Important Information Every Practice Needs to Know Before You Outsource!
By: Joseph Castranova III of HRS
A recent report released from Reuters shows a fast-growing epidemic in this country as medical practices and RCM providers are increasingly sending their Revenue Cycle Management work to overseas companies (India, Philippines, South America, Indonesia, etc.). Medical practices as well as third party RCM providers are suppling these overseas companies with their patient demographics (SS#, DOB, Address etc.) as well as their personal health information (PHI).

Why is this so alarming?

Once you have submitted your patient’s private information overseas, HIPPA rules and regulations no longer protect the patient’s personal information. There are over 154,000 open cases today of where overseas billing companies have sold patient information to other parties including people who are committing fraud in identity theft. Worst of all, there is nothing the US Government can do but go after the medical provider.

Most medical practices that hire a Revenue Cycle Management companies to process their claims, have no idea where their actual claim processing is being done. It’s becoming a trend of “billing companies” to send their claims overseas because they pay pennies on the dollar for labor. Not only is this putting your practice at risk, but you’re also putting your patient’s personal information at risk as well. Not if, but when your practices patient’s information is sold at the highest bidder it’s the provider that is going to be penalized and sanctioned not the company overseas nor the billing company. SCARY!

What Can You Do?

First, you need to do your due diligence whenever you outsource to anyone any PHI. You must always have it in your written contract with the RCM provider you are hiring that all work is to be done in-house and you or your practice Does NOT authorize any patient information at any time or circumstance to be given in any means of transmittal without the written consent of the provider. You also must have the same clause in the Business Associate Agreement (BAA) from your RCM provider. Another very good practice is for you to get to know your billing agent that your RCM provider has assigned to your account. If you do not have an assigned billing agent on your account, it’s a good sign that your claims processing may be done at a different location (overseas). You should call your billing agent from time to time to discuss any issues, such as claims aging, denials, refunds etc. Also, have them come to your office at least once a month to sit with you and go over the financial health of your practice (not just the owner, also your biller).

Here is a link from the American Medical Billing Association on the dangers of outsourcing overseas.

As you can read, CMS (Medicare and Medicaid) does not allow any overseas billing or coding without the written approval from CMS. To obtain an approval takes many months of waiting and a lot of paperwork and applications, and in the end the provider ultimately signs a waiver that they are still responsible of any PHI breaches.

We Can Help!

Healthcare Revenue Services, in 22 years of business has never outsourced there work to anyone at any time. We have joined together with the Florida Medical Billing Association and we are currently working with law makers in Tallahassee to ban all outsourcing any medical billing from Florida overseas. The support we have in our state capital is refreshing and hopefully soon we will lead the nation in getting this law passed.

Stay tuned to our blogs, we will have continued updates on our success.

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