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US Healthcare Revenue Cycle Management: Offshoring of Medical Coding and Billing Services
ValueNotes, Feb 2007, Pages: 58
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. The author 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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