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Management Services Organizations (MSOs) are healthcare-specific management and administrative business entities that relieve physicians and other healthcare providers from non-clinical functions while controlling costs, increasing efficiency, and ensuring a smooth operational flow.
MSOs help encourage physician groups and hospitals to grow by expanding management services such as training sessions for new practices while enabling providers to focus more on their healthcare services and delivery. With such a diverse field of healthcare needs to support, MSOs have to formulate the best solutions to resolve the current and future demands of their providers and clients.
MSOs come in two models. The first model takes full or partial ownership of the practice while the second model is geared towards providing administrative services without taking any form of ownership. The efficiency of these two types of MSOs can depend largely on the size and complexity of the organization, so their output can vary from one organization of one model to another.
MSO Acquisition
The first model partners with clinical practices that align with the MSO’s visions when it comes to the size of the practice as well as the location, revenues, and other factors. The acquisition of clinical practices is not the same as traditional sales since established MSOs will be dedicating a team to take inventory with company-specific healthcare and quantitative criteria to assess the clinical practices’ overall performance.
The process can be time consuming since the acquisition team will have to go through a clinical practice’s data to ascertain if the practice is a sound investment for the MSO. Depending on the agreements and negotiations, the acquisition of the clinical practice by the MSO will often result in a smooth transition for both parties, allowing the clinical practice to resume operations that can focus more on delivering quality healthcare.
MSO Administrative Support
MSOs that offer administrative services offer another layer of support to clinical practices and providers. Providers are becoming more eligible for premium incomes through efficient case management, claims adjudications, and other back-end support services. As an integral support system to many providers, MSOs are increasingly seen as important healthcare partners.
MSOs play an essential role in the management of value-based healthcare and population health by providing the manpower and the technology necessary for updated electronic health records (EHRs), care coordination management, and claims lifecycle workflow processing. As a support system, MSOs help keep costs down, encourage clinical practice expansions, and prepare physician integration into the organization.
While MSOs provide the required healthcare support for providers, they, in turn, need assistance in the delivery of their services. Operational issues such as financial management, credentialing, coding, billing, and collection services are often some of the biggest challenges that MSOs have to face.
With trends looking towards more agile and strategic supply chains, MSOs must keep looking for alternative care support and delivery options using technologies for smarter, faster, and more predictive information at their fingertips.
This means that artificial intelligence (AI) will prove to be more valuable than ever to MSOs who need to deliver quality services using real-time analytics to expedite care and increase productivity in non-clinical areas.
Developed by MedVision, QuickCap 7 (QC7) provides essential MSO functionalities for health plan audits, primary and specialty capitation payment structures, as well as automated claim adjudications on a HIPAA-based EDI encryption-enabled security platform to facilitate data movement.
Aiming towards more streamlined operations and services delivery, QC7 supports MSOs with its customizable user interface (UI) that can perform basic and complex administrative tasks while allowing MSOs to trim down unnecessary costs and expenses.
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MedVision has successfully met the criteria outlined in the SOC (System and Organization Controls) audit for service organizations. This certification demonstrates MedVision’s adherence to rigorous standards for security, availability, processing integrity, confidentiality, and privacy.
As a service provider managing sensitive data and overseeing critical functions on behalf of clients, this certification underscores MedVision’s commitment to maintaining high standards of operational excellence and data security.
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The Health Care Administrators Association is the nation's largest nonprofit trade association for third-party administrators, stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, and health care consultants. HCAA has spearheaded the change of self-funding for more than 35 years.
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