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HIPAA Compliance Requires Coding, Processes Update

Michael H. Smith, for HealthLeaders Media, October 11, 2010

Total Outsourcing: Embracing an outsourcing strategy can provide significant opportunities to curtail costs, streamline processes and increase efficiencies while empowering healthcare payers to focus on core competencies. The benefits include immediate access to necessary expertise and qualified resources that eliminate backlogs and tighten turnaround times by as much as 50%.

With an outsourcing service partner, service level agreements provide predictability in service, and claims are processed in less than 24 hours. An outsourcing service provider will offer the flexibility to handle volume fluctuations. This enables payers to scale effectively and to focus on more value-added activities such as high-touch customer service. By ensuring timely claim processing, payer organizations can reduce the risk of penalties for non-compliance.

Outsourcing also provides rapid access to industry compliant technology solutions and electronic workflow tools that automatically route claims for review, action or approval. This results in greater efficiency. When delivered via SaaS, organizations alleviate the need for additional capital expense and gain access to a secure Web-based data repository and data protection via online backup and recovery. Administrative expenses and claims processing time is reduced and customer service improves as a result of smooth and accurate transactional activity. Payers also gain improved visibility into claims processing, enabling them to better manage internal operations.

Another benefit: outsourcing increases operational first pass rate improvement due to enhanced business rules and greater claim accuracy. It alleviates the need for manual adjudication, thus reducing the cost per claim. By improving the first pass rate and eliminating manual intervention, payer organizations are able to save millions of dollars each year, improve service to members and reallocate staff to value-added functions.

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4 comments on "HIPAA Compliance Requires Coding, Processes Update"


Linda Walker (10/19/2010 at 9:59 AM)
What carriers do you know outsource overseas? I've worked for 3 of the top 5. And as for HIPAA compliance, how do US entities make sure offshore entities ARE HIPAA compliant? do they rely on them just saying it's so? Are compliance officers from the US positioned overseas? Other countries do NOT have to adhere to HIPAA compliance. HIPAA compliance is the liability of the US entity!

catherine.woods (10/13/2010 at 1:52 PM)
Hi Linda, Most health care insurance companies already offshore most claims and provider data management. There are specific data security protocols that are used to safeguard the data to ensure the all HIPAA requirements are maintained. Does your practice work with a claims clearing house? Thanks, Cathy

Jeremy Engdahl-Johnson (10/12/2010 at 12:10 PM)
There's no way to eliminate the risk and uncertainty of the move to ICD-10, but there are four steps organizations can take throughout ICD-10 implementation to manage the risk. More at http://www.healthcaretownhall.com/?p=2420