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Leveraging BPO to Navigate Regulatory Compliance Challenges in Healthcare

September 5, 2023

The healthcare industry faces increasing pressure to comply with various regulations and standards, such as HIPAA and Health Information Technology for Economic and Clinical Health  (HITECH). Patients are concerned about their privacy and protected data, while providers strive to protect a patient’s information and deliver quality care. Regulations are in place to protect the privacy and security of patient’s data, but they also pose significant challenges for healthcare providers and organizations. How can we ensure compliance while maintaining efficiency and quality of service? One of the trending practices in healthcare is partnering with a company for business process outsourcing (BPO). 

The Role of BPO in the Healthcare Industry

BPO, or business process outsourcing, involves outsourcing non-core functions of a healthcare organization to reduce costs, improve efficiency, and enhance the patient experience. Some of the common functions that healthcare providers outsource to BPO companies include: 

  • Scheduling
  • Eligibility verification and pre-authorization
  • Data entry
  • Insurance Billing and F/U
  • Denials Management
  • Cash acceleration
  • Edit resolution
  • Low balance and credit balance claims
  • Legacy A/R wind down
  • Payment posting
coronis health medical professional discussing business process outsourcing

Outsourced tasks allow healthcare providers to focus on providing quality care to patients, improving clinical outcomes, and innovating new solutions. BPO can also help organizations comply with regulatory standards, maintain data security, and access skilled talent and advanced technology.

How BPO Can Help Address Compliance Challenges

BPO compliance is a key concern for any healthcare organization. Compliance challenges can arise from changing laws, complex regulations, and increasing patient expectations. A lack of compliance can result in fines, lawsuits, reputational damage, and loss of trust.

Choosing a reputable agency for healthcare BPO can help to mitigate these challenges by taking over some of these tasks:

  • Quality assurance, monitoring of data security and privacy
  • Risk management, mitigation, audit support, and documentation
  • Required updates and training

Healthcare BPO can help organizations adapt to changing compliance requirements and stay ahead of the competition, keeping the provider’s focus on patient care. Compliance in the BPO industry facilitates higher levels of quality care because these tasks are eliminated from the workflows of a healthcare organization. 

Future Trends: BPO and Healthcare Regulatory Compliance

coronis health medical worker talking with patient at reception desk

The healthcare industry is evolving and facing new challenges, especially in the areas of regulatory compliance and data security. Many organizations are outsourcing some of their functions to stay ahead of the changes, allowing them to keep their focus on patient care. Choosing a BPO partner involves entrusting sensitive information and critical processes to a third party, and while the trend of outsourcing is not new, there are important points to remember:

  • BPOs must adhere to strict regulations related to the Affordable Care Act, HIPAA, General Data Protection Regulation (GDPR), and Payment Card Industry Data Security Standard (PIC-DSS), and maintain certifications and quality assurance processes.
  • Enforcement of policies and safeguards for the protection of confidentiality, integrity, and availability of healthcare data is critical. This includes management of data breaches, incidents, and disaster recovery scenarios.
  • Share expectations, deliverables, metrics, and penalties for non-compliance in service level agreements (SLA), and the ability to audit performance and compliance in BPO.

The Impact of AI and Automation on Healthcare BPO

Artificial intelligence (AI) and automation can help healthcare BPO providers streamline and optimize processes and accuracy, offering more value-added services, such as data analytics, fraud detection, and patient engagement.

AI and automation are emerging technologies that can transform the healthcare BPO industry by focusing on intelligent data processing, analysis, and decision-making, while automation can streamline repetitive and manual tasks. They can enhance the quality, accuracy, and speed of healthcare BPO services and reduce human errors and operational costs.

  • AI automates medical coding and billing processes, reducing errors and improving BPO compliance. It analyzes large volumes of patient data, generating insights for diagnosis, treatment, and prevention. “Chatbots” and virtual assistants improve customer service and patient engagement.
  • Automation manages appointment scheduling, claims processing, and document management and improves data security and privacy by encrypting and anonymizing sensitive information.

AI and automation create new opportunities and challenges for healthcare BPO providers, but they require an investment in new skills, technologies, and infrastructure. Adapting to changing market demands and leveraging the benefits of AI and automation ensures an organization remains competitive and relevant in the industry.

Anticipating Future Regulatory Challenges in Healthcare

Healthcare evolves through technology, new treatments, and changing business models, so it’s necessary for organizations to anticipate and adapt to the changing rules and expectations of regulators. Preparing for the future will require healthcare organizations and BPO vendors to focus on the following:

  • Data privacy and security – critical when considering the use of digital health tools, such as telemedicine, wearable devices, AI, and blockchain. 
  • Quality and safety standards – must adhere to higher quality and safety standards to ensure efficacy, reliability, and usability. 
  • Ethical and social implications – may challenge existing norms, values, and laws, such as gene editing, stem cell therapy, organ transplantation, and human augmentation. 

Keep the future in sight when considering a healthcare BPO. As fast as technology advances – the need to keep up with the changes is critical to the success of the transition from in-house processes to outsourced services. 

Choosing the Right BPO Partner

A good BPO partner can help you reduce costs, improve efficiency, and enhance customer satisfaction. However, not all BPO providers are created equal, and you need to do your homework before signing a contract. Here are some tips to help you find the best BPO partner for your needs:

  • Define your goals and expectations clearly – determine your main objectives for outsourcing.
  • Do your research and compare different options – look for BPO providers that have experience and expertise in your industry and domain.
  • Evaluate their capabilities and infrastructure – make sure they are equipped to manage your volume and complexity of work.
  • Negotiate the terms and conditions of the contract – make sure you understand the scope, duration, and cost of the project.
coronis health infographic illustrating the benefits of BPO in healthcare

Choosing the right BPO partner can greatly impact your business performance and growth. At Coronis Health, you can trust that you’re partnering with experts who understand your challenges and how they can take the burden from your organization. Coronis is the next step in giving you the opportunity to manage what matters the most. Contact us today to determine if healthcare BPO is right for your organization.

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