The total value of the U.S. healthcare business process outsourcing market is about $38 billion, according to Sutherland. According to industry data, demand for healthcare outsourcing services has been growing at a pace of about 25-35 per cent every year over the last few years. Healthcare provider outsourcing has the highest growth rate of 31.9% from 2013 to 2018 because of the conversion from ICD-9 coding system to ICD-10 coding system to be implemented by October 2014 in the US. Provider outsourcing capabilities are Medical billing, Medical coding and Medical transcription. Medical Billing is the major process outsourced by the providers from the US market and Claims processing is the dominating outsourcing process for the Payor market. U.S. is the largest source of outsourcing, followed by Europe. The most preferred destination is India in payer and provider outsourcing. Philippines is an upcoming destination making its mark in payer and provider outsourcing. Medical Transcription is a US$ 18 billion industry growing at 15% every year and is expected to reach US$ 20-25 billion in next five years.
India has advantages when compared to the other outsourcing destinations such as has availability of high number of healthcare professionals, affordable cost of living, large patient pool, and decreased time and cost of recruitment. The skill sets for this sector demands graduates in Life Sciences with a specialization in biology, microbiology, physical therapy, biochemistry and nursing for the medical coding space. The data entry segment looks for not just typing skills but candidates with analytical abilities. The voice based assignments call for graduates with excellent communication skills. India has now established itself as an outsourcing destination of choice for the medical coding work, which is a complicated process. Over the last two years, more and more of the in-patient coding work is being outsourced to India and is by far the most complex coding work. Medical Billing & Coding is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. Medical transcription, also known as MT, is an allied health profession, which deals in the process of transcription, or converting voice-recorded reports as dictated by physicians or other healthcare professionals, into text format. (Source: Wikipedia)
Medical Coding and Billing have evolved into complex process due to the change from ICD-9 coding to ICD-10 coding mechanism which is much more detailed in its Code-sets, stresses the need for clinical documentation to be precise in order to get accurate payments. Many Providers also recognized the extent of revenue loss incurred due to poor documentation based on the past claims data and poor documentation also created problems during audits which led to revenue losses too. The next few years there is good opportunity for growth in this segment and large Indian players too are looking at this segment but this segment is predominantly dominated by small specialist players only. Medical Transcription outsourcing projects to India started nearly 15 years ago and many companies have been successful in servicing the US clients with the availability of the skilled talent pool and labor arbitrage as the cost is very less in India. Most of the Indian BPO vendors offer the medical coding and transcription services and are also looking to acquire companies in this segment as evident with M&A activity in Healthcare BPO segment.