RISE OF MEDICAL OUTSOURCING SERVICES IN INDIA
Author: P A Thanseeha Thasneem
Health care industry is flourishing at a hair-raising rate. While running at the same pace of growing demands from patients and maintaining the position in the race, expenses the hospital has to manage has also hiked up. Apart from the expenses, the workload has also become a burden to the hospitals. It is extremely arduous to manage the core and non core areas altogether. There came the need to entrust the non core competencies to highly dedicated third party companies. Also, for countries like the US, hiring a team from other developing countries has helped them with cutting down expenses at a large rate. India is widely known for its Technology services and also provides developed countries with low-paid labor. This has made India to become one of the prominent offshore outsourcing service providers.
What is medical outsourcing?
Medical outsourcing or healthcare outsourcing is a booming business sector that provides various services to medical institutions. Medical coding, billing, transcription, claim processing and all other hectic tasks can now be given as contracts to outside providers. And India is one of the notable outsourcing hubs preferred by Western countries. Currently India grows from a mere managing sector of claim processing and transcription to handling software development and data analysis.
Medical coding involves assigning universal alphanumeric codes to all the aspects of healthcare from diagnosis and prescriptions to services. Coding, a form of translation, is the crux that plays a crucial role in claim processing. This process of assigning medical codes is in the hands of professional medical coders who aren’t familiar to the patients visiting hospitals. It is common for a normal man to think why complicate the diagnosis with various codes rather than just sending the actual reports for claim processing. Enormous data collection and processing is the reason that introduced the health sector tp coding that helps in storing huge amounts of data and easy analysis.
When it comes to health insurance, hospitals find it chaotic to do all at once. Also, the hospitals only receive money once the insurance claims are settled. To break down the whole process into simple and faster, medical coding and billing comes into the picture. Medical billing simple means giving payment to the provider. It involves handling and transferring the documents of a patient and submission of these documents to the insurance companies.
Claim processing is the procedure of obtaining all the relevant details of a patient so as to pay the insurance amount to the patient. The data has to be precise and should be clearly defined.
It was one of the difficult task that a hospital had to take care of. However, most hospital administrations now assign this tedious task to various third party organisations. This gives complete responsibility of insurance processing to the dedicated professionals of these companies. They have to thoroughly assess the documents to assure its credibility.
Outsourcing claim processing gives relief to the administrative section and makes it hassle free.
RCM ( Revenue cycle management)
All the above-mentioned processes including medical coding, billing and claim processing sums up RCM. It helps the hospitals track the revenue of patients starting from their initial appointment to the final payment.
Financial processing is a pivotal part of healthcare system which requires constant attention. Outsourcing it not only aid in betterment of hosptilal services but also helps them to focus more on core competencies.
Instances like insurance denial by the companies could arise due to improper coding or any data errors. There comes the role of RCM team which assures quick recovery of payment. Being a liaison between hospital and insurance company, proper communication is an indispensable factor that RCM follows.
Data analytics is an infant branch that is being outsourced which is in the development stage. Analysis of bulky data of patients with the assistance of AI has been an astonishing revolution in the health sector.
It involves interpretation and evaluation of all the data including history, present condition, diagnosis and prescription of a patient. Based on the interpretations, any future risk factor suspected can be identified and measures can be taken to eliminate the risks.
Data analytics empower physicians in taking better decisions in patients and also helps in upgrading the global health.
Outsourcing customer service helps the organisation by reducing the work burden and also relieve from the cost of hiring and training staffs.
Statistics show that 68% of US companies are relying on various third party companies, that too from different countries for customer services. This assure higly efficient customer service to the hospitals that can reduce the cost and improve patient satisfaction.
HRO, or human resources outsourcing is also a BPO where the HR functions are leaded by highly committed team of a third party company. Giving access to BPOs, the necessary activities and functioning of HR will be smoothly handled and it helps the hospitals to flourish their business. It also provide the employees better workspace with added benefits.
The emergence of medical outsourcing services in India
India has observed a compound annual growth rate(CAGR) of 150% from the US in the past 2years. At present, the industry is thought to be worth $300 million. However, it has great potential that needs more utilization.
Medical outsourcing has 4 consumers: the provider (hospitals and physicians), payer (health insurance companies), pharmaceutical companies and healthcare IT companies.
An outsourcing company in the US has to spend about $8000 on each healthcare employee which would result in $8 billion for all the employees. 90% of this huge amount can be saved by outsourcing the medical needs to a country like India well known for great potential and IT services. The steady rise of medical insurance in the US and enormous cost required for it is another reason that makes the US depend on India for healthcare services.
Top 10 healthcare Outsourcing companies in India(2022)
TCS, headquartered in Mumbai is a branch of Tata group.
It is one of the largest Indian multinational IT companies with services spread over 46 countries.
It offers services including claim processing, documentation, data analysis etc.
Cognizant is a leading multinational company founded in Chennai, India now headquartered in New Jersey, US. Health care is one of the sector of this IT company. They offer offshore outsourcing services including data analytics, medical coding, transcription, billing etc.
In august 2003, Promantra with certification of ISO 27001 and ISO 900 entered the field of IT services providing outsourcing services globally.
Corporate offices located in Somerset, New Jersey and delivery center in Hyderabad, India, Promantra aid in helping US healthcare providers work more skillfully and compete with full potential in their markets and provide incomparable patient care.
WNS Global Services is a global BPO company with its headquarters in Mumbai offering services to over 60 international clients.
The services encompass claims, revenue cycle management, healthcare analytics and more. This trusted company is accredited by HITRUST, URAC and NCQA.
FinThrive, erstwhile known as nThrive caters the revenue cycle management.
It has over thousands of satisfied customers worldwide effortlessly.
Revenue integrity, revenue recovery, patient access, and patient finance are the prominent services offered by FinThrive. In addition, they play crucial roles in ambulatory and physician practices, payers, partners, and resellers.
With a team of about 20,000 employees, Access Healthcare offers services in revenue cycle services and process automation solutions.
They assure compliance and efficiency in their services which help health systems to reduce total cost on the process.
Fusion BPO is one among the prominent companies with 33 years of service offering call center services in more than 40 languages in 14 countries and 27 locations across the globe. In compliance with HIPAA, Fusion provides AI-powered insurance verification, claim processing, patient communication, billing and settling invoices.
Anion is an organization with ISO 27001:2013 certification and in compliance with HIPAA.
They excel in the field of Healthcare Services, offering Back Office data processing (BPO) for Providers/Physicians, Clinics and Payers. They offer other services including medical coding,billing and claim processing.
BOSS is one of the largest BPO in India investing in their technology and providing long term services to its clients.
They provide services like medical coding, billing, transcription, denials management, RCM, and accounts receivable analysis.
Mediscript is a trusted BPO located in Pune providing high quality services in medical transcription and documentation.
They aid in client centered service and have excelled with an experience of over 20 decades.
How has the rise of Indian BPOs benefited us?
Offshore outsourcing has made Indian BPOs to hire highly committed employees which has increased employment opportunities to the professionally qualified personnel. Not only has the opportunities increased, it has become wider that can accommodate more individuals with different professional qualifications and skill sets.
Working for foreign countries not only helps the employees with better job opportunities but also with fair pay and other added allowances. This has attracted the youth to kick start their career in these outsourcing services.
The third-party companies are highly and attractively paid by the US that helps in development of technology in India. This makes more and more newer companies to rise and flourish in the market.
Statistics prove that the GDP from BPO has risen from 1.2% to 5.4% which itself potrays it’s impact. BPO, along with IT industry has boosted Indian economy to a higher level. It also plays a vital role in education, urbanization, development etc.
India is well-known for its healthcare professionals including doctors, nurses and pharmacists. Currently, India is also flourishing in other aspects of health sector. As a developing country it has been a great gain for India to work for these highly developed countries.
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