There is no doubt that these modern problems have created a situation in healthcare where patients and providers often want fast and efficient solutions to billing questions and insurance issues. The current system of medical billing codes, insurance benefits, and reimbursement of insurance can bog down administrative processes with bottlenecks, delayed paychecks for providers, and absent or incorrect reimbursement for family members and patients receiving medical attention. Call centers for healthcare providers can offer a solution for the following reasons.
So, let’s go into how a call center can streamline these processes as a means of reducing costs, improving the patient experience, and helping healthcare organizations thrive.
Understanding The Role of Call Centers in Healthcare
A healthcare call center is an extra set of hands answering the phones in a healthcare provider’s office and is an essential extension of its administrative staff. It can help with calls ranging from working-out patient scheduling to appointment reminders, post-care follow-up, or whatever might be required. But the most important processes these centers help manage are our billing and those necessary inquiries associated with insurance.
In a call centre setting, patients are served by agents who get specialized training in reading and making sense of healthcare terminology, the processes behind insurance, HIPAA compliance call centers, and more. If a provider can outsource the billing, coding, and other financial questions and direct patient calls to a healthcare call centre, they can smooth out a lot of the clogging of the pipeline that occurs around these sorts of financial exchanges between providers, insurers, and patients.
7 Benefits of Using Call Centers for Billing and Insurance Inquiries
1. Reducing Administrative Burden for Healthcare Providers
Medical providers such as doctors, chiropractors, or physical therapists are trained in patient care, not in the minutiae of medical billing or insurance queries; that’s exactly why a provider’s frontline call centre can offer a dedicated team to handle all the issues that arise regarding billing on behalf of its medical providers. A frontline call centre allows its provider to concentrate on its core competency, which is providing patient care.
2. Enhancing Efficiency Through Expertise
Coding of medical services – including procedural codes (CPT codes) and diagnoses (ICD codes) codes along with other types of insurance-specific billing codes – must be done correctly to ensure proper payment. It is increasingly common for healthcare call centres to include specialised agents who understand coding to answer patient questions more accurately and to reduce errors in claims submission and reimbursement time.
3. Accelerating the Payment Process
One of the biggest delays healthcare providers experience is payment by either patients or insurance companies. Call centres wield a big stick to speed up this payment process by making sure that claims are submitted correctly the first time around, thus reducing the likelihood of those claims being denied or needing to be resubmitted.
4. Improving the Patient Experience
Medical bills and insurance terms confuse patients. They may not understand their insurance coverage and co-pays, deductibles and out-of-pocket expenses. A patient service centre provides another way for patients to ask questions and understand expenses. Detailed concise patient-friendly explanations from good healthcare call centre agents can help patients have a clear understanding of the billing process, and insurance benefits and make decisions that best suit them.
5. Ensuring HIPAA Compliance and Data Security
With private information like medical records and patients’ billing data up for discussion, there are laws and regulations in place to ensure privacy (eg, the Health Insurance Portability and Accountability Act, better known by its American acronym as HIPAA). Healthcare call centres and their software and management processes must follow HIPAA regulations to provide secure services without causing violations or unlawful access to private information. An insurance billing inquiry can be a sensitive call, as it could touch on some embarrassing medical issues.
6. Handling High Volumes of Inquiries Efficiently
Questions relating to billing and insurance in a busy practice can easily monopolise the front-office staff and overwhelm their capacity. A call centre can easily take over these enquiries and answer them fast and accurately, using application-centric systems designed to deal with high call volumes and query routing. This improves patient wait times for their answers, hence enhancing the satisfaction of the provider.
7. Offering 24/7 Support for Billing and Insurance Inquiries
Another advantage of having a call centre handle the billing and insurance enquiries is that one can provide round-the-clock support. It is often seen that healthcare providers are open during usual business hours but the billing questions could arise at any point of time. At this juncture, the call centre comes to the rescue with its around-the-clock support. This would definitely help the healthcare providers to cater to the patient’s billing questions outside office hours thereby speeding up the resolution of billing issues and thus delay or confusion. That is a big thing in my opinion.
Common Billing and Insurance Challenges in Healthcare
Healthcare providers routinely receive various calls related to billing or insurance matters: Call centres are especially equipped to deal with these recurring problems.
- Claim Denials: Reimbursement claims are often requested for services provided where real-time payments were not made. Medical claims often get denied for reasons such as coding errors, missing information, or pre-authorisation issues.
- Verification of insurance coverage: Obtaining verification of a patient’s insurance coverage is tedious, complicated and time consuming, especially with different insurers and plan types, some of which are fairly esoteric. Using a call centre to obtain pre-visit verification of insurance is a huge time saver, freeing up front desk and billing staff from the tedious process of verifying benefits and reducing the risk of ‘down-coded’ claims and unpaid accounts.
- Patient Billing Confusion: If you’re a patient, the odds are that you will be confused by your medical bill. Do you have to worry about co-pays for the services of other physicians, too? How many separate services were provided? What is an ‘Other Referral’? The goal of most of the other AI medic agents up to this point was to ‘tickle’ the patients’ experience of their disease, leaving patients and providers sometimes uncertain as to why or how the AI solved the problem. The goal of this agent is to increase transparency in a system that can be arcane and impenetrable for Patient Billing Confusion.
- Multiple Insurance Plans: Some patients have coverage under more than one insurance plan, and agents assist in coordinating the interaction of benefits across multiple payers, to ensure proper and timely claims submission and reduce denials.
Key Features of an Effective Healthcare Call Center
An effective healthcare call centre must fulfil specific features and capabilities that will provide better billing and insurance inquiries, and that a general customer service centre will not be able to provide. Some of these features include:
- The Discipline of Medical Billing and Insurance: In order to provide the best service to patients and providers alike, the call centre employee must be thoroughly trained in the different medical billing codes, insurance policies and protocols that are unique to healthcare, and how to handle medical cases on the phone.
- HIPAA Compliance: patient information is one of the most critical pieces of data in any healthcare setting, and at absolutely any cost, there must be no breach in compliance with HIPAA, which includes data encryption, walled garden data transmission channels and strict perimeters protecting sensitive information.
- Being integrated with the provider’s practice management software, or electronic health records (EHR) system: An excellent healthcare call centre is integrated with the provider’s practice management software or electronic health records (EHR) system so that an agent can retrieve and process this data at their fingertips. This minimises data-entry errors and expedites claim resolution.
- Multi-lingual support: Healthcare professionals often treat patients from many different backgrounds and having a multi-lingual call centre agent ensures that everybody receives support regardless of linguistic differences.
- Customisable Scripts: Call centre agents should fully script interactions to protect the brand and provide standardised care. These scripts can cover everything from verifying insurance to explaining patient balances.
Get Call Center Support Services For Your Healthcare
In an evolving healthcare environment, processing billing and insurance inquiries can be a daunting task for healthcare providers and their patients. It’s time to streamline the process with the speciality given to healthcare call centres. When healthcare insurances continue to rise, working with a call centre can make the process easy, decrease administrative pressures, expedite payments and enhance the patient experience. When healthcare providers specialise in patient care, hiring a call centre helps reduce claim denials, 24/7 support, patient experience and education.
