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.
