The main goal of healthcare companies is to provide excellent patient experience, so it is important that they get paid for the services they offer. When payers don’t pay for these services, however, things can go awry. This leads to several issues and frustrations that these companies often face.

Some of the top frustrations of healthcare companies, are:

• High number of denials – claims mismanagement leads to denials, which evidently leads to revenue loss. Often the main reasons why there are too many denials is that there are several charge entry errors and incorrect or duplicated information on data registration. This is why claims processing companies require a large team of medical coders and billers to avoid errors and denials, as well as process the right claims.
• High claims processing time – high volume of claims and a lack of manpower lead to unpaid claims. One medical coder may face hundreds of claims a day and will undoubtedly feel overwhelmed with the workload. The processes will slow down, but incoming claims continue to pile up.
• Updates on regulations – trends and regulations will always change without prior notice, so your team needs to update itself whenever possible. If it can’t, your business might be left behind in delivering quality service to your own customers.

If your in-house team feels almost burned out with everything, what can you do?

Outsourcing can help healthcare companies streamline operations to increase claims processing, decrease denials and unpaid claims, and stay on top of regulations and new trends in revenue cycle management.

A dedicated outsourced team of claims processing specialists who have an intimate experience with RCM will create customized solutions for your company. This team, though working outside your office, still acts as your in-house Claims Processing team, adapting to your processes but improving them all the same.

Take the example of a client that needed an extra hand that improved their claims processing strategies.

Growth Pains

A Toronto-based digital health platform sought to outsource their claims processing activities. With the goal to transform a client’s employees’ health benefits while automating the administrative work for their employers, the business involves connecting people to a wide network of health services and benefits. This enables their client’s employees to lead healthier lives by making benefits and services more accessible. Thus the platform also provides personalized health programs to improve the employees’ overall wellness and engagement.

They started growing so fast that the business could not keep up with itself, and soon enough they there were a number of problems such as operational inefficiencies and an ever-growing budget of expenses.

Results after Partnering

They partnered with Infinit-O and helped them build a dedicated team of Claims Processors that augmented their claims processing activities. Our unique specialization in supporting healthcare processes, particularly within the RCM spectrum, as well as working with SMEs and large enterprises, has provided us insight into solving the company’s pain points and delivered excellent results.

The team has improved the average turnaround claims processing time by 70%, with 95% processed claims within one hour of submission. Furthermore, the team was able to remain cost-efficient while improving the company’s original capacity by managing claims three times faster. The team has also grown to more than three times its original size and includes an additional function that is core to its business.

The RCM Wheel

Key Takeaways

• Expect Growth Pains: Your business is bound to grow, but not without growing pains. As you expand, you will also experience operational and financial challenges that could make or break your business.
• Partner Up: An outsourced team specializing in RCM solutions improves cost containment and provides access to experts. Beyond that, as your business grows, your outsourced team can also grow with you.
• Get the Results You Need: Are you after cost-efficiency? Need to scale? Desire access to specialists? With outsourcing, you can achieve your goals in record time. Our client was able to reach record claims processing effects in a short amount of time, and has been growing since.

Infinit-O is the trusted customer-centric and sustainable leader in Business Process Optimization to Small and Medium businesses in the Financial Services, Healthcare and Technology sectors by delivering continuous improvement through technology, data and people.

When you’re ready to grow, think Infinit-O!

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