healthcare workforce and resources, medical professionals need the back-up support they can get from Revenue Cycle Management (RCM). This article will showcase 3 ways a dedicated RCM team helps lighten the burden from healthcare providers.

1. Correct billing and collection errors freeing healthcare providers from administrative tasks

Medical billing and collection errors account for 80% of problems for healthcare revenue management. Examples of these are;

• Upcoding: where entering the code of a more serious medical condition than what was treated inflates the bill
• leftover billing
• duplicate billing
• incorrect patient information
• mismatched diagnosis codes

These errors make it difficult to ensure collections from patients. If your primary healthcare team has to handle these administrative tasks, they would need to spend more time completing paperworks and trying to adjust to the latest changes in medical billing than actually performing care and treatment related responsibilities. But having a dedicated RCM team will help your business overcome these challenges, not only because they are trained with the latest billing and coding standards such as the ICD-10,  they also focus solely on getting these tasks done right with quality and proficiency (i.e. <1hour turnaround time and zero coding errors). In return, this will lead to an increase in the level of patient care and thus make practices more patient-centric.

2. Improve business revenue and practice profitability

According to the Medical Group Management Association (MGMA), 50-65% of denials go unworked. It means that healthcare businesses are missing out on revenue and on the opportunity to detect denial trends to prevent future occurrences if there is no dedicated team to perform revenue management tasks. 

While this can happen at various points in the revenue cycle, denial management is a common weak spot for many practices. That is why outsourcing an RCM team that can solely perform tasks from claims submission to payer collections to a trusted partner can help you avoid revenue slipping through the cracks. As they focus on RCM cycle processes, there will be increased cash flow and more prospects for optimization. On the other hand, this promotes clarity between responsibilities from your in-house healthcare team by allowing them to devote their time and energy on patient care.

3. Business recovery support allowing patient-centric efforts from healthcare team

A trusted partner who can build you a great, high-performing RCM team will be your additional support during business recovery because they help you overcome the limited supply of workforce which not only lighten your in-house healthcare team’s workload but also allows you to save 70% on operation cost, innovate care technologies to ease manual labor and process improvement for your healthcare business, and ensure patient data security with an established Information and Cybersecurity processes.

A reliable partner and RCM team mitigates disruption from major industry changes. Not only would the right partner help you manage ICD-10 updates in coding, they are more likely to generate and complete higher volume of denials at a required turnaround time and also share industry expertise to help you navigate through any industry transition more easily. Whether it’s ICD-10 or another monumental shift, outsourcing to a trusted partner can be a great way to mitigate disruption during times of change.

Building Top RCM Teams

Building the right team creates a well-oiled RCM process. In return it can result in:

• 95% coding, billing and documentation accuracy
• 1 hour turnaround time
• Improved denial management rate
•  HIPAA and DPA-20212 compliant

And turning to a trusted outsourcing company to help you build this team gives you access to a world-class pool of talent all the while saving up to 70% operational cost without compromising quality of work and maintaining operational excellence. The right partner also has an established Information Security in place to ensure patient data confidentiality regardless if working on site or remotely. 

Partnership with Infinit-O

Infinit-O’s mission is to create endless opportunities for your company to realize its full potential.

Infinit-O Key Benefits:

We can build you a great, high-performance Revenue Cycle Management team composed of:

Patient Support Services

• Patient Concierge Specialist
•  Insurance Verification Specialist
• Collections Specialist
• A/R Specialist

Provider Management Services

• Medical Coders
• Medical Billers
• Claims Processors
• Enrollment Processors
• Denial Management Specialist

Health Analytics and Risk Management Services

• Healthcare Analyst

Others

Let’s work together to build a great  RCM Team.

Start small. Exceed expectations. Think infinitely. Think Infinit-O.