Healthcare BPO: All you need to know

Prashant Flowace

Prashant Kumar

Performance Marketing Head
healthcare BPO

Healthcare BPO: Today’s patients are on the hunt for cutting-edge healthcare solutions that match their digital lifestyles.

They crave the convenience of booking appointments online, accessing medical records digitally, and even receiving virtual care.

Yet, providing this level of service can be daunting for organizations without the right resources and tech prowess.

Enter Healthcare BPO—the game-changer in the industry. It’s not just a solution; it’s a revolution.

When you outsource non-core tasks to specialized providers, as a healthcare firm, you can elevate the patient experience to new heights while streamlining operations behind the scenes.

In this article, we’ll see how healthcare BPO helps streamline your operations and how it works.

What is a Healthcare BPO?

Healthcare Business Process Outsourcing (BPO) is when a medical provider brings in another company to manage tasks not directly related to patient care. Under this, hospitals and clinics usually outsource work instead of performing the tasks in-house. These tasks might involve:

  • Medical coding
  • Billing
  • Transcription
  • Charge entry services
  • Medical records indexing
  • Medical data entry services
  • Payment posting
  • Medical claims processing services
  • Revenue cycle management services
  • Medical accounts receivable

When you outsource these tasks, you can concentrate on patient care. It also gives your in-house medical workers more time to focus on important tasks.

Note: Companies often outsource tasks to third-party vendors in foreign countries to cut costs. However, hospitals can also find healthcare BPO services within their own country. Another option is hiring freelancers directly to handle tasks like medical coding and billing, which can be quite tedious.

Types of Healthcare BPO Services

Types of Healthcare BPO Services

Here are the different types of healthcare BPO services you can get:

Medical coding and billing

Medical coding and billing are essential processes in healthcare. Billing involves creating health claims to send to insurance companies and seeking payment for services provided by healthcare providers. However, this process can be frustrating and time-consuming, often taking months and multiple communications before reaching the collection stage.

To avoid delays and errors, it’s crucial to have specially trained staff handle medical records and billing. Without the right expertise, processing patient bills can become complicated.

This is where healthcare outsourcing steps in. When you partner with professionals in healthcare business process outsourcing, organizations can ensure accurate and efficient handling of coding and billing tasks. This allows medical staff to focus on patient care, research, and other critical aspects of healthcare delivery.

Medical billing charge entry

Medical billing charge entry involves accurately coding and entering medical charges for billing and payment collection. Determining how much the provider gets from insurance payers is an important step in the medical billing process.

Here are some tasks included in charge entry services:

  • Receiving files from the client, such as checks, documents, and Explanation of Benefits (EOBs)
  • Downloading files
  • Entering patient encounter and follow-up encounter details
  • EOB follow-up
  • Denial analysis
  • Client feedback
  • Capturing billing information, such as provider details, patient admission, and coding-related details
  • Getting clarification from the client about pending or held claims and processing them promptly
  • Data entry, coding, and verification of charges

Having trained individuals handle these tasks ensures accuracy and prompt processing, leading to clean claims submitted to payers.

Payment posting

Payment posting is a critical process for healthcare organizations to manage their finances effectively and identify areas for improvement. It involves various tasks to ensure accurate recording and tracking of payments, ultimately improving the bottom line. Here’s what the payment posting includes:

  • Recording payments
  • Depositing funds
  • Reconciling numbers
  • Posting changes and dissents
  • Analyzing root causes of recurring problems
  • Preventing recurring problems
  • Posting claim denials

These services include accurately recording and updating financial transactions in the client’s payment system, including inputting payment data from different sources, reconciling payments with invoices, and ensuring the correct reflection of payments.

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Claims processing

Claims processing is a complex procedure that requires careful attention to detail. To ensure success, your business must have reliable healthcare claims business process outsourcing that follows every necessary step.

Each step is crucial, whether it’s reviewing medical claims, conducting investigations, making adjustments, or making final acceptance or denial decisions.

Specialized teams with the right resources and manpower are assigned to handle large volumes of medical claims. With their sole focus on this task, you can trust that distractions won’t compromise the claim processing accuracy.

Data processing services

Healthcare providers treat patients and handle vast amounts of medical data daily. Managing and processing this data can be overwhelming, considering the various types involved:

  • Tests and lab reports
  • Prescriptions and drug inventory
  • Patient insurance details
  • Other hospital records

Outsourcing data entry activities can help healthcare organizations save time and resources for their core activities. While data entry is relatively straightforward, you must outsource it to a reputable healthcare BPO. Using healthcare forms can streamline data collection and ensure security.

Here are 5 reasons why you need to outsource your healthcare activities and focus on business development more:

AI advancements

One major factor driving this trend is integrating artificial intelligence (AI) and other cutting-edge technologies.

AI has transformed BPO services by introducing intelligent automation solutions that boost operational efficiency and accuracy.

Technologies like natural language processing and machine learning enable BPO firms to handle large volumes of data, extract insights, and automate repetitive tasks. This increases productivity, minimizes errors, and ensures compliance with regulations.

With AI, BPO firms can offer advanced solutions for medical coding, claims processing, clinical documentation, and data analysis.

These AI-powered services improve the speed and accuracy of tasks, resulting in faster claims processing, fewer errors, and better overall performance. Moreover, AI algorithms continuously learn and adapt, leading to ongoing enhancements and increased efficiency over time.

Reduction in expenses

In any case, cost reduction is a constant pursuit for owners, and healthcare companies are no exception.

Teaming up with a dependable BPO provider proves cost-effective, saving expenses that would have been spent on hiring and training in-house employees.

This eliminates the need for additional onboarding processes, including advertising, interviewing, and training costs.

Maintaining an in-house administrative setup involves extra expenses like office space, equipment, and software licenses. Outsourcing tasks to a BPO provider significantly trims these costs.

Focus more on core tasks

Outsourcing allows you to prioritize your company’s strengths while entrusting non-core tasks to specialists. This shift in focus liberates your time and resources, empowering you to fuel business growth.

Moreover, outsourcing offers cost savings and operational streamlining.

Healthcare BPO allows healthcare companies to outsource key tasks such as:

  • Processing claims
  • Managing bills
  • Logging data entry
  • Resolve patient disputes

They no longer have to manage that themselves, so they have more time and resources to focus solely on patient care. This helps them improve their customer experience, which will increase their reputation — helping them get more customers in the long run.

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Get expertise at a lower cost

Outsourcing non-core activities is a common strategy for reducing business expenses. Healthcare companies, for instance, often choose to outsource tasks to countries like the Philippines.


Because in such locations, you can access skilled workers at lower wage rates, allowing you to save costs without sacrificing quality. Plus, since these professionals are well-trained, you can trust them to handle tasks efficiently and accurately, minimizing any potential errors.

Guaranteed HIPAA compliance

Outsourcing healthcare services comes with a significant perk – ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA lays down strict rules for safeguarding patient health information and maintaining data privacy and security.

When you team up with reputable BPO firms, you can rest assured that they adhere to HIPAA regulations.

Moreover, these firms conduct regular audits and assessments to identify and rectify any potential vulnerabilities, thereby reducing the risk of data breaches and ensuring ongoing compliance.

5 factors to consider while choosing a Healthcare BPO

5 factors to consider while choosing a healthcare BPO

Here are some factors to consider while choosing a healthcare BPO:

Their expertise in Healthcare

The healthcare industry is complex, with strict regulations and intricate processes. Therefore, a BPO partner must have extensive experience and understanding of these unique challenges.

This involves in-depth knowledge of medical billing, coding, revenue cycle management, and other specialized tasks essential to healthcare operations.

To assess a BPO partner’s expertise in these areas, examining their track record and client references is important. Past performance and success stories with other healthcare clients can provide valuable insights into their proficiency and reliability.

Boost employee satisfaction

Healthcare outsourcing brings a host of benefits, including enhanced profit margins and increased focus on core tasks.

This stability assures in-house team members of job security, easing their stress and allowing them to take on more significant responsibilities.

With reduced workload and enhanced peace of mind, employees can dedicate themselves to delivering exceptional patient care, leading to greater job satisfaction.

Effective communication

The success of a BPO partnership hinges on strong communication. When assessing a healthcare BPO provider, healthcare practices must inquire about available communication channels.

While a vendor may have its preferred mode of communication, it should be willing to adapt to the practice’s preferences to ensure seamless collaboration. This flexibility is essential for addressing challenges promptly.

Reduces risks and errors

Healthcare companies face numerous challenges, including evolving legal requirements, compliance issues, and outdated technology. Government regulations and financial constraints further compound these risks.

Outsourcing certain functions allows hospitals to focus on sustaining and expanding their core strengths, while BPO firms handle secondary operations. Trusted BPO companies certified under HIPAA can securely manage patient data, prescriptions, and inventory records.

Tackling talent competition

Medical practices grapple with a significant talent shortage, evidenced by a 54.5% year-on-year increase in job openings in the healthcare sector. As demand for skilled workers rises, filling vacancies becomes a pressing challenge.

Partnering with a BPO provider offers a solution to augment your team and organization. It grants access to trained medical professionals proficient in billing, coding, and claims processing.

When you entrust hiring and training processes to your service provider, you can save both time and money.

Whether they have performance monitoring measures

Tasks like claims management and billing require the utmost attention in healthcare operations. Distractions during these tasks can lead to errors and patient issues. However, when your healthcare BPO partner is located far away, the time it takes to complete the work is challenging.

You may wonder:

  • How productive they are
  • If they use idle time as work hours,
  • Whether they exclusively work on your tasks during designated hours
  • If the time taken to complete tasks is justified,

While finding a BPO partner with built-in monitoring procedures is ideal, it’s only sometimes feasible. Fortunately, there’s a solution: performance monitoring software like Flowace.

Revolutionize productivity:

Boost by 31% using the innovative solution by Flowace!

Free Trial

What’s Flowace?

Flowace is a robust performance-tracking tool trusted by top BPOs worldwide. It enables you to:

  • Monitor the working hours of your outsourced staff.
  • Track the time they dedicate to your activities.
  • Identify inefficient time usage and hold the provider accountable.
  • Prevent your outsourced staff from getting sidetracked by other activities.

Flowace.ai stands out for its dynamic engagement with users and managers, functioning as a motivational coach for work. It efficiently empowers individuals to achieve more in less time, all while promoting a healthy work-life balance.

Flowace Features:

Flowace Features

  • Recognizes and rewards hardworking individuals who prioritize important tasks.
  • Uses performance data to ensure fair evaluations, free from bias or favoritism.
  • It assists in establishing fair rules for overtime and compensation and prevents unauthorized side jobs.
  • Provides insights to improve workflow efficiency and minimize time waste.

Key features for remote BPO teams:

Timesheet Data Analysis and Reports
  • Analyzes employee behavior, time allocation, and project costs.
  • Categorizes tasks and activities.
  • Generates invoices for billable and non-billable hours, benefiting both individuals and teams.
  • Aligns resource distribution with project budget requirements.
  • Identifies and addresses workflow bottlenecks.
Hands-free Time Tracking
  • Identifies peak productivity periods.
  • Accurately records work hours and locations.
  • Integrates precise employee monitoring tools.
  • Provides insights into individual and team productivity levels.
Project Communication
  • Establishes clear expectations and task priorities.
  • Facilitates successful project execution.
  • Adapts management strategies to suit remote work dynamics.
Revolutionize productivity:

Boost by 31% using the innovative solution by Flowace!

Free Trial

What Next?

Healthcare BPO outsourcing is a smart way to save time and money while ensuring quality care for your patients. However, it’s not a decision to rush into.

First, take time to identify which tasks you want to outsource, then thoroughly evaluate potential healthcare BPO partners. Once you’ve chosen the right one, you can set up a system that suits your business’s needs.

Do you have more questions or concerns about healthcare BPO?

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