FEATURE sTORY Be Aware of the Risks THE BENEFITS (AND DANGERS) OF OUTSOURCING MEDICAL PRACTICE ANCILLARY SUPPORT SERVICES OVERSEAS By Robert Liles, Esq. H ealth care providers around the country are facing a myriad of serious economic and operational challenges. While both Medicare and private payor reimbursement rates have steadily declined in many areas, the regulatory obligations imposed on the provider community have continued to increase. In response, many billing companies and providers have looked overseas in an effort to further reduce the cost of ancillary support services. Functions outsourced overseas include the coding and billing of medical claims for services and supplies, medical transcription work, and offsite server maintenance of Protected Health Information (PHI) and patient financial information. The purpose of this article is to examine both the positive and negative points you should consider before choosing to outsource one or more of your coding, billing, and other administrative support functions overseas. Benefits of Overseas Outsourcing There are a number of real, measurable benefits to outsourcing one or more business functions. These benefits include, but are not limited to: INCREASED COST SAVINGS many billing companies are now facing an indefinite economic future. Declining reimbursement rates and expanding medicare, medicaid, and private payor audits have made it more difficult for health care organizations to remain profitable. Concerned health care providers have reduced both their employment rolls and their overhead costs in an effort to reduce expenses. When assessing their options, a number of billing companies have chosen to outsource their coding, billing, or medical transcription functions, thereby cutting their labor and overhead expenses. Overseas thirdparty billing companies typically charge a significantly lower percentage to process medical claims than do their american counterparts. as a result, many billing companies have chosen to send their work to an organization outside of the united states. In doing so, they have significantly cut their costs and have streamlined their cash-flow. additionally, overseas billers are able to quickly hire additional qualified billing staff to handle periods where the number of claims may increase or new clients come on board. HIGHER LEVELS OF TRAINING ExPERTISE Health care coding, billing, and documentation rules are constantly being revised. It is often difficult for small and mid-sized companies and their staff to keep up with the latest regulatory and contractual changes imposed by medicare, medicaid, and private payors. Outsourcing billing services to an organization that specializes in these functions can provide a number of advantages other than mere cost savings. Outside third-party coding and billing companies are required to keep up with changes that may be made to the coverage, coding, and billing rules. as a result, their skill sets are often improving. Their employees are typically welltrained and can greatly assist a health care provider with its compliance efforts. In addition, the staff of domestic third-party billing companies are often certified by one or more national coding/billing associations. Notably, the staff of many overseas billing companies employ english-speaking coders and billers, many of whom are certified in coding/billing by one or more national associations. many overseas billing companies have insisted that their employees become certified. In doing so, they have been able to assemble a reliable group of experienced coders and billers, most of whom have received nationally-recognized certifications in multiple areas of practice. QUALITY OF SERVICES RENDERED No one is perfect. Regardless of which outside billing company is employed, mistakes will occasionally be made. Nevertheless, THe JOuRNaL OF THe HeaLTHCaRe BILLINg aND maNagemeNT assOCIaTION 21
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