One of the largest overhauls of the US healthcare systems has been the Patient Protection and Affordable Care Act. Popularly known as Obamacare, it became a law five years ago. Around the same time the World Health Organisation came up with the 10th revision of the of its medical classification system namely the International Statistical Classification of Diseases & Related Problems (ICD-10). With over 30 million additional Americans getting into the health insurance net now, this has subsequently given rise to hundreds of thousands of jobs in clinical coding and billing.
A Landmark transition
This landmark transition to ICD-10 has also given the much awaited breakthrough to the businesses of healthcare BPOs and service providers, both within and outside of the United States. ICD-10 has more than 125,000 available codes to benefit the patients with the flexibility to add newer ones unlike the older system which had only 16,000 codes with limited provision. The full implementation of ICD-10 will lead to more precise coding that is aimed to benefit both healthcare providers and patients in more ways than one.
With over 75% of the US healthcare companies outsourcing work like insurance claims processing, adjudication & receivables management, billing & coding services, etc. this transition is being looked up to as a herald of good news for businesses of healthcare BPOs and service providers. Most part of this work is outsourced. As the US healthcare system adapts to new the systems the healthcare BPO market that includes payer, provider and pharmaceutical outsourcing, is being transformed as well.
Complications to give rise to Skilled Professionals
The complications of the transition to ICD-10 from ICD-9, has given rise to the demand of skilled medical coders. In order to handle the growing volumes of work from the US, a large number of medical coders will be needed in India by 2020 (presently there are only 15, 000 – 16, 000 coders in the country). The sharp rise in employment opportunities for medical coders is an indication of the increasing career growth and options that are available for mostly life sciences graduates who choose to work in the space.
Medical coding, being a niche segment, has a dearth of certified professional coders, which could be due to low awareness about ‘medical coding as a career’ among life sciences graduates and other healthcare professionals. Moreover, medical coding protocol is complex and many a time is abstruse.
Defining the new medical coder
A medical coder should definitely possess desirable skill-sets, such as being detail-oriented, having strong analytical skills with a basic grasp of medical terminology and human anatomy and good decision making skills. They should have a logical mind with the ability to think technically and be adept at learning to work on new software programs as and when required. Coders will have to be discreet and respect patients’ right to privacy as they often act as liaisons between patients, healthcare providers and payers.
On the technical front, their word processing abilities should be good with familiarity in proprietary billing and coding software systems, mandatory clinical documentation, legal aspects of health information, health data standards, classification, conventions and computer or paper-based data management. These could be obtained through formal education or on-the-job-training. A medical coding aspirant has to gain proficiency in Medical coding, Medical billing, and HIPAA (Health Insurance Portability and Accountability Act) compliance.
Overall, Indian healthcare BPO industry’s rapid spread over the last decade is no doubt one of the major catalysts for the country’s economy, providing employment to a significant many. The industry also has played a significant role in transforming India’s image from a slow moving, bureaucratic democracy to a land of world-class business services. According to NASSCOM, if the country is able to maintain its current offshore market status, the BPO exports from India will exceed US$330 billion by 2020. The percentage contributed by healthcare BPOs may be comparatively small, but with the growing demand in this sector, a sharp increase is expected.
Amidst competition from low-cost countries and regulatory changes, India’s healthcare BPO sector has to rise to the forefront and build capability in the complex processes and specific services to take the first-mover advantage of this new development in Obamacare. This could possibly be India’s biggest BPO bonanza since the IT industry’s Y2K!