Currently, insurance desk is one of the most under managed resources in the hospital business.
One of the reasons behind it is the quality of manpower.
There is no great career progression for an insurance desk resource. At the same time, the amount of knowledge this resource is expected to have is quite a bit.
There is no value add in terms of help to claimant, inputs to the TPA/insurer or Information sharing with the other departments or the patient. This is because all the people manning the insurance desk are not “knowledgeable” on insurance.
Hospitals do not have a decent choice in implementing a automated solution since there aren’t many software vendors in this space.
Hospitals employ anywhere between 1 – 10 members in their insurance desk based on the size of the hospital and the foot falls they have.
Let us look at the activities an insurance desk performs
Receive the cash-less request : Many insurance holders opt for cashless facility at networked hospitals. Once the receipt of such a request is made, it is the job of the insurance desk person to check on eligibility and co – pay criteria and educate the patient.
Forward to the TPA / Insurance Company : Each TPA and insurance companies have a different format in which this request needs to be forwarded. If the proper format is not entered, TPA/ Insurance Companies do not process this.
Get the approval : Once the request is sent in the right format, TPA/ Insurance company may ask for more particulars to give a go ahead. The insurance desk resource needs to understand the processes in each of these areas and ensure that approval sought is got.
Forward to billing/accounts/finance deparment : Once the approval is cleared, the papers need to go to the billing/ accounts/ finance team for them to take the baton in the Revenue Cycle Management process.
What are the challenges faced by Insurance desks?
Very low knowledge about insurance
Since these positions are mainly entry level and hospitals do not have resources to train them, they learn on the job at the hospital’s expense
Ignorance about the operating procedures of the TPA / insurer
If the insurance desk people do not have the required knowledge, this leads to delayed approvals, delayed payments and shows up as inconvenience to patients which make patients rate hospitals poorly.
No SOP in case of a query raised by the TPA /insurer
There is no Standard Operating Procedure when TPA/Insurer raises queries. Since these queries may not be standard, the insurance desk person feels limited in his/her response.
No connects with the insurer or TPA
Today’s business is all about leveraging professional relationships. Patients come with the understanding that their experience is cash less. TPA/ Insurance company people are not in a benevolent mood always. They have targets to manage their bottom lines. Connections help hospitals in getting more for less effort.
Why should hospitals outsource.
Outsourcing is an increasingly popular strategy that healthcare organisations can use to control the rising costs of providing services. With outsourcing, an external contractor assumes responsibility for managing one or more of a healthcare organisation’s business, clinical, or hospitality services. Because the contractor specialises in providing a specific service and can achieve economies of scale, he/she may be able to provide a service more efficiently and less expensively than the healthcare organisation.
Outsourcing services peripheral to the organisation’s primary operations may also enable healthcare administrators and staff to concentrate more efficiently on their organisation’s core business.
Benefits of Outsourcing
Better Profitability – By outsourcing insurance desk operations, hospitals can save at least thirty percent of costs incurred by utilizing own resources. There can be a significant growth in profit margins by procuring economic infrastructure and manpower.
Talented Workforce Accessibility – Apart from financial benefits, outsourcing promotes accessibility to the skilled workforce who are ready to undertake responsibilities and other associated tasks of varying complexity. This professionally competent and skilled manpower is vital in the medical industry because it’s a people-driven industry. Here, patient satisfaction largely is dependent on the human touch as well as the customization offered by the hospital staff in rendering the services.
Enriched focus on Patient Care – Medical practitioners may be unburdened in the boring and routine administrative tasks through outsourcing. This enables them to focus on patient needs and provide quality care as the non-clinical tasks are largely managed by the outsourcing partner.
Improved Patient Experience and Engagement — Considering Insurance desks are managed from the outsourcing vendor, hospitals may focus on a larger extent on patient care thereby improving patient encounters, goodwill and public image.
Decreased Administration Overheads – Administrative overheads constitute a bulk part of costs incurred and have to be managed carefully. By outsourcing, excessive and unnecessary expenditure could be reduced. This amount saved may be reinvested for improving the services and hospital facilities for enhancing patient experiences.