In January 2014, insurance regulations enforced by the Affordable Care Act (ACA) are set to begin. The numerous provisions of this law are almost 1,000 pages long and will affect individuals, small businesses, and large corporations alike.
According to the Kaiser Family Foundation, health premiums have increased more than 80% over the last decade, for employers and employees. Additionally, Towers Watson reports that healthcare costs will continue to rise at a minimum rate of 5-7% annually. These elements combined with the new requirements set by the Affordable Care Act make this the most expensive time to be an employer in America.
Despite the perplexities of the dynamic healthcare market and the regulations it faces, outsourcing solutions exist to streamline the added administrative burden triggered by these challenges and minimize their impact on today's employers.
Here are some key ways outsourcing can help cut medical administrative costs:
1. In order to comply with the Medical Loss Ratio, every proportion point counts.
The Affordable Care Act requires health insurance issuers to acquiesce data on the number of premium returns disbursed on medical amenities and eminence advancement. This is oftentimes referred to as the Medical Loss Ratio (MLR). MLR necessitates insurance enterprises to spend 80%-85% of premium dollars on medical care.
The ACA will bring to the surface for the healthcare industry what large companies have always known: Outsourcing high-volume, data-intensive business processes will tighten overall spend for long-term, sustainable business growth.
When complemented by industry-leading processing systems and convenient provider portals, BPO capabilities will save you money, reduce turnaround time and increase control of your claims processing.
2. Annually, healthcare providers write off over $92 billion due to inaccurate and timely claim and payment information.
BPO companies do not just offer reserves on administrative personnel. Outsourcing gives providers the opportunity to make additional money from abandoned claims. Business process outsourcing experts streamline the revenue cycle to make the payer-provider relationship more efficient and profitable for you.
BPO claims management capabilities can form a highly flexible, comprehensive solution that can be customized to meet the specific needs and requirements of the insurance carrier. Vendors that have extensive knowledge and expertise in the full range of claims processing services can deliver options from simple front-end claims data capture with technologies such as DDC's Intelligent Capture to full, end-to-end claims processing as an integral part to your entire claims operations.
3. The high cost of healthcare is attributed to the fact that 50% of transactions between payers and providers are paper-based.
Healthcare remains one of the few industries that still rely on paper records. The Affordable Care Act requires standardized billing and electronic exchange of health information.
Reliable BPO vendors will clear out the warehouse of dusty paper records and replace them with fully secure, searchable, and usable data.
DDC offers its Electronic Payment System as a warehouse replacement: An automated print and mail check issuance and EFT payment service that reflects payment records and activity on a web portal. This allows providers direct access to their eBills, EOBs / EORs, and payment remittance statuses.
John Eisele, DDC's resident healthcare and insurance expert, explains the mandates that America's employers now face:
“Because of the law’s numerous mandates, providers' focus should be on protecting themselves against all these expensive provisions. Outsourcing will alleviate a majority of the pressure stemming from federal regulations that companies will be under in January.”
Outsourcing solutions can protect you from the large and complicated business hindrance that is the Affordable Care Act.
Readers who have questions or want to continue this discussion further, contact John Eisele directly: 770-653-5052.
