BPO SERVICES FROM
INDIA
MEDICAL BILLING &
CLAIM FORM PROCESSING SOLUTIONS
FOR
PHYSICIANS & HOSPITALS
By: Structured Concepts
AGENDA
India Edge Coding Services
Vision Coding Expertise
Who we are Claim Form
Medical Billing Processing
Expertise
Control System
Medical Billing
Services Key to Success
Specialty Value Proposition
Experience Summary
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
SPECIALTY EXPERIENCE
Radiation Oncology EKG
Anesthesia ENT
Ambulatory Surgery Family Practice
Center Emergency Room
Cardiology Physiotherapy
Radiology Orthopedic Surgery
Pulmonary Internal Medicine
Critical Care
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