Outsource Buzz

As our world continues to evolve, our needs for survival evolve with it. The change in lifestyle and phase of living are proofs on how much times have changed. To keep up with the times and to stay relevant, different industries have learned the necessity to find ways to adhere to these kinds of demands. In these kinds of stipulations, outsourcing has become a reliable solution in providing flexible options even in the field of healthcare.

There is no questioning the importance of healthcare and its pertinence in the survival of humanity. It is great to know that there are different trends that reinforce the quality of healthcare that we are receiving. Moreover, outsourcing trends has kept healthcare a profitable industry by providing access to skilled workforce while reducing staff acquisition costs and training costs without sacrificing the quality of patient experience. But what’s really making medical outsourcing keep up with current times is its smart utilization of medical billing and medical coding services.

Together, these services have been valuable assets to modern healthcare. In medical coding, the description of diseases, injuries, and healthcare procedures are converted into computer codes that are essential in keeping track of the patient’s medical records. These records are vital to today’s medical trend since these records are valuable for diagnosis, preventive care, and treatment. Medical billing, on the other hand, is not just about keeping the medical industry running as a business. Medical billing makes sure that accurate figures are provided to the patients. These will prevent billing errors that often create disputes in medical insurance claims and apprehension on the quality of medical treatment that patients receive.

Realizing how crucial keeping medical billing and coding managed on a professional level, AAPC, previously known as American Academy of Professional Coders, and American Health Information Management Association or AHIMA have set certification standards to ensure the competence in the field. Though the two certifying bodies have a slight difference in the qualifications, both are widely respected in the business of healthcare and are nationally recognized by employers, medical societies, and government organizations.

AAPC has transcended beyond medical coding and now provides training and credentials in documentation and coding audits. There are nearly 103,000 healthcare professionals that hold AAPC certifications in physician offices, clinics, outpatient facilities, and hospitals. AAPC offers certification not just in medical coding and billing but also in medical auditing, medical compliance, and physical practice management.

AHIMA, on the other hand, have long established their goal in mind of improving patient care by establishing clear standards for medical record-keeping through informatics, leadership, information governance, innovation, and public good. It has 71,000 members and offers credentials pertaining to health information management, coding, data analysis, and privacy.

Knowing that there are certifying bodies that uphold the standards of reliable healthcare services, consumers can be assured that they are getting the best out of their healthcare. And with the expected growth of healthcare business in the future, so will roles of these certifying bodies affect the whole landscape of healthcare outsourcing.

The historic implementation of the Patient Protection and Affordable Care Act in the United States has set healthcare providers in a stiff situation. Now, more than ever, the healthcare outsourcing industry has further proven that it could be a very valuable asset to anyone.

With over 32 million new customers to cater to, healthcare providers have turned to outsourcing companies to bolster their capabilities to accommodate the newly implemented guidelines and increase business process requirements. This includes new customer enrollment, customer service, claims processing, revenue cycle management, and medical billing services. The medical outsourcing industry has demonstrated how they can be useful with their proper utilization of technology and manpower. However, these don’t make them safe from the prying eyes of entities that would do anything to take advantage of other people.

Medical billing fraud is one of the challenges that medical outsourcing companies face. The most common type of fraud usually involves stealing personal information which often leads to identity theft. In the field of medical outsourcing, it is used in a variety of ways to avoid payment, get extra benefits, or to maintain benefits they no longer qualify for. Even some healthcare providers have been reported to be engaging in medical billing fraud. And with the surge caused by the Patient Protection and Affordable Care Act, it would be no surprise if someone will exploit these legislations for medical billing frauds.

The best way to protect you from these medical billing service anomalies is to get familiar with it. The following are just some of the existing methods the industry has experienced to date:

• Made-up claims for services or supplies that never really occurred
• Identity theft or using someone else’s medical insurance information to obtain services or supplies
• Falsification of signatures or medical records to support misrepresented services or supplies
• Unbundling services from a group to unlawfully increase medical payment
• Misrepresenting the location where services or supplies were provided
• Rendering medical care without a license
• Duplicate claim submissions

It is also important that you review your statement to verify the accuracy of its contents. Always ask your doctors the reason why any service will be needed. It would also be wise to report discrepancies in your medical insurance plan and to never give your insurance number to anyone.

There are already existing government laws that protect us from such medical billing frauds including The Health Care Fraud Statute, The False Claims Act, The Anti-Kickback Statute, Exclusion Provisions, and The Civil Monetary Penalties Law. The US Department of Health & Human Services together with OIG or Office of Inspector General acknowledges the damages that healthcare frauds can bring. Together, they are working to enlist the health care industry and the public in the fight against fraud. OIG website even offers extensive information to health care providers and patients about ways to reduce the risk of fraud and abuse.

Medical Fraud is an issue that shouldn’t be taken too lightly. It costs taxpayers billions of dollars every year and requires focused attention and commitment to solutions. As an individual, it is our obligation to remain vigilant and to keep our eyes peeled for issues that concern our safety.

For a safe and secure medical billing service provider, Infinit Healthcare can help you! Quality and Security Guaranteed!

It has been almost 6 years since the Patient Protection and Affordable Care Act (ACA) or popularly known Obamacare has been signed in the United States.

The idea of the health bill is to make quality health insurance affordable for everyone through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms. It has required even small scale companies to provide health insurance for their employees. Companies that won’t be able to provide healthcare insurance for their full-time employees will be penalized. It has also expanded the coverage of Medicare and Medicaid.

Through the development of the bill, a lot of other benefits and protection have been added to the already long list of advantages of the health care bill. This includes amendments which make it illegal to charge for pre-existing health conditions and prevents discrimination. It has also required insurance companies to provide a short, plain-language summary of coverage and benefits but most of all, it has created a Marketplace for private health insurance companies to compete fairly though the standardizing the minimum coverage and developing a body that will monitor the insurance companies.

Paying close attention to the even ground that the Marketplace has created, health insurance companies now have to win the favor of the public so they can profit. This will put pressure on them since they will be forced to handle a huge increase in the demand on medical and pharmaceutical services. In the 2014 open enrolment alone, 8 million enrolled in the Marketplace. An estimated of 11.7 million are projected to have enrolled in the 2015 open enrollment and the numbers are only expected increase this year. Now that more people have easier access to health services, there will be a need for them to bolster their services. This trend has turned outsourcing into a valuable solution for them.

Outsourcing has provided health insurance companies with the necessary help to adjust to the increasing demand that ACA has created. Since the current international trade regulatory regime does not stand in the way of enterprises moving jobs around to obtain skills anywhere, offshore outsourcing has become a very economical solution for health insurance companies. Although this could widen the gap between U.S. labor costs and foreign labor costs, outsourcing can give a quick solution for center services; back offices; medical, legal and other data transcription and coding; animation; software development; engineering design; and digital content. This will not just save them production expenses but will also cut the time necessary to transition to the Patient Protection and Affordable Care Act era of healthcare insurance.

Most of the major provisions of the Patient Protection and Affordable Care Act have phased in last January 2014. As of the moment, there are still provisions that need to be completed until the year of 2020 and with the US presidential election on the peak of its heat, there are chances that more reforms on healthcare will be put into discussion and will hence continue to shape the industry of outsourcing.