US Healthcare Revenue Cycle Management: Offshoring of Medical Coding and Billing Services

The Indian share of BPO revenues from the offshoring of revenue cycle management (RCM) services is estimated at USD 125 million for the year 2006. ValueNotes Research expects the total revenues from this segment to reach USD 410 million by 2011.

Two of the “core” processes in revenue cycle management (RCM) services are medical coding and billing. In this report, we have discussed billing and coding within the context of RCM services. The emphasis (and estimates) for this report relate to medical coding and billing. Medical transcription, which is another “specialized” service not offered by “generic” BPOs has not been covered in this report, and revenue and manpower estimates exclude medical transcription.

The RCM industry in India is still at a nascent stage. While there are certain large vendors offering end-to-end RCM services such as Perot Systems, Apollo Health Street, Zavata and Ajuba there are few others focused on offering certain specific services such as medical coding, payment posting, accounts receivable, etc. Aradhana Kolhatkar, analyst, ValueNotes says “Zavata’s achievement of landing a USD 80 million contract with US hospital groups is the beginning of a future trend that will gain traction rapidly.” Adds Neeraja Kandala, analyst, ValueNotes, “there is a relatively un-addressed and large segment of mid-sized hospitals (<500 beds) market that is an ‘attractive niche’ for the Indian vendors.”

ValueNotes has recognized four vendors as potential winners in this space: Ajuba, Apollo Health Street, Perot Systems and Zavata.

The report provides an overview of the buyer scenario and an in-depth analysis of the Indian vendor space along with profiles of major industry players. The report is designed to help:

  • US hospitals, physician groups and US based RCM companies looking to outsource/offshore
  • Potential vendors / facilitators to assess opportunities
  • Outsourcing consultants to evaluate and compare the offerings of vendors
  • Venture Capital companies looking for investment opportunities
  • Researchers looking for detailed information on RCM offshoring

This study is based on secondary data as well as extensive interviews with key people at various BPOs (captive as well as third-party) in India.

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Table Of Contents

1. Executive Summary
2. The US Healthcare Industry
2.1 Industry structure
2.2 Type of services in each segment
2.3 US healthcare industry spending
3. Healthcare Provider Services 
3.1 Medical coding
3.2 Medical billing
4. Service Buyer and Outsourceability
4.1 Who is the buyer?
4.2 Challenges faced by the US healthcare provider industry
4.3 Segment-wise offshoreability of jobs
4.4 Ease of outsourceability
5. Indian Vendor Landscape
5.1 The industry structure
5.2 Large players comprise three-fourths of the offshore workforce
5.3 Indian vendor space: Segmentation by services
5.4 Comparative analysis of vendors
5.5 Most Indian vendors claim to adhere to HIPAA
5.6 The vendors’ approach
5.7 Likely winners
5.8 Pricing – how is the matrix designed?
5.9 Key industry issues
6. Future Moves: Perspectives
6.1 The India opportunity
6.2 Offshoring from hospitals will increase
6.3 All vendor types will continue to co-exist
6.4 Large vendors will offer integrated services
6.5 Limited threat from large multi-service BPOs
6.6 Cross border acquisitions amongst larger players
7. Company Profiles
Apollo Health Street
Medusind Solutions
Perot Systems
8. Short Profiles
9. Research Methodology
10. About ValueNotes

Table Of Exhibits

Exhibit 1: Establishments in health services, 2004
Exhibit 2: Segment wise services
Exhibit 3: US healthcare expenditure
Exhibit 4: Revenue cycle management services
Exhibit 5: Value chain
Exhibit 6: US-based revenues cycle management companies
Exhibit 7: Challenges
Exhibit 8: Segment-wise offshoreability
Exhibit 9: Frequently outsourced function
Exhibit 10: Large hospitals outsource more work
Exhibit 11: Ease of outsourceability
Exhibit 12: Evolution of healthcare outsourcing
Exhibit 13: Vendor segmentation
Exhibit 14: Tier 1 & 2 players together dominate in revenues & manpower
Exhibit 15: Manpower and clients
Exhibit 16: Vendor presence in the provider segment
Exhibit 17: Business value differentiators
Exhibit 18: Business associate contract
Exhibit 19: Two different vendor approaches
Exhibit 20: Expected winners among third party offshore vendors
Exhibit 21: Effective realizations
Exhibit 22: India revenues
Exhibit 23: Manpower growth
Exhibit 24: Offshoring maturity
Exhibit 25: Some contracts won by Indian vendors
Exhibit 26: Typical clientele
Exhibit 27: Some recent M&A deals

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