It’s no secret that healthcare is a complicated industry. Healthcare payers — such as health insurance companies and other plan providers — can face a lot of difficulty when recovering money. In many cases, inefficient or poorly coordinated internal processes could mean funds are slipping through their fingers every day.
For instance, approximately 80% of pharmacy compliance audits uncover a potential opportunity for recovery. This means there are potentially millions of dollars just sitting on the table going unclaimed. However, the complexity of the business means it can be extremely difficult to recover as much money as possible without negatively impacting your organization’s daily operations. How can payers continue to keep their track of their audits and recovery efforts while ensuring they don’t get bogged down in the process?
Finding the Right Partner
Rather than devoting their own resources to these often tedious and time-consuming tasks, many companies in the healthcare sector choose to find a reliable business process outsourcing (BPO) partner. Utilizing advanced technology and proven techniques, a BPO provider can help payers recover their money in the most efficient and cost-effective manner possible. There are several services available, and businesses can often take advantage of them individually or as part of a comprehensive suite of services.
For example, subrogation services ensure that applicable healthcare costs linked to medical and disability expenses related to accidents and injuries are being paid by the proper liable party. This can help cut down on delays and confusion that typically result in such instances. Additionally, a properly managed pharmacy audit can monitor retail pharmacy operations. This not only ensures costs are contained, but also provides comprehensive oversight and deterrence against fraud and abuse. In some cases, a BPO provider can even act as an extension of the payer’s business office to maximize overpayment recoveries and strengthen relationships with healthcare providers.
Choosing a capable BPO partner could be the tool your enterprise needs to cut through the red tape and get more from your recovery efforts. Best of all, this partnership can allow your staff to concentrate on fulfilling your core mission and avoid getting overwhelmed by the recovery efforts.
Conduent is a leading BPO provider aimed at helping our clients in the healthcare realm and beyond improve their internal processes and gain the insights they need to succeed. To learn more about how you can improve your payment recovery process and how Conduent can help, take a look at the accompanying resource.