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Learn the pros and cons of contracting medical claims processing services

Medical claims processing has emerged as a professional niche wherein dedicated agencies are offering bunched auxiliary services to the healthcare service providers. The reason for the demand for specialist claims processing firms in the medical sector is due to the discrepancy in the respective roles of the practitioners and the health insurance firms. While the doctors and hospitals are experts in offering dedicated treatments and carrying out the diagnosis for the patients, their ability to prepare the medical codes and bills are highly constrained; thus requiring the specialists. Therefore, we find that the medical claims outsourcing has gained demand around the world. Medical billing process UAE outsourcing has increased as more healthcare institutions are approaching the specialist agencies. However, the debate regarding the pros and cons of contracting and pricing in medical claims processing is still on; and both the sides offer strong points to support their assertions. Health care auditing UAE reports from the expert quarters has shown either way of benefits and pitfalls and therefore practitioners and hospitals are choosing as per their desirability. Here is a differential analysis as regards to the benefits and disadvantages of contracting in the medical claims processing.

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The pros of contracting medical claims processing –

  • High professionalism
  • Healthcare auditing UAE figures reveal that due to lack of professionalism during ‘in-house’ medical claims processing, plenty of gaps and discrepancies exists, that leads to delays, lesser reimbursements and even lots of rejections. These are all the dimensions of the inefficiency in the claims processing. On the other hand, specialist agencies ensure a high level of professionalism and thus better revenue cycle management for the healthcare service providers. Leading medical billing process UAE companies offer hassle free and speedy claims payments from the health insurance firms.

  • Higher returns and better revenue cycle management
  • The healthcare service providers often have to struggle to maintain optimized returns due to poorly filed medical claims at the desk of insurance companies. When the claims are managed by the expert agencies then the revenue cycle is optimized and better returns are achieved. Top medical billing process UAE firms have developed wider specializations towards ensuring the best claims management for the practitioners and hospitals.

  • The healthcare service providers can focus on the core job
  • When the healthcare service providers undertake medical claims management on their own then their - time, energy and money are spent on performing the revenue cycle management, it means that the core service potential is affected! Healthcare auditing UAE facts that were offered in a recent report revealed that the service efficiency decreases when hospitals have to take up claims management themselves.

  • The cost to set up ‘in-house’ infrastructure is negated!
  • In order to maintain a dynamic medical claims processing desk ‘in-house’, the healthcare service provider needs to set up a dedicated infrastructure including manpower. This entails cost dimensions for the practitioners. However, this cost can offset through outsourcing the services to the specialist agencies.

  • Speedy claims processing and thus financial viability is not faltered
  • When the medical coding and billing is done in a professional manner then the errors and discrepancies are eliminated. This speeds up the claims processing through the channels of a healthcare insurance company. The rejections are also reduced significantly and thus the bill payments are received in the least of time.

    The cons of contracting medical claims processing –

    • One time investment- like the claims processing software
    • The healthcare service providers can negate the outsourcing costs by adopting medical claims processing software. Thus with one-time investment and training, continued costs could be offset.

    • Cost of direct claims processing is much less ‘in-house’
    • Direct claims can be filed with insurance companies without incurring many costs. These claims are also processed within the stipulated timeframe thus ensuring an optimized returns for the hospital. Healthcare auditing UAE showed that many hospitals are opting to self-manage the direct claims.

    • Data security is kept optimized through an ‘in-house’ protocol
    • While not sharing the patient’s data with the external agency, the security and confidentiality are maximized and never compromised. Conversely, sensitive data could get leaked through deliberate attempts or by mistakes.

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  • Better coding efficiency due to medical speciality
  • Coding and billing for super speciality medical procedures are better handled by ‘in-house’ staffs that are adept in the terminologies and processes. Of course, training is warranted after which the claims processing staffs achieve efficiency in filing the bills before the healthcare insurance firm.

  • Programmed customization ensures lesser overall costs!
  • The overall cost of outsourcing to an external agency will get lesser year on year; provided programmed customization has been established in claims management. This can be done through the adoption of smart software.

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    Fast Track Claims Management Consultancy
    Abu Dhabi, U.A.E

    Phone: +971 2 6580360

    Mobile: +971 52 3747557

    Fax: +971 2 6657764


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