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BPO SERVICES FROM INDIA. MEDICAL BILLING & CLAIM FORM PROCESSING SOLUTIONS FOR PHYSICIANS & HOSPITALS By: Structured Concepts. India Edge Vision Who we are Medical Billing Expertise Medical Billing Services Specialty Experience. Coding Services Coding Expertise Claim Form
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BPO SERVICES FROM INDIA MEDICAL BILLING & CLAIM FORM PROCESSING SOLUTIONS FOR PHYSICIANS & HOSPITALS By: Structured Concepts
India Edge Vision Who we are Medical Billing Expertise Medical Billing Services Specialty Experience Coding Services Coding Expertise Claim Form Processing Control System Key to Success Value Proposition Summary AGENDA
INDIA EDGE • Large pool of English speaking labor force • Large pool of resources with domain skills in US Healthcare rules • Excellent work ethics • Low cost of labor compared to developed countries • Beneficial time difference for quick turnaround of work
INDIA EDGE ….cont • Excellent international bandwidth available for data and voice • High level of government support for BPO activity • Major companies like GE, AETNA, Stanchart, Amex, British Telecom and World Bank opting for India for BPO services
VISION • To develop business solutions to meet service standards and operational goals • Provide powerful,flexible and cost effective solutions individual to client needs
WHO WE ARE • Structured Concepts has been a leading edge outsource solutions partner who has consistently delivered customized, cost effective solutions to their overseas clients by leveraging a vast network of Joint Venture partners across India • The key management members have among them vast management expertise
WHO WE ARE ….cont • Strategic focus on Healthcare and Insurance verticals with past record of successful execution of large projects • Inducted Senior level Healthcare expert to transition and manage large Medical billing and Insurance processing projects • Successfully built up a large capacity through joint partnerships
MEDICAL BILLING EXPERTISE • Team of Medical Billing Experts • Members who have been in the US Healthcare BPO since 1995 • Excellent domain skills and operational experience in managing US insurance and healthcare transaction processing • Significant program development and project management experience to ensure timely and high quality implementation • Developed custom-designed business transfer methodologies for fast, effective and efficient processing
MEDICAL BILLING SERVICES • Claims data entry • Payment posting • Unpaid claims identification, appeal and follow up • Account receivables analysis and management • Financial reporting including customized reports
MEDICAL BILLING SERVICES ….cont • Patient billing and follow-up • Handling patient inquires • Special projects for recovery of old uncollected receivables • Provider enrollment assistance and database management-Credentialing and re-credentialing
Radiation Oncology Anesthesia Ambulatory Surgery Center Cardiology Radiology Pulmonary Critical Care EKG ENT Family Practice Emergency Room Physiotherapy Orthopedic Surgery Internal Medicine SPECIALTY EXPERIENCE
MEDICAL CODING SERVICES • Coding for higher level of specificity resulting in optimal reimbursement • On the job training for coders using educational resources to ensure that coding is in compliance with Correct Coding Initiatives and LMRP’s and other coding standards • Fast reliable assistance for ICD-9-CM & CPT coding
MEDICAL CODING SERVICES ….cont • Coding by AAPC Certified coders available in the industry for compliant coding • Quick turnaround after coding • HIPAA compliant procedures to ensure compliance • Coding from charts, Op notes, Surgery notes and imaging reports
MEDICAL CODING EXPERTISE • AAPC certified coders available out of the large domain pool of Medical Billing talent • AAPC chapter opened in Chennai, India enables the staff to take the certification test in India • Large pool of Medical Transcriptionists and Para Medical staff available for Coding training and certification to build a large pool of Certified coders
CLAIM FORMS PROCESSING • Data capture from paper and images of forms • Insurance/Medical claims and Clinical trials • Field edits and Double key verify for high level of accuracy • Quick turnaround as per clients requirement • Capacity for handling quick increase in volumes.
CONTROL SYSTEM • Transition manual prepared on commencement to document details of the information made available • Operations manual with detailed policies and procedures for each account to ensure that the processing rules are agreed upon • Project leaders identified in both organizations for smooth coordination
CONTROL SYSTEM ..cont • Performance parameters defined and daily reports generated • Weekly review of the work for the first quarter by Management • Tight auditing procedures
The Key to Success: Labor Efficiencies and Technology • Processing takes place in India • Large college educated middle class with English as the language of business and education • Low wage structure (and cost of living) relative to International standards • Reliable infrastructure and technology base • Abundant and committed workforce that can work to, and exceed International standards • Beneficial time difference for overnight turnaround • System utilization during off-peak period
VALUE PROPOSITION • Administrative transactions can be processed at a much lower cost to the client while meeting or exceeding current performance standards for quality and timeliness • All transactions can also be processed directly on Client’s existing information system • Quick processing of claims (24/48 hours)
VALUE PROPOSITION • Higher deployment of Quality manpower • Assured Cost Savings of 25 - 40 % • Reduce your investment in hiring, training and retaining staff • Quick capacity ramp up for increased volumes • Enables clients to focus on core objectives in a competitive market
SUMMARY • We will deliver : • High Quality transaction processing services • Immediate savings in the range of 25% - 40% • Rapid turnaround time for transactions • Ability to quickly handle fluctuations in transaction volume (e.g. peak workloads, new product offerings etc.) • Ability to retain control/ audit over the process