Healthcare

Revolutionising healthcare: The role of BPM services in patient care and management

Challenges in the healthcare industry

Regulatory compliance

Navigating complex and constantly changing regulations regarding patient privacy, data security, and care standards. The stringent regulatory framework in healthcare, along with false claims and reimbursement changes, also add to an already overloaded sector.

Shrinking budgets

Rising inflation coupled with clinical, non-clinical, and non-labour expenses, are contributing to shrinking budgets. Managing financial constraints while trying to improve care quality and invest in new technologies is challenging.

Changing patient expectations

Meeting the demand for more personalised, efficient, and accessible healthcare services. In an era of virtual care, people expect speed and efficiency as opposed to traditional clinical pathways. 

Burnout

The burnout rate is more in the healthcare sector than any other industry. Furthermore, maintaining a work-life balance is a challenge leading to emotional strain. Workforce burnout is a national economic constraint and is one of the biggest challenges within this sector.

How is BPM helping with these challenges?

At the heart of healthcare BPM services lies improved patient healthcare. BPM healthcare services are automating and streamlining complex processes of patient admissions, treatment protocols and discharge procedures. Digitisation and automation are reducing the administrative burden on the staff and helping them focus on delivering optimum healthcare. With real-time monitoring and analytics, healthcare providers identify bottlenecks and inefficiencies in workflows and make timely adjustments and interventions. This proactive rather than reactive approach improves the overall patient experience, helps prevent medical errors, and ensures patient safety.

BPM healthcare services and their benefits

1. Medical claims processing: Medical claims processing services include an array of sub-services, including document scanning, adjudication of claims, patient demographic entry, and explanation of benefits. Medical claims benefits are significantly reducing the volume of claims rejections.
   


2. Medical Billing: End-to-end medical billing and coding solutions are completing tasks such as following up on pending medical claims, validating claims denials, initiating collections, and tracking receivables.
   


3. Medical coding: Medical coders assign healthcare diagnoses, treatment procedures, types of equipment and medical services to the relevant code, providing efficient summaries of physicians' notes and test results.
   


4. Medical transcription: This includes the following sub-services:
1. Emergency room transcription
2. Neurology transcription
3. Pathology transcription
4. Psychiatry transcription
5. Discharge summary transcription
   
   
5. Revenue cycle management (RCM): Right from scheduling appointments to payment of balances, RCM is streamlining administrative costs and payment processes and boosting growth in the following ways:
1. Reduced administrative burden: Identifying and addressing loopholes in the revenue cycle.
2. Better people experience: Increased satisfaction and loyalty due to clear and transparent billing processes.
3. Improved revenue: Increased revenue for healthcare providers, which ensures focussed patient care rather than billing and payment issues.
   


6. Insurance verification services: Verification of the following sub-points of insurance include:
1. Insurance plan type and coverage benefits
2. Effective date
3. Policy status
4. Payable benefits
5. Plan exclusions
6. Co-pays and Co-insurances
7. Pre-authorisations and referrals
8. Claims communication address
   


7. Better work-life balance: With non-medical tasks outsourced, healthcare providers can enjoy a better work-life balance, thereby improving both job and patient satisfaction.

The immediate impact of BPO services in healthcare includes the consolidation of collaborative care team efforts, enhanced transparency in patient cycle management, and the maximisation of medical professionals' efficiency. Automated document approvals, dynamic assignments to approvers, integrations, electronic forms, and predefined form builders work seamlessly to create an optimal pathway for patients.

In conclusion, care teams are moving from manual data entry and allocating more time and resources to improve patient outcomes, bringing together all stakeholders to ensure positive patient cycles.

How does Infosys BPM help in healthcare management?

Infosys BPM leverages its deep expertise in healthcare business processes, flexible operating models, and integrated IT-BPM solutions to address the evolving needs of the healthcare industry. Its innovative solutions aim to transform operating models, enhance business performance, standardise processes, and reduce operational costs. Explore comprehensive BPO services in healthcare that include benefits administration, member management, claims administration, provider management, analytics, care management, and clinical services.