Back Office Management in Healthcare

At a glance:

• The main takeaway: Healthcare organizations often struggle with back office management tasks, such as claims processing, medical billing, and data management.
• Impact on your organization: The right tools and technology platforms can help healthcare organizations automate critical back office functions to improve efficiencies and reduce costs.
• Next steps: Aprio’s Healthcare Practice team can help healthcare organizations choose the right back office management solutions based on their pain points.

Schedule a consultation today

The full story:

Healthcare clinics and practices are increasingly using technology, tools, and automation to create greater efficiencies and reduce the cost of back office management. Before investing in technology to optimize non-clinical administrative tasks, healthcare leaders must first identify and analyze their most common back office pain points.

Below, we provide a framework for this analysis, as well as potential solutions, technology recommendations, and emerging trends in back office management.

Back office pain points in the healthcare industry

In healthcare, back office management encompasses a range of functions, such as claims processing, medical billing, patient scheduling, and data management. Challenges that prevent healthcare administrators from properly managing those tasks include:

• Insurance company noise: Insurance companies frequently deny claims or make payments that don’t align with contracted amounts. Healthcare personnel devote significant time and effort to resolving those issues, including contacting insurance companies and navigating their processes.
• Lack of system interfacing: Many healthcare organizations use best-in-breed systems for various functions without investing in interfaces for these systems to communicate, including interfaces between cost accounting and clinical and claims systems. Therefore, administrators often rely on manual workarounds, which are error-prone and lead to issues with data reliability, redundancy, and integrity.
• Dashboarding and reporting: Though some systems have decent dashboarding and reporting capabilities, they often lack the ability to provide a truly comprehensive and holistic view. 
• Data analytics: Due to unprecedented competition for staffing as well as poor training, healthcare personnel often lack expertise in data management and analysis, making it difficult for them to extract and understand data properly. This leads to a shortage of actionable insights and potentially poor decision-making.
• Physician bonus calculation: Calculating physician bonuses is often a manual, error-prone, and time-consuming process for healthcare administrators and personnel.
• Scheduling: While patient scheduling systems are fundamental and widely implemented among practices, there is still room for improvement. Issues like high no-show rates and patients showing up late can disrupt schedules and reduce efficiency.

Back office technology recommendations

In the recommendations below, you will notice there is an overlap between technology solutions and the pain points they address; this is because each tool addresses pain points differently and with varying degrees of efficacy. Some pain points may not necessitate additional tech tools and may only require procedural changes or outside support to properly optimize existing systems.

Key tech platforms and tools to consider for back office management include:

1. Electronic health record (EHR) and revenue cycle management (RCM) systems, such as athenaOne, eClinicalWorks, and ModMed

These EHR and RCM systems are comprehensive software solutions designed to digitize and streamline the management of healthcare practice functions. These solutions help store and manage patient medical records, handle billing and insurance claims, schedule appointments, and ensure compliance with healthcare regulations. They also leverage API technology to allow integration with third-party applications. These systems reduce manual paperwork, enhance data accuracy, and improve overall operational efficiency.

Pain points addressed:

• Dashboarding and reporting
• Scheduling
• Insurance company noise
• Data analytics
• Physician bonus calculation
• Lack of system interfacing

2. Data analytics and business intelligence tools, such as Tableau, Power BI, and QlikView

Data analytics and BI tools help healthcare organizations make sense of their data by providing visualization, reporting, and analytics capabilities. These tools enable users to create custom dashboards, generate detailed reports, and perform in-depth analyses of various datasets. By leveraging these insights, healthcare providers can make data-driven decisions, improve patient care, and enhance operational efficiency.

Pain points addressed:

• Data analytics
• Dashboarding and reporting
• Insurance company noise

3. Automation and workflow optimization tools, such as UiPath, PowerAutomate, Automate Anywhere, and Blue Prism

Automation and workflow optimization tools help streamline repetitive and time-consuming tasks within healthcare practices. These tools use robotic process automation (RPA) to automate processes like data entry, claims processing, and scheduling. They reduce manual workload, enhance efficiency, and reduce errors.

Pain points addressed:

• Physician bonus calculation
• Data analytics
• Insurance company noise
• Lack of system interfacing

Regardless of your pain points and the solutions you choose, investing in back office automation brings significant financial and operational benefits. In addition to saving time, these tools provide greater insights and more actionable data that lead to quicker, more informed decision-making, allowing employees to focus on more critical and value-added tasks. While the effect is difficult to quantify, it can profoundly impact your healthcare organization’s trajectory.

Emerging trends in healthcare back office management

As you look ahead to the future of your healthcare operation, keep the following trends in mind:

• Increased outsourcing: Given the relatively low cost, medical groups will increase their use of outside experts and consultants to assist in back office operations and optimization.
• Artificial intelligence and predictive analytics: Though some tools exist, there will be improvement and increased adoption of AI tools that help facilitate processes such as insurance coding analytics and scheduling optimization.
• Increased adoption of telehealth and virtual care: Telehealth and virtual care popularity will continue to grow, necessitating integration with existing systems and specialized handling of billing and coding.
• Focus on staff recruitment and retention: Industry-wide issues with recruitment and retention of both skilled and unskilled personnel will necessitate tech-enabled solutions.

The bottom line

Does your healthcare organization need help navigating back office management and preparing for future trends? Our advisors can help you identify pain points and select the appropriate back office tools, technology, and processes to resolve them.

Schedule a consultation with Aprio’s Healthcare Practice team today.

Related Resources

5 Healthcare IT HIPAA Compliance Options

Technology and the American Healthcare Revolution

Video: Rightsizing HIPAA Compliance for Business Stage