The healthcare industry has proven to be one of the toughest industries to operate in. Those that struggle the most in the industry are the healthcare payers, typically the countless health insurance companies and plan providers. What challenges these entities the most is payment recovery, largely in part due to their ineffective internal processes bottlenecking them.
A staggering statistic recently revealed that 80% of all pharmacy compliance audits will uncover some form of recovery opportunity for the audited organizations. As this industry typically deals in large sums of money, this could mean that a handful of organizations could be missing upwards of millions of unclaimed dollars. Typically organizations will fail to recover this money as it often comes at the price of ruining their day-to-day operations. As these payers continue to struggle to identify ways in which they can keep track of these audits and recovery opportunities, they’re left wondering: what options are there to simplify their efforts without crumbling internally?
Partnerships Breed Innovation
In order to effectively recover some of this lost capital, these organizations must determine strategies in which their own resources aren’t depleted. Typically this will be accomplished through a partnership with a business process outsourcing firm. These firms leverage the use of advanced technology coupled with their proprietary strategies in order to recover the capital lost by these healthcare organizations. These firms are capable of meeting the most unique needs of an organization, meaning they’re able to provide immense value to any organization in the industry.
One of the most premier services offered by these firms are their subrogation services. These services take an in-depth look at the healthcare costs associated with medical and disability expenses resulting from accidents or injuries and ensure they are being paid by the liable party. Guaranteeing that these expenses are being paid by the correct party can make all the difference in organizations being capable of reducing internal delays and confusion. These services don’t stop there, though. An additional offering known as pharmacy audits are also available. Through these audits, retail pharmacy operations are able to be closely monitored and overseen. These audits help reduce costs and highlight some of the potential causes of fraud and abuse in the pharmaceutical industry. These partnership providers are even capable of standing in during negotiations with various healthcare providers.
The benefits that stem from a business process outsourcing partnership can’t be fully realized without the correct partner. Determining which organization will provide you with a meaningful partnership will result in the best payment recovery efforts for your organization. Conduent remains as one of the most notable leaders in business process outsourcing services, namely those developed for the healthcare industry. For additional information on the ways Conduent can improve your organization’s’ payment recovery strategy, be sure to review the infographic coupled alongside this post.