As the deadline for compliance approaches, the big question on everyone's tongue is what is the greatest path to compliance and efficiency? The options include managing the process in-house, taking a blended approach using internal resources and external support or electing to fully outsource to a Business Process Outsourcing (BPO) provider.

Going it alone: For many organizations it doesn't make sense to manage claims processing and compliance conversion in-house. In addition to diverting resources from core responsibilities and other strategic initiatives, organizations don't necessarily possess the expertise and knowledge to ensure compliance with increasing regulatory complexities. Managing claims processing in-house also requires maintaining and training staff as well as devoting significant physical space to house equipment and documentation ? real estate that could be devoted to primary profit-generating activities.

Partial outsourcing: Some organizations may elect a hybrid or blended approach to achieve ICD-10 and HIPAA 5010 compliance. That is, retaining some processes in-house with third-party support or employing a multi-vendor strategy. For example, a BPO provider might provide a Software-as-a-Service (SaaS) infrastructure for claims processing and the internal operations staff would handle the data entry. This allows for the sharing of cross-industry and cross-organizational knowledge and can provide insight to benchmarking and opportunities for streamlining processes. It offers the advantage of flexibility, but it also places more responsibility on the payer organization, requiring them to manage multiple processes and increases the risk of oversight while requiring additional staff to manage the relationship.

Total Outsourcing: Embracing an outsourcing strategy can provide significant opportunities to curtail costs, streamline processes and increase efficiencies while empowering healthcare payers to focus on core competencies. The benefits include immediate access to necessary expertise and qualified resources that eliminate backlogs and tighten turnaround times by as much as 50%.

With an outsourcing service partner, service level agreements provide predictability in service, and claims are processed in less than 24 hours. An outsourcing service provider will offer the flexibility to handle volume fluctuations. This enables payers to scale effectively and to focus on more value-added activities such as high-touch customer service. By ensuring timely claim processing, payer organizations can reduce the risk of penalties for non-compliance.

Outsourcing also provides rapid access to industry compliant technology solutions and electronic workflow tools that automatically route claims for review, action or approval. This results in greater efficiency. When delivered via SaaS, organizations alleviate the need for additional capital expense and gain access to a secure Web-based data repository and data protection via online backup and recovery. Administrative expenses and claims processing time is reduced and customer service improves as a result of smooth and accurate transactional activity. Payers also gain improved visibility into claims processing, enabling them to better manage internal operations.

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