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Outsourced Medical Billing and Coding ServicesThe global healthcare payer BPO market covers a wide range of services such as medical billing and coding, insurance claims processing, accounts receivable management, medical transcription, radiology reporting, and clinical outsourcing. A recently published report by Research and Markets indicates that the market for these outsourced services will reach over USD 34.2 billion by 2022. Several factors have been identified as driving the growth of the market:

  • ObamaCare – The Patient Protection and Affordable Care Act (PPACA) extended insurance coverage to more than 30 million U.S. citizens. This has increased outsourcing of claims processing tasks by payers.
  • Shift to the ICD-10 coding system – The ICD-10 coding system not only involves more codes – 68,000 codes compared to the ICD-9 system’s 13,000 codes – but also more complex coding requirements. Precision is the key to getting paid. With their staff of expert coders and billing specialists, healthcare BPO companies are well-positioned to handle the transition to ICD-10 coding, encouraging providers to entrust the task to them.
  • Growing adult population – Increased demand for healthcare services due to the growing geriatric population has contributed to the rise in medical outsourcing.
  • Increasing disease burden – The increasing incidence of chronic diseases such as cancer, Alzheimer’s and infectious diseases has increased government funding on R&D activities. Market research reports show that the growing pressure on industry players to maintain stringent timelines has increased the demand for outsourcing of R&D activities.

The changes sweeping the U.S. healthcare system are expected to strengthen the healthcare BPO services market growth in the next seven years, according to the Research and Markets report. Surveys also indicate that the growth of the market is restricted by certain factors, importantly, data security and confidentiality concerns. Healthcare providers and payers intending to outsource PHI should ensure that the healthcare outsourcing services provider they contract with is HIPAA compliant. The company should be able to ensure secure storage, transmission and processing of information in keeping with U.S. federal regulations.