As predicted, the Australian healthcare BPO will confront major challenges especially in claiming and delivery of medical billing services.

The medical billing and coding services has been a complex process as it takes longer days to clear the revenue payments. So, it’s significant to coordinate with internal workflow and clearing House for feasible billing payments.

Here are the 5 major challenges of healthcare BPO companies:

  • Updating and maintaining patient details
  • Training for success
  • Tracking the denials
  • Problems in Quality Control
  • Frequent Claim follow ups.

1.Updating and maintaining patient details:

  • Patient demographic details and insurance verifications are crucial part of medical billing process in healthcare BPO companies.
  • Usually, the insurance policies and the coverage limits may change frequently when the patients change their location or if there are changes in the age number.
  • The healthcare BPO companies must be aware of the changing policies and the patient demographic details and enter them accurately by updating the files on a regular basis.
  • Efficient claim process is maintained and based on accurate insurance verification and policy confirmation along with patient information submitted to the insurance companies.

2.Training for Success:

  • Every insurance company maintains their own set of rules and regulations that may require notes with claims for new patients.
  • Others may require chart notes for AR follow up and non-standard treatment protocol.
  • Most of the training programs include components that enable healthcare BPO companies to access the files and patient demographic details or information quickly and ensure if the insurance companies carry all the information provided and required to speed up claims after submission.

3.Tracking the Denials:

  • Tracking the denials is the most important denial management process in healthcare BPO companies as it accommodates every denial and rejection if not followed up accordingly.
  • Every denial and rejection after claim submission is an opportunity to improve the process by correcting the claims and resubmitting them on time.
  • Higher denial rates leads to frequent and huge revenue loss and also may indicate that the medical billing/coding team requires more concentration on tracking the denials or rejections.
  • Most common reasons for denials:
  1. lack of healthcare credentialing
  2. Support documentation is insufficient
  3. Uncovered codes for services or equipments
  • Tracking denial codes can also increase the efficiency of the healthcare professionals’ medical practice as well as enhance medical billing process.
  • Accurate chart notes to the healthcare BPO companies will save time and also improves the claim processing by managing better medical coding system.
  • If claims are constantly denied due to uncovered policies, then it’s time to review the coverage and verify the insurance policies to check the claims are eligible to submit according to policy regulations.

4.Problems in Quality Control:

  • Eliminating errors in the claims can be critical, the billing and collection process will continue without any disturbance once the claim gets approved.
  • Post payments and record payments help healthcare professionals keep an eye on the cash flow and growth in revenue payments.
  • The only way to make sure if the account balances are accurate to create a log for the receipts those are transferred to the medical billing team.
  • The log sent to the billing team must include all the necessary information and every detail to ensure deliberate payment posting with confirmation.
  • The log details are :
  1. Patient name
  2. Account number
  3. Cash Reimbursement
  4. Amount
  5. Date of Service

5. Frequent Claim Follow ups:

  • Reviewing the account aging is essential to determine the claims those are unpaid in the timely manner.
  • Thorough follow ups on the account receivable will reveal the barriers between the insurance companies and healthcare BPO companies.
  • Most of these claim delinquencies are caused by medical billing errors.
  • High delinquency rates can indicate the seriousness of the medical billing problems. So, reviewing all these accounts can result in improving the billing performance.
  • It’s important to execute process that enables quicker and more efficient claims within the timely filing limits.
  • Regular follow up and reviewing revenue cycle management process from patient demographic entry to post payments will enable healthcare BPO companies to upgrade and increase reimbursement more efficiently by also improving the revenue flow.
  • Well trained staff or the medical billing/coding team has the ability to lower the denial rates by frequent AR follow ups on the unpaid claims.

Medical Coding in Australia:

  • Australia ICD-10-AM coding is different from USA ICD-10-CM coding.
  • ICD-10-AM 10th edition is followed in Australia as well as other countries like New Zealand, Ireland, Qatar and Saudi Arabia.
  • The medical coding classification system in Australia is ICD-10-AM, ACHI, ACS (International Classification of Diseases 10th edition Australian Modification, Australian Classification of Health Interventions, Australian Coding Standards).
  • Understanding these codes ICD-10-AM and ACHI and apply the conventions according to the instructions is the crucial part of medical coding system of Australian healthcare BPO.
  • Identification and application of ICD-10-AM and ACHI coding edition changes are the skills required to grow knowledge in coding.
  • The knowledge to interpret and apply the Australian coding standards are essential.
  • By assigning complete and accurate medical codes from ICD-10-AM and ACHI for diseases, conditions, injuries and procedures, so that the team can concentrate more on the denials due to coding errors for the submitted claims.
  • The Australian coding standards have developed with a motive to satisfy the use of ICD-10-AM and ACHI and apply it to all the public and private healthcare centres in Australia.
  • This particular ongoing revision of Australian coding standards ensure reflects of changes in the healthcare professionals practice along with clinical amendments and patient requirements.

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