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Why Should You Outsource and Offshore Medical Coding Processes?

Outsourcing and offshoring are two imperative factors that could help boost your revenue cycle process. They help to bring in certified coders who could institute lesser denials, enhance reimbursements, and eliminate any revenue leakages.

It is also crucial for healthcare and revenue cycle managers to choose the right service provider for outsourcing in order to boost the coding quality. It can help uncover potentiality for healthcare institutions through state-of-the-art technology tools, increased revenue, and an accelerated cash flow cycle.

The merits of outsourcing and offshoring medical coding processes are:

Access To Experts: Certified Coders

The process of reviewing and coding from a medical record requires trained personnel who are well versed with the different coding systems including but not limited to International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and Healthcare Common Procedural Coding System. Apart from this, medical coders are expected to have a good amount of knowledge in terms of medical terminology, anatomy, and clinical terminology that they need to interpret and assign codes based on provider documentation. The buck doesn’t stop here; instead, medical coders are supposed to know and understand different insurance guidelines and apply those when coding the records. All this put together, one has to be proficient enough, well trained and on top of that professionally certified to prove his or her ability to handle all these tasks together in a proficient and professional manner.

Offshore coders play a significant role in a healthcare provider’s revenue cycle management. They undergo robust training and complete a certification program to ensure rich skills that can bring in the required knowledge and experience for an efficient medical coding system. This could also result in enhanced first-pass ratio for claims submission which is a critical criterion for practices to improve their practice income.

With access to such well-equipped talent, provider practices can enhance their revenue sky-high as the accuracy of the coding system radically improves profitability.

Prioritize What’s Important: Patient Care

Clinical operations must focus on patient care, diagnosis, documentation, conducting necessary tests, procedures, and such. If clinicians have to take on the RCM process for billing and coding accuracy, they cannot prioritize proper delivery of patient care. Also, being medical practitioners, they would be more aligned to the diagnosis aspect rather than coding and billing.

With the participation of a third-party RCM service provider, the entire revenue cycle can be efficiently handled by experts who know what they are doing. This not only improves the accuracy of coding and billing but also compliance standards. Improved quality of coding and billing ensures enhanced reimbursements and when it comes through an outsourced platform, clinicians can have their time to look into ways to improve patient care and experience.

PHI and HIPAA Compliance

Outsourced services handle patient information with utmost caution, abiding by the PHI and HIPAA compliance. As the RCM service providers make major investments in information security management solutions, it provides clients with a secure operating environment with rigorous sets of controls that ensure data security and client satisfaction.

Quality Assurance

Healthcare audits are robust processes that bring in increased first-pass resolution through enhancements of RCM processing. It also aids in the discovery of missing or unbilled procedures, thus increasing revenue sources. A strong audit and clinical documentation framework can help you recover more money and ensure nothing is left out on the table.  Medical coding is one process which requires a robust quality assurance program to ensure coding accuracy is on par with industry standards.

Enhanced Compliance

In order to keep coding and billing compliances intact, it is necessary to improve the quality of coding and billing processes. All standard procedures and guidelines must be thoroughly documented and followed, even for payer-specific requirements. Certified coders already come under the framework and offshore service providers are well-versed with the medical necessity guidelines, compliant use of modifiers, and local coverage determinations (LCDs). Up-coding and down-coding errors can also be avoided with better coding quality.

Optimized Cashflow

As we have discussed earlier in this article, outsourcing incorporates coders with indisputable expertise over coding standards that ultimately improve the accuracy of the same. The more accurate the coding gets, sooner would be the claims processing completed. This improvement in billing and coding aspects of healthcare services will help enhance the first pass resolution rate, adding up to an improved revenue cycle.

Cost-efficient Practices

Outsourcing and offshoring provide healthcare practices a cost-effective solution including reduced manpower requirements, first-pass resolution rates, faster turnaround time for claims submission, and the added advantages of state-of-the-art technology. The unavailability of certified coders onshore is a major challenge that medical practices are facing at present. This has led the industry to face spiralling losses due to reduced reimbursements and increasing timelines for claims resolutions.  By outsourcing the RCM process, healthcare providers can lift this burden off their shoulders and increase their time and money.

When it comes to choosing the right RCM service provider, it is important to look for a robust framework that effectively manages day-to-day operations.

Practolytics is a third-party service provider that offers effective offshore Medical Billing, Medical Coding and Accounts Receivables services by leveraging the right resources and solutions that could help medical practices enhance practice performance and thereby increase reimbursements.

Visit to know more about the different services provided by Practolytics and to obtain progressive information on Medical Billing, Medical Coding, and Accounts Receivables.

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