Outsourcing
Far far away, behind the word mountains, far from the countries Vokalia and Consonantia, there live the blind texts. Separated they live in Bookmarksgrove right at the coast of the Semantics, a large language ocean. A small river named Duden flows by their place and supplies it with the necessary regelialia. It is a paradisematic country, in which roasted parts of sentences fly into your mouth. Even the all-powerful Pointing has no control about the blind texts it is an almost unorthographic life.
One day however a small line of blind text by the name of Lorem Ipsum decided to leave for the far World of Grammar.
The Big Oxmox advised her not to do so, because there were thousands of bad Commas, wild Question Marks and devious Semikoli, but the Little Blind Text didn’t listen.
She packed her seven versalia, put her initial into the belt and made herself on the way.
When she reached the first hills of the Italic Mountains, she had a last view back on the skyline of her hometown Bookmarksgrove, the headline of Alphabet Village and the subline of her own road, the Line Lane. Pityful a rethoric question ran over her cheek, then
Drivers of Outside Growth
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RCM is a highly specialized and complex area with myriad state and federal regulations. Clinical providers are not well positioned to keep up with the demanding budget, talent, and technology requirements necessary to adequately manage their billing and collections, let alone optimize for maximum efficiency.
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The complexity of US health insurance reimbursement and lack of standards surrounding reimbursement requirements (ex. claim formatting and remittance code usage) has led to the need for deep, specialized knowledge and expertise of individual payers and health plans within each state and even local municipality. Acquiring and maintaining this knowledge and expertise requires an enormous effort and investment in staff training and retention.
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With healthcare margins under intense pressure, administrative functions (in particular RCM) are the primary target for cost reductions. Often this comes in the form of required staffing reductions (through attrition or otherwise). Most healthcare groups struggle to maintain adequate staff productivity, especially as routine processes now require strong computer skills. Automation tools can help remove some manual tasks allowing staff to focus on more complex issues (e.g. clinical denials).
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Health systems are struggling to find and retain qualified staff due to ongoing labor crisis. In addition, there is significant cost associated with hiring and training new revenue cycle specialists, who require months of education and learning in order to understand the intricacies of their functional role in the provider specific environment. Health systems offer generous benefit programs that make it more expensive to retain internal staff as compared to vendors that specialize in services or technology.
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The core competency of healthcare providers is medical expertise, clinical services, and patient care. For most organizations, the only way to leverage the available capabilities of their EMR and ancillary systems to drive efficiency and reduce cost is by hiring an external vendor that specializes in technology and revenue cycle process optimization. Emerging Automation Capabilities
EMR systems and bolt-on “point” solutions have developed powerful functionality to automate many time– intensive manual processes and increase efficiency and productivity output of patient access, coding, and business office staff. However, these technologies are highly complex and difficult to implement, preventing most healthcare organizations from leveraging capabilities available within the EMR and ancillary systems they have purchased.
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EMR systems and bolt-on “point” solutions have developed powerful functionality to automate many time– intensive manual processes and increase efficiency and productivity output of patient access, coding, and business office staff. However, these technologies are highly complex and difficult to implement, preventing most healthcare organizations from leveraging capabilities available within the EMR and ancillary systems they have purchased.