Healthcare Outsourcing Services: Which Ones Should You Outsource?

Healthcare organizations have a lot to manage beyond patient care. Billing, scheduling, patient support, data, and IT can all add to the daily workload.

Healthcare outsourcing services give organizations another way to manage this work. Instead of keeping every task in-house, they can turn to outside teams for specific areas of support. In fact, a 2024 survey found that 77.4% of healthcare organizations surveyed outsourced at least part of their revenue cycle.

This article looks at which healthcare services can be outsourced, why organizations choose to outsource, and what to consider when choosing a provider.

Healthcare outsourcing means using an outside provider to handle certain areas of work. This can include admin, billing, patient support, IT, and other day-to-day operations.

Healthcare business process outsourcing (BPO) can cover both patient-facing and back-office work. For instance, healthcare BPO services may include appointment scheduling and patient support. Healthcare back-office outsourcing often covers tasks such as billing, coding, claims processing, and data entry.

There is also flexibility in how much work is outsourced. An organization may outsource one task, a full process, or an ongoing function based on where it needs extra support.

Healthcare organizations can outsource many of the tasks that keep daily operations running.

Some of the most commonly outsourced healthcare services include:

Medical Billing and Coding

Medical billing and coding involve turning patient care into the codes and claims used for payment. An outside team can handle tasks such as medical coding, charge entry, billing, payment posting, and accounts receivable follow-up.

Accuracy matters throughout this process. Incorrect codes or missing information can lead to payment issues and extra work. In FY2025, Medicare Fee-for-Service had an estimated improper payment rate of 6.55%, or $28.83 billion. CMS notes that improper payments are not always fraud. They can result from issues such as missing records or other administrative errors.

Outsourced billing and coding teams can also follow set coding standards and review work for accuracy and compliance.

Claims Processing and Denial Management

Claims processing covers the work needed to prepare, submit, and track claims with health plans. If a claim is denied, an outsourced team can also investigate what went wrong and manage the next steps.

This may include correcting errors, gathering missing information, filing appeals, or resubmitting claims. Teams can then follow up on outstanding payments and track the status of each claim.

Revenue Cycle Management

Revenue cycle management (RCM) covers the financial process from patient registration through final payment. Healthcare organizations can outsource one part of this cycle or use a provider for broader, end-to-end RCM support.

Depending on the organization, outsourced RCM services may include:

• Patient registration
• Insurance eligibility checks
• Medical billing and coding
• Claims processing
• Denial management
• Payment collection

Outsourcing the full revenue cycle can bring these connected tasks under one external team. Other organizations may only outsource the areas where they need more support.

Insurance Verification and Prior Authorization

Checking insurance coverage and getting approval for certain services can take significant staff time. Outsourced teams can verify patient eligibility, confirm coverage, manage referrals, and submit prior authorization requests.

They can also communicate with health plans, gather required documents, and follow up on pending requests. This workload can be substantial. Physicians and their staff spend an average of 13 hours per week on prior authorization work for each physician. The same AMA survey found that 40% of physicians have staff who work only on prior authorization.

Patient Support and Appointment Scheduling

Patient-facing healthcare support services can also be outsourced. An external team may answer questions, schedule appointments, send reminders, or help patients change existing bookings.

Healthcare organizations may also outsource 24/7 patient support to give patients access to help outside normal business hours. Omnichannel support can connect service across phone, email, chat, SMS, and other channels. Multilingual support may also be available.

Medical Records, Data Entry and Documentation

Managing health records involves a large amount of administrative work. Healthcare back-office services can support this work without moving clinical decisions outside the care team.

Outsourced services may include patient data entry, EHR or EMR administration, medical transcription, and document management. Providers may also offer virtual medical scribes or health information management services.

The exact work depends on the provider and the healthcare organization. Access to patient information should be limited to what is needed for each task and handled under the required privacy and security controls.

Healthcare IT and Technical Support

Healthcare organizations rely on technology for many parts of daily care and operations. Some of the technical work behind these systems can be handled by an outside provider.

Healthcare IT outsourcing may cover:

• IT help desk support
• EHR and EMR technical support
• Software maintenance
• Cloud and infrastructure support
• Data security and cybersecurity
• Systems integration and interoperability
• Telehealth platform support

The right level of support depends on the organization’s systems and internal IT resources. Some may outsource a specific technical function, while others use external teams for ongoing IT support.

Other Healthcare Administrative and Back-Office Services

Healthcare back-office outsourcing can extend beyond billing, records, and IT. Depending on the provider, organizations may also outsource provider credentialing, HR and recruitment, healthcare analytics and reporting, supply-chain administration, or compliance support.

Healthcare organizations outsource support services for many reasons. They may need extra staff, specific skills, or a simpler way to manage daily tasks.

Reduce Administrative Workloads

Admin work can take up a large part of the day. Outside teams can take on tasks such as billing, scheduling, claims, and data entry. This can free up time for internal staff.

Access Specialized Expertise

Some tasks require specific skills. Outsourcing can provide access to teams with experience in billing, coding, RCM, IT, and other areas. Organizations can use these skills without building every team in-house.

Improve Efficiency and Scalability

Patient volumes and workloads can change over time. Outsourcing gives organizations a way to add support when demand grows. It can also help teams keep work moving during busy periods.

Control Operational Costs

Outsourcing can reduce the need to hire, train, and maintain extra in-house staff. It can also give organizations access to technology and more efficient workflows without building them from scratch.

There is significant room to cut costs through more efficient admin processes. CAQH estimates that healthcare could save $20 billion each year by moving remaining manual and partly electronic transactions to fully electronic systems.

Keep Internal Teams Focused on Patient Care

Administrative work can pull staff away from their main roles. Moving some of this work to outside teams can give internal staff more time for other priorities. For clinical teams, that can mean more time focused on patient care.

Before choosing a provider, look at how well it can work with your team, systems, and needs. Price matters, but it should not be the only factor.

Key areas to consider include:

• HIPAA and patient data: Ask how the provider protects protected health information (PHI) and meets HIPAA requirements.
• Data security: Review its security measures and how it responds to cyber threats.
• Quality: Look at how the provider checks its work and handles errors.
• Healthcare experience: Check for experience with the services you plan to outsource.
• Technology: Make sure its tools can work with your EHR, software, and current systems.
• Communication: Set clear ways to share updates and manage work between teams.
• Scalability: Check whether support can change as your needs grow or shift.
• Performance: Agree on reports, KPIs, and service-level agreements (SLAs) to track results.
• Business continuity: Ask how the provider plans to keep services running during outages or other disruptions.

Healthcare outsourcing can take time-consuming operational work off your internal team. The right partner can also provide the people, processes, and technology needed to manage that work at scale.

Horatio provides healthcare outsourcing services built around each organization’s needs. Our teams support patient communication, back-office operations, and revenue cycle processes. We also offer 24/7 and omnichannel support to help healthcare organizations stay connected with patients across channels and time zones.

Ready to explore what you could outsource? Contact Horatio to find the right support for your healthcare operations.

What is the difference between healthcare outsourcing and healthcare BPO?

Healthcare outsourcing is the broad use of outside providers for certain tasks or services. Healthcare BPO focuses on outsourcing specific business processes, such as billing or patient support.

What healthcare back-office services can be outsourced?

Organizations can outsource billing, coding, claims, data entry, medical records, credentialing, reporting, and other administrative tasks.

Is healthcare outsourcing HIPAA compliant?

It can be. Providers that handle protected health information (PHI) must follow the HIPAA rules that apply to their role. A business associate agreement (BAA) may also be required.

What are the most commonly outsourced healthcare services?

Common services include billing, coding, claims, RCM, patient support, scheduling, prior authorization, data entry, and IT support.