Outsourcing Your Billing Processes: When does it make sense for outpatient diagnostic services?

  • Product Marketing Manager, Product Expansion, XiFin, Inc.

From IT and EHR support to back-office functions, hospitals are increasingly turning to business process outsourcing (BPO) to relieve staffing and financial pressures. Within the hospital ecosystem – where technology and processes are typically optimized for high-acuity clinical encounters – outpatient and ancillary services departments can find it difficult to overcome their unique business challenges. This is especially true for outpatient diagnostic services, namely those in radiology, pathology, and lab. Fluid, effective revenue cycle management is critical to maintaining profitability in these high-volume departments. Here are some factors to consider that will help you assess the potential value of seeking out a billing BPO partner.  

Systems and Technology 

When was the last time you gave the technology your department uses to manage its revenue cycle a close look? Is it keeping pace with high-volume transactions – and the constantly changing relationships, regulations, and requirements behind them? Optimized for the way your department works? Providing a level of security high enough not to cause any sleepless nights? Playing nicely with the other systems in your hospital? Bringing you the business insights and analytics to drive informed decisions? If not, a simple technology upgrade may be in your future. 

Technology upgrades, however, are never simple. The pathway to implementation – and realization of ROI – is rarely linear. Or fast. Or easy. And even after identifying a solution identified and signing the contract, there’s the matter of timelines and prioritization from your IT department, as well as training staff on the new system. 

If that seems like too much to navigate, outsourcing can make a lot of sense. With the right BPO partner, you can realize a speedier ROI, reaping the rewards of updated technology without the challenges and delays inherent in implementing that technology yourself. 

Financial Performance  

Key financial performance metrics can point to a need for a new approach to managing your billing processes. Shrinking profitability is an obvious one. But before issues bubble up to that level of visibility and urgency, other lead indicators can tip you off: 

  • Too many back-end denials
  • Delays in appeal resolution
  • Widening lag in time to reimbursement
  • Shrinking cash collections

A knowledgeable BPO resource can help you identify the root causes behind these indicators, mitigate them, and keep you on track.   

Changing Business Dynamics 

Whether within the walls of your organization or beyond them, things change. Sometimes quickly. Often unexpectedly. Reacting to and managing in response to those changes impedes efficiency and imposes friction, changes such as: 

  • Amendments to current regulations – and the introduction of new ones
  • Variability within and among payor behavior
  • Wide variations in order volume
  • Shifts in organizational priorities

Working with a BPO partner shortens response time to manage and these changes – especially if that partner is already helping manage similar issues for other hospitals and providers. They can, for example, scale quickly to meet an emerging need.  

Managing these changes internally, however, may not be ideal, especially because of… 

Staffing Challenges 

It’s no secret: Hospitals are facing a critical staffing shortage. Although the spotlight has largely fallen on clinical and care-delivery roles, billing teams have been hit, too. Every open position means delays in reimbursement. And even if you locate and hire the ideal candidate, there’s the matter of training.  

If you have trouble attracting, training, and retaining staff, it’s time to look for outsourcing help.  

The Right Partner 

If outsourcing some – or all – of your billing processes makes sense, it’s time to start your search for a partner. Choosing the wrong partner, however, can often be worse than doing nothing. Key attributes to consider include: 

Expertise and experience – In a BPO partner, a global understanding of healthcare isn’t enough. To realize the most value as quickly as possible, you’ll need specific expertise in the work your department performs, ideally cultivated over time. Find where that expertise lives in your potential partner. Who has it – and how long have key staff been with the organization? And if feasible, ask to talk to some of the people with whom you’d be working.  

Technology – Even if you won’t be implementing the software yourself, it’s useful to know what your potential BPO partner uses. How do they use it? What does it automate or streamline? Does it provide business intelligence and reporting to help drive iterative improvements? Is it secure? Consider asking for a demo. As a bonus, if you ultimately decide to keep you billing processes in house, you have a leg up on identifying a potential technology solution.  

Customer base – The number and types of customers can tell you a great deal about a potential BPO partner. Finding peer organizations provides a degree of assurance that your needs will be met. And in the high-volume, process-intensive world of outpatient billing, the number of customers matters. A higher number of customers means more transactions, and consequently, more insights gleaned. That, in turn, means fewer headaches for you and your department. Look to the numbers. They can be illuminating.   

Analytics and insights – It’s not enough that a partner relies on analytics. You want to know how (and if) they share them, how they surface insights and proactively provide them, if at all. And if you have specific questions, can they tap into the data you need? 

Advocacy – An ideal partner does more than robotically manage a list of tasks. They offer a consultative resource that transcends the transactional value of those tasks. A true advocate takes it a step even farther, working to positively influence the broader environment in which your organization operates. Advocacy is the hallmark of a partner who gets it. It shows that they’re right there with you. That they have the hard-won credibility to drive meaningful change. That they care. 

Flexibility – Maybe you’re ready to outsource your entire billing operation. Maybe you have the perfect team in place and simply need a new technological solution to support them. Maybe you have a few open headcounts, and are looking to outsource the high-volume, lower-value tasks – freeing your team to focus on more complex issues. Or maybe you’re not sure exactly what you need and just need a little time to figure it out. That’s okay. And your BPO partner should think so, too. They should be willing to meet you on your terms to provide you exactly what you need. 

Next Steps 

If these factors resonate with you, it’s time to take a deeper look. Take some time to scrutinize the numbers and take an honest assessment of where your departments stands – and the barriers to profitability. Then, talk to your team and your colleagues. Are they seeing the same things? If so, then it’s time to research potential BPO partners – and ultimately reach out for help.  

Additional Reading 

Interested in how your RCM process stacks up compared to your peers? Read “Outpatient RCM Gap Analysis for a Better Bottom Line” to learn how similar organizations manage their outpatient revenue cycle, what systems they use, and what challenges they face – as well as how to overcome them.  

Read Now

Published by XiFin
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