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The healthcare BPO industry is defined as payer, provider and pharmaceutical outsourcing. Each of these industry divisions is further segmented into appropriate service segments and sub-segments. The provider market is segmented into medical billing, medical coding, medical transcription, and finance and account segments.

The global healthcare BPO market is expected to grow at a CAGR of 10.7% from US$113.2 billion in 2013 to US$188.9 billion in 2018. The global medical billing outsourcing market is expected to grow at a CAGR of 9.29% over the period 2014-2019. Healthcare spending is expected to increase, which will put additional pressure on healthcare delivery systems, governments, and insurers. The major reasons for increased spending in developed countries are an aging population and lower fertility rate; in emerging countries, it is the lack of infrastructure, increase in chronic diseases, and inequality in availability of patient care.

Many medical providers in the global market are struggling to provide real-time access to customer information which allows customer executives to respond better to customer requirements in an efficient manner. In addition, billing services are evidence of the trustworthiness of the service provider and there is a high chance of losing a customer because of even a small mistake in the billing system. Thus, increasing customer satisfaction is likely to be one of the primary drivers contributing to the growth of the global medical billing outsourcing market.

Migration issues in the medical billing process are one of the major challenges for global medical billing service vendors.

Key Vendors:

Accenture
AGS Health
Cognizant Technology Solution!

Genpact
HCL Technologies!
Medusind
GeBBS Healthcare

US Market

The U.S. is the largest source segment for the global market, followed by Europe and Asia. The U.S. is also the largest destination geography for the healthcare BPO market, followed by India and Europe.

According to ST Advisors, LLC, the U.S. medical billing (revenue cycle management) market is projected to grow from approximately $4B in 2010 to more than $9B by 2018, spurred in part by expected medical reimbursement regulation changes.

Due to an increase in regulatory compliance challenges, including the move to ICD-10 coding standards, more and more medical practices are outsourcing medical claims management.

The US healthcare outsourcing market has significant potential for growth due to measures taken by the US Government to lower increasing health care costs.

Indian Market

Medical billing companies in India have grown tremendously, just like other outsourcing functions in India such as legal outsourcing, IT outsourcing, etc. Growth in communications and the Internet access and speed have been the biggest enablers of the cost arbitrage between developed countries and India. The outsourced market in the healthcare segment is estimated to be around US$ 8 billion, of which between US$ 3.3-4.2 billion is based in India. Encouragingly, a number of US healthcare payers and providers are moving their non-core processes to third-party service providers into other English speaking countries, with India being one of the leading destinations. Earlier apprehensions about India’s ability to handle complex US healthcare processes coupled with other compliance/security regulations have been erased.

Secrecy of patient data is of utmost importance and most companies providing medical billing services in India are 100% HIPAA compliant. Having a professional and competent medical billing service provider has helped ensure expansion in the patient base, thus allowing healthcare providers to devote more quality time towards patient care. Another India advantage is its large English speaking population and talent pool besides a matured medical education system. Talent in India can also boast of good analytical skills and a structured thought process – skill-sets suitable to the healthcare BPO industry, particularly for medical billing.

Myths

You can learn to code in 6 weeks

Fact: You can learn a little bit about coding in 6 weeks, but a 6-week training program without other experience or skills may not be sufficient to land that first coding job. Coding requires life-long learning and constant skills improvement. Hospital-based positions in particular require formal training with courses in health information management and various classification systems with a practical component or on-the-job experience to be proficient.

SectionCoders work from home

Fact: Remote coding is becoming more popular as electronic record systems become adopted and most remote positions are staffed with experienced coders. Entry-level coders will need to obtain coding experience, most likely onsite, until they build coding proficiency and are able to work independently.

Medical Coding Is A Data Entry Job

Fact: The truth is that medical coding is something that you need to learn and it is not similar to data entry. It is really important to understand medical records, interpret them and read them appropriately. At the same time, you need to see what data is necessary and what is not. Medical coders basically have a lot of knowledge and the job is not at all as simple as a data entry position.