Medical Coding Demystified - An Interview

by Thilaka Ravi on  August 18, 2010 at 2:47 PM Medindia Exclusive - Interviews and In depth Reports
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Though offshore Healthcare Business Process Outsourcing (BPO) and Knowledge Process Outsourcing (KPO) services are expanding slowly to different parts of the world, it is no secret that the biggest players are still based in India. No doubt, there is a raging debate in India about BPO culture making inroads into the traditional Indian social milieu, equipping young people with high disposable incomes and taking them on the fast lane. Nevertheless, it cannot be denied that offshoring has brought economic independence to young people who have just stepped out of college. 

Medindia visited the  Chennai office of Omega Healthcare Management Services Ltd., the premier offshore providers of medical coding, billing, accounts receivable management, claims processing and healthcare revenue management and heard Mr. Gopi Natarajan, Co-Founder and Chief Executive Officer of Omega Healthcare Management Services Ltd., speak on the challenges and rewards of excelling in business outsourcing in India.

Q. Why did you opt for Healthcare services when you ventured into business? 

A. Healthcare is a dynamic field offering a wide range of challenges and opportunities.Out of the 25 years of my corporate career in the United States, I spent 18 years working in the US healthcare industry dealing with payers, providers and vendors. I was constantly interacting with business users in the healthcare sector and the experience helped me learn the nuances of this industry. Prior to Omega, I was heading a $40M medical billing company in the US with 900 employees (250 of whom were in India). My senior management stints with Aetna, EDS and Healtheon/WebMD added to my experience in IT, Business development and BPO/KPO outsourcing. 

Healthcare is the single largest industry representing 13-15% of GDP in the US—which roughly translates to $1.8 trillion. Healthcare industry in the US is very complex and highly evolved. I enjoy the challenge of playing a vital part in facilitating an efficient reimbursement process to the providers of healthcare, i.e. the hospitals and physicians.

Omega Healthcare Management Services was started in 2004 and operates from a 50,000 sq ft office in Bangalore equipped with state-of-the-art facilities and a similar office in Chennai.

Q. What kind of healthcare services does Omega Healthcare Management Services offer? 

A. The first thing that comes to the public mind at the mention of BPO is Call Centers and Medical Transcription.  Our company does not deal with medical transcriptions, nor is it a call center.  We are in the business of managing the entire reimbursement to the hospitals and physicians by the insurance companies, the process being commonly referred to as "revenue cycle management".

The quality of healthcare in the US is arguably one of the best in the world and this kind of quality doesn't come easy. The entire healthcare delivery is a complex procedure involving patients, doctors, hospitals and insurance companies. It is our job to see that doctors and hospitals get paid by insurance companies for services rendered.

Technically, Omega Healthcare provides the following services to our clients:

  1. Medical Coding - Professional and Facility - reviewing of patient charts to determine appropriate medical codes that drive reimbursement for services rendered.
  2. Data Entry into Software and Practice Management Systems - Charges,  Demographics and Cash/Payment Posting
  3. Accounts Receivable Management - Analysis and Collections  (voice based work)

We have to our advantage years of experience in working with various hospital information systems and medical billing software, experience in several physician specialties like Emergency Medicine, Cardiology, Radiology, Pathology, Anesthesia, Internal Medicine etc., and an excellent team that delivers prompt and accurate services to our clients.

Q. Could you elaborate on the importance of your services in Healthcare revenue cycle management?

Let me briefly explain the method of healthcare delivery in the United States. About 250 million people in the US are covered by one of the three tiers of insurance—Medicaid, Medicare or private insurance companies. Medicare is the medical insurance offered by the Federal government for medical services rendered to those above 65 years of age. Medicaid is sponsored by the State governments, mostly for low income families below a certain level and then there are the private insurance companies, which offer a range of flexibility and people typically pay premiums through their employers to be a member of one of these private insurers.

The services we offer are vital in the healthcare information industry. For example, Medical Coders assign specific codes to medical procedures and services rendered to patients, which facilitate prompt payment for doctors, hospitals and other healthcare providers.

Specific codes are used to identify specific diagnosis, and outpatient and inpatient procedures and services (such as diagnosis and treatment) for billing insurance companies. Medical coders accurately read patient charts, assign proper codes, and key the codes into the proper form into a computer application. These will drive how much Medicaid, Medicare and other insurance companies have to pay to healthcare providers by way of medical reimbursement for services rendered.

Codes must strictly follow insurance requirements and federal regulations and any error in coding can result in false claims and delayed payment.  Our coding team comprises of highly qualified people in life sciences with a thorough knowledge of medical terminology, anatomy and physiology.  

Q. You have mentioned that your workforce is Omega's biggest strength. What makes the team unique?

Like I said, our selection process is very stringent and the basic requirement for our medical coders is a University degree in any Life Sciences area (Microbiology, Bio-chemistry, Zoology, Physical Therapy, Homeopathic/Ayurvedic medicine, Nursing, etc).  Apart from our regular recruiting process, every day more than a hundred walk-in applicants visit our offices for interviews. Our HR team scrutinizes their credentials and résumés for suitability.  The candidates are then tested in various areas such as typing skills for data entry, knowledge of anatomy and medical terminology for medical coders, and aptitude and communication skills for accounts receivables follow up staff. Those who pass these tests are then interviewed by the HR and the respective functional managers.

Selected candidates attend our training sessions conducted by the best trainers in the industry in multiple training rooms where several batches of candidates can be trained simultaneously. Training period ranges from 2 weeks for data oriented projects to 8 weeks for medical coders.  Beyond all this initial training, Omega offers a continuous learning environment because of the constantly changing nature of the business we are in and this keeps the boredom and monotony  out.

We offer excellent employee benefits like in house physician service, fully catered meals and snacks provided free of cost to employees, health insurance coverage and a highly subsidized door to door transportation for night shift employees.

We follow our corporate values of customer service, respect for the individual, transparency, equal opportunity for all and collaboration at all levels of our organization.

Q. What gives you great satisfaction in your line of work?

A. It gives me immense satisfaction that Omega Healthcare Management Services is able to train and provide employment for over 2,600 young people in Bangalore and Chennai, India. It is generally difficult for science graduates to find a suitable employment in India that keeps them in touch with their subject. We offer well paying jobs as soon as youngsters step out of college and they work in an atmosphere that still connects them to their subject—life sciences. Our employees are unparalleled in the industry in terms of skill and accuracy and our clients can vouch for the fact that we are the leading player in providing high quality business and knowledge process outsourcing services to the US healthcare industry.

Mr. Gopi Natarajan demystified medical coding, billing and similar terms in healthcare revenue management and showed how the world is now a global village with countries supporting each other in myriad ways. Medindia wishes Omega Healthcare Management Services all success in their business ventures in the healthcare industry.

Source: Medindia

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