Tyler Benware’s Post

The Future of Payment Integrity: Insourcing is the Way Forward For the past decade, the focus in payment integrity has been on moving post-payment audits to pre-payment reviews. But here's the reality: not all audits belong in the pre-payment phase. And when health plans flood providers with excessive medical record requests—often through third-party vendors—it leads to provider abrasion in an already delicate system. However, some audits work brilliantly in the pre-payment space—like Itemized Bill Reviews (IBR). This type of review ensures that items billed separately (like a simple “water pitcher”) aren’t already covered in the room and board charges. It's an easy win, and health plans have been doing it for years to save money and improve accuracy. But here's the real game-changer: today’s trend in payment integrity is the shift towards insourcing these reviews, rather than outsourcing them to third-party vendors. And the reasons why this shift is happening are undeniable: - Control: Insourcing gives health plans better control over their payment integrity programs. - Consistency: Keep workflows streamlined and consistent, avoiding the variability that comes with multiple third-party vendors. - Transparency: In-house teams have full visibility into the process, improving decision-making and accountability. - Cost-effectiveness: With technology and workflow automation taking the lead, health plans can accomplish more with fewer resources. Imagine generating $100M in savings with just a handful of staff—5 vs. 30 auditors—thanks to automation. Technology has revolutionized the game. Today, health plans can leverage software to do the heavy lifting, meaning they don’t need massive teams to see huge returns. Small in-house teams can now scale and tackle more complex reviews, starting with simple items like IBR and gradually taking on more as the system proves its effectiveness. The mantra? “Insourcing first, outsourcing only when you must.” A strategic, step-by-step approach means health plans don’t have to fully abandon third-party vendors. They can carve out manageable portions of the work and insource gradually, leveraging automation tools to boost efficiency and reduce overhead. The bottom line: Insourcing isn’t just a trend—it’s the future of payment integrity. And with the cost and operational benefits, it’s here to stay. #PaymentIntegrity #Insourcing #HealthPlan #CostSavings #Automation #MedicalBilling #HealthcareEfficiency #HealthTech #ProviderRelationships #InnovationInHealthcare

More than 80% of #healthcare executives are struggling with Revenue Cycle Management labor shortages – and nearly half are operating 10-20% below steady-state levels. At the same time, rising healthcare costs leave nearly half of U.S. hospitals grappling with negative margins – making fast and effective revenue collection more critical than ever to financial stability. Read our latest Auxis case study to learn how Auxis' #BPO nearshore services in conjunction with #automation helped a top U.S. healthcare provider successfully deliver complex, time-sensitive RCM processes while accessing top-tier, cost-effective talent from #LatinAmerica Adriana Bombaci Eric Liebross Laura Moreno Ronni Sayewitz Dan Day Gustavo Romero Fallas https://lnkd.in/eaW-VUtU

More than 80% of healthcare executives are struggling with revenue cycle management labor shortages – and nearly half are operating 10-20% below steady-state levels. At the same time, rising healthcare costs leave nearly half of U.S. hospitals grappling with negative margins – making fast and effective revenue collection more critical than ever to financial stability. Read our latest case study to learn how Auxis' nearshore shared services solution helped a top U.S. healthcare provider successfully deliver complex, time-sensitive revenue cycle management processes while accessing top-tier, cost-effective talent. Fabiana Corredor Eric Liebross Sruthi Ramakrishnan Adriana Bombaci Laura Moreno #revenuecyclemanagement #outsourcing #nearshoring #healthcare #laborshortage https://lnkd.in/eR9-XYw5

Medium's recent piece on RCM outsourcing took a deep dive into the current labor market crunch in healthcare. The article sheds light on the challenges stemming from a shortage of skilled RCM personnel, compounded by the rapid pace of technological advancements and increasing burnout among RCM workers. RCM outsourcing could be the game-changer that healthcare organizations need. By partnering with specialized external providers and tapping into automation, providers can streamline operations, reduce errors, and bolster efficiency—all while staying laser-focused on delivering top-notch patient care. DME Service Solutions specializes in RCM outsourcing solutions tailored to meet the unique needs of healthcare providers. Talk with our experts and learn how we can streamline your revenue cycle management processes, reduce errors, and improve efficiency. #RCM #DMEServiceSolutions

🌟 Unlock Efficiency and Profitability: The Advantages of Outsourcing Your Revenue Cycle Management (RCM) 🌟 In today’s fast-paced healthcare landscape, organizations are constantly seeking ways to optimize operations and enhance patient care. One powerful strategy to achieve these goals is outsourcing Revenue Cycle Management (RCM). Here are some compelling advantages of outsourcing your RCM work: Cost Efficiency 💰 By outsourcing RCM, healthcare organizations can significantly reduce costs associated with payroll, training, and compliance. This allows for reallocation of resources to more critical areas like patient care and technological advancements. Expertise and Specialization 🎓 Outsourcing partners often have specialized expertise and access to the latest tools and technologies, ensuring your revenue cycle processes are managed by experienced professionals who stay current with industry regulations and best practices. Focus on Core Competencies 🚀 Outsourcing RCM allows your team to concentrate on what they do best—delivering exceptional patient care. By offloading administrative tasks, you can enhance overall efficiency and promote a more patient-centered approach. Improved Cash Flow 📈 Dedicated RCM partners can streamline billing and collections processes, minimizing delays and optimizing cash flow. This boosts financial stability and allows for better forecasting and planning. Scalability and Flexibility 🔄 As your organization grows, your RCM needs may evolve. Outsourcing provides the flexibility to scale operations up or down quickly without the headaches of hiring or retraining staff. Reduced Compliance Risks 🛡️ The ever-changing landscape of healthcare regulations can be daunting. Outsourcing to specialized RCM firms ensures that compliance is prioritized, mitigating risks and keeping your organization up to date with legal requirements. In a world where staying competitive means continuously improving operational efficiency, outsourcing RCM can be a game changer. It’s not just about cost-cutting; it’s about driving innovation, enhancing patient satisfaction, and ultimately, positioning your organization for long-term success. 💬 Are you considering outsourcing your RCM? Share your thoughts or experiences below! #Healthcare #RCM #Outsourcing #RevenueCycleManagement #Efficiency #PatientCare #HealthcareInnovation #BillingFoxTechlologies

Are healthcare providers prepared to explore the transformative potential of outsourcing healthcare services to streamline operations, reduce costs, and improve patient outcomes? Learn more in this blog below. #healthcareservicesoutsourcing #healthcare #outsourcing #MenalPartners

In today’s healthcare landscape, reducing administrative burden is key to improving patient care and operational efficiency. By outsourcing non-core tasks like billing, scheduling, and compliance, healthcare organizations can focus more on their core mission—delivering quality patient care. 🏥💼 Here’s how outsourcing can transform healthcare operations: 🩺 Enhanced Patient Focus: Outsourcing administrative tasks frees up clinical staff to spend more time with patients, enhancing care and satisfaction. 💰 Cost Savings: Specialized providers reduce overhead costs, allowing for flexible, on-demand support without long-term commitments. 📈 Access to Expertise: Outsourcing partners bring specialized knowledge and stay current on the latest healthcare regulations. 🌐 Scalability & Technology: Advanced, scalable solutions help healthcare organizations adapt to demand changes with ease. Discover how FYDI Global can help reduce your administrative burden and boost your focus on patient care. https://hubs.ly/Q02YM9zK0 #HealthcareBPO #AdministrativeEfficiency #PatientCare #FYDIGlobal #Outsourcing

🌟 Transforming Healthcare: Unpacking the Benefits of Outsourcing 🌟 Healthcare is evolving, and outsourcing is at the heart of its transformation. From enhancing patient care to streamlining costs, the benefits are undeniable. But what does this mean for healthcare providers? How can outsourcing create a lasting impact on operational efficiency and patient satisfaction? 👉 Dive into our latest blog to discover how healthcare outsourcing is reshaping the industry, offering strategic solutions to modern challenges. Whether you're in healthcare management or simply curious about industry innovation, this is a must-read! 💡 Click here to explore: https://lnkd.in/gingXei9 #HealthcareOutsourcing #InnovationInHealthcare #OutsourcingSolutions #DynaQuest

Choosing the right healthcare BPO partner is pivotal for enhancing both operational efficiency and patient care. A well-suited BPO partner not only provides essential services but also offers solutions that are intricately tailored to meet specific healthcare operational demands. This partnership ensures that the digital and operational representations of healthcare organizations reflect the high quality and reliability of the care they provide. Elevate your healthcare operations with a BPO partner that aligns seamlessly with your goals and needs. Connect with our experts today! #DMEInsights

Should Growing Healthcare Agencies Outsource Billing and Intake? (An Honest Pros and Cons) Outsourcing medical billing and intake can be a smart solution for growing healthcare agencies, but it comes with both advantages and potential challenges. Here’s an honest breakdown of the pros and cons. Pros: - Scalability Without Infrastructure Costs: Growing healthcare agencies can scale quickly without the need for additional office space or equipment. - Reduced Employee Turnover: Outsourcing tasks helps alleviate burnout in your in-house staff, which leads to lower turnover rates. - Better Performance Management: Hiring an employee directly from abroad can be difficult to monitor. Outsourcing companies manage their own employees to ensure productivity. - Faster Turnaround & Extended Hours: Outsourcing companies work across time zones, allowing for 24/7 processing and faster claim submissions or intake handling. - Cost Savings: Outsourcing costs less considering there will be no costs for benefits and training. These pros may seem too good to be true, but what are the potential downsides of partnering with outsourcing companies? Cons: - Data Security Risks: Outsourcing can increase the risk of data breaches or HIPAA violations. - Quality Control Challenges: Mistakes in billing or intake may take longer to fix with an outsourced team, which can delay payments or hurt your reputation. - Dependence on Third-Party Timeliness: If your outsourcing partner misses deadlines, it can affect cash flow and disrupt operations. - Hidden Costs: Additional fees may arise, especially if service levels fall short or extra resources are needed. Some outsourcing companies even take a percentage of the submitted claims. If the potential downsides have raised concerns and you're wondering whether outsourcing is truly the right choice, our company, NexSync PH, addresses many of these challenges. If you're curious about how we manage these issues, you can read more in this post: https://lnkd.in/ea9VP7Xw #OutsourcingAgency #HealthcareAgencies #HealthcareOperations