Outsourcing Healthcare Services

On December 2, 2011, in Outsourcing, by Business Development Group

Healthcare organizations often have multiple divisions or departments that handle the different areas involved with delivering healthcare services. Outsourcing various functions within a healthcare agency, such as billing, staffing needs and business functions, can go a long way towards reducing overall costs.

Medical coding or medical classification is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. Be it knowledge process outsourcing (KPO) or business process outsourcing (BPO) the diagnoses and procedures are usually taken from a variety of sources within the medical record, such as the transcription of the doctor’s notes, laboratory results, and other sources. Diagnosis codes are used to track diseases, whether they are everyday diseases such as norovirus, the flu, and atlete’s foot. These diagnosis and procedure codes are used by government health programs, private halth insurance companies, workers’ compensation carriers and others.

When implementing an outsourcing program, it is crucial to confirm that your potential business partner has staff trained in all regulations related to Medicare and Medicaid, as well as managed care and preferred provider organizations. They should also be well trained in third party liability and indemnity insurance policies as well as workers compensation processes. Their agents or staff should also be proficient in medical bill coding such as CPT, HCPCS, ICD-9 coding Level I, II, III.

Related articleOutsourcing Services Effectively

Medical classifications systems are used for a variety of applications in medicine and medical informatics:

*statistical analysis of diseases and therapeutic actions
*reimbursement, e.g. based on DRGs
*knowledge-based and decision support systems
*direct surveillance of epidemic or pandemic outbreaks

Related article: Knowledge Process Outsourcing

Types of classification
*Diagnostic codes
*Procedural codes
*Pharmaceutical codes
*Topographical codes

Read related article: Call Center as a Marketing Channel

In-house or to Outsource? Know the difference!

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