Productivity council to provide medical transcription training

Staff Reporter

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Plans to conduct free seminar

50 candidates to be admitted

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TIRUCHI: Tiruchi Productivity Council (TPC) has decided to step into its 50th year of existence by offering a 180-hour training programme in medical transcription through a tie-up with U.S. based itrans Solutions that has an operational base in Coimbatore.

Based on a survey carried out to determine the nature of job that would suit bright graduates of arts and science colleges the most, the TPC decided upon Medical Transcription programme, the Council Hon. Secretary Raja Mutthirulandi told ‘The Hindu.’ The TPC will conduct a free seminar during the third week of this month.

The training would be offered for a maximum of 50 candidates in two batches at the TPC’s own premises in Woraiyur in the city. Candidates completing the training programme also have the option of working for itrans Solutions. The TPC will also admit candidates identified by the Tiruchi District Tiny and Small Scale Industries’ Association (TIDITSSIA) to groom them as entrepreneurs.

TIDITSSIA is keen on adding value to the entrepreneurship ventures in the Business Process Outsourcing segment, said the Association president S. Sridharan, who is also the president of TPC. For further information, contact TPC at the dial of 0431–2762320 or email tpcsecretary@gmail.com.

© Copyright 2000 - 2008. The Hindu

Philippines - English proficiency improved but BPO leaders warn against complacency

By JESUS F. LLANTO
abs-cbnNews.com/Newsbreak

Despite improvement in the self-assessed English language proficiency of the Filipinos, the Philippines should not remain complacent and should sustain its efforts to further improve its competence in the language to maintain its position as top destination for the business process outsourcing (BPO), experts said.

The results of the April 2008 survey of the Social Weather Stations on the self-assessed proficiency in the English language of the Filipinos showed a "substantial recovery" in understanding, reading, writing, speaking and thinking using the language compared to 2006.

The survey, which was commissioned by Promoting English Proficiency Project of the American Chamber of Commerce and the Makati Business Club, was conducted by interviewing 1,200 respondents and has a margin of error of +3%.

Ramon del Rosario Jr., president of the MBC, said the improvement in self-assessed competence is a market-driven response to the rise of BPO industry.

"They realized that if they want to be employed, they really need to hone their skills and one of the skills needed by the market is English proficiency," del Rosario said.

Don’t be complacent
Experts in the BPO industry, however, said that although the results of the survey sound positive, there is a need to sustain the measures that have been started to improve the Filipinos’ competence in the language since others countries are also trying to get a share of the global BPO market.

"It’s a step forward but we have a long way to go," said Jamea Garcia, executive director for talent of the Business Process Association of the Philippines (BPAP).

Garcia added that other countries have been striving to improve the quality of their workforce by strengthening the English proficiency of their workers to become attractive BPO destinations. She said China, Vietnam and Latin American countries are fast becoming important destinations of outsourcing firms.

"We should not be complacent so we can still maintain our advantage," Garcia told abs-cbnNEWS.com/Newsbreak.

The Philippines was named by the UK National Outsourcing Association as the outsourcing destination of the year for 2007. BPAP estimates that by 2010 the BPO outsourcing industry can generate US$13 billion revenues, or 10-percent share of the global market, and provide one million jobs.

As of 2007, around 300,000 people are working in the BPO sector. This means that the industry needs to augment its workforce by 600,000 in the next two years to meet the target for 2010.

Lack of qualified applicants
BPO firms, however, are having a hard time filling positions because of the low recruitment yield and lack of applicants who are fluent in English.

A November 2007 industry-wide survey by the BPAP and Outsource2Philippines.com showed that 46 percent of the companies surveyed found that only 6-20 percent of applicants qualified. Two-thirds (66 %) of the companies, the survey showed, had to provide new hires free remedial English training.

Other sectors in the BPO industry, like medical transcription, also experience low absorption rate due to lack of qualified applicants. Raymund Eruma, executive director of the Medical Transcription Industry Association of the Philippines, Inc (MTIAPI) said some transcription companies found only 2-3 out of 10 applicants qualified. "Most of them are having problems comprehending dictations."

Garcia said in a previous interview that this scenario is one of the threats to the growth of BPO industry. "If we continue with what we are having this moment, we might not have enough workers to meet future demand."

Language proficiency training
A number of programs have been designed by the government, the industry players and the academe to develop English proficiency of the students and the workers. Scholarships from the government and tie-ups between the industry and academe are among the measures taken to develop a pool of qualified workers for the BPO industry.

Oscar Sañez, CEO of BPAP, said these measures should be continued and strengthened as the demand for workers continues. He added that a large pool of qualified applicants can save the resources of a company.

"Recruitment and training [of new hires] cost a lot of money," Sañez said adding that minimizing recruiting and training costs can add roughly 2-3 percent points in the company’s profitability.

Sañez said that the measures being undertaken today are just short-term solutions. He said that what is needed are reforms in the education, particularly changes in the curriculum. — With research by Fharhana Abdurahim.

Dealing with Medical Billing Errors

Submitted by Nicole Wilson on May 9, 2008 - 5:00pm

Medical billing errors may sound innocent; however, these so called mistakes may be just another way for either doctors or billing agencies to make some extra money. Filing false claims and double billing can be big trouble for the medical industry with the serious charge of fraud.

According to Medlaw.com a Michigan psychologist plead guilty for filing false claims with both insurance companies and Medicare. He was said to have filed $853,000 false claims.

Other doctors that commit this crime may double bill for procedures and doctor visits. They also will pad the bill with procedures they did not complete. The medical offices will defend that it is difficult to come up with the correct codes for appropriate billing to insurance and Medicare. It can also be difficult getting paid for honest claims that are not fraud they argue.

I was always under the impression that doctors were generally honest and that they mean well. I guess I wouldn’t have been so irked if it didn’t happen so often. My personal experience with billing errors has happened not once but five times in just the past couple of years. Since we have major medical and very little coverage we get to pay the majority of the bills. Doctor visits are not covered, so I always pay for the doctor visit up front.

The first time this happened was with a surgery for a lump that was removed. We paid the doctor visits with a credit card at the doctor’s office. A couple months later a bill for what we already paid for showed up in our mailbox. We talked with the accounting person in the office, and they were actually good about correcting this medical billing error.

The second time we had a medical billing error was when I had to go to registered dietician. They were so wonderful to have a pay up front before the doctor visit for the cash patients. They also took my insurance card, they insisted upon it, and I told them that my doctor visits are not covered. The service provided by the dietician was wonderful and helpful. But around 5 months later we receive a bill in the mailbox saying that we owed for the visits that we already paid for! What got tedious with this one was an intermediate medical billing company that didn’t answer their phone calls. I called the regular office, and they gave me the run around. Needless to say, I had to leave several messages on the billing offices machine to get anywhere. I finally got the problem straightened out, but both the doctor office and the billing office had no concern to fix the problem, unless they knew I was going to be calling them every single day for the rest of their lives. The problem did get resolved. But it really was annoying that I had to prove my innocence even though I paid for the visits up front.

The third time I encountered a medical billing error was at a different procedure for a biopsy. This time the insurance company gave a discount. They sent a statement for the allowed amount that the biopsy could be charged for and what part I was to pay. The office that did the biopsy sent the bill but it was over $200 when the allowed amount was only $40. I wrote a letter with the bill and sent a copy of the insurance paperwork and paid the correct amount. They never sent another bill after that. But I started to wonder how many people will pay the full price and never look at the other information sent by the insurance company.

The fourth time that I had a medical billing error was when I had to get an ultrasound done. This time the lab decided to pad the procedure with an additional ultrasound that they never did! I called the office up and had to explain that I did get the one ultrasound but not the other. The extra ultrasound that never happened was an additional amount of $280. I was happy that this time, they fixed the problem fairly quickly.

The fifth time that I have experienced this mysterious medical billing error was a bill that I had already paid for and have received another bill saying that they haven’t received payment. They cashed the check, and I have the copied check that I have mailed, faxed, and called them about. They have a medical billing agency too, and I first left a message but, no calls came back. So I faxed them and called them and got through to that person assigned to your bill. They assured me that they will not send the bill to collections and that it will take a bit of time to figure out. By now, after it being a regular thing these medical billing errors, I have lost my patients with the hours that I have to put into correcting them.

I haven’t had every single bill go this way. I will think twice about going back to those offices that I had these problems with in the first place. I don’t want to go through the headache again! If you have PPO you can shop around a little bit more than the dreadful HMO.

So the moral of the story is if I am just one individual that has encountered numerous medical billing errors, I would suspect that this is common practice and that there are a lot of individuals that are overpaying for their medical services. Since it is a fraudulent activity I would think that the medical billing offices would have absolutely no chance for medical billing errors.

Take your time and don’t be afraid to speak up if you do find a medical billing error. It is your hard earned money. I believe that doctors deserve what is fair and agreed upon and anything not completed or over billed is just wrong.

- by Nicole Wilson

Clinton's hardline view on outsourcing were not against India

8 May, 2008, 1541 hrs IST, PTI
The Economic Times.

WASHINGTON: Democratic Presidential frontrunner Hillary Clinton's recent hardline stance on outsourcing were mainly directed against China rather than India, her top aide has said.

"Her primary language has been directed towards China. Obviously, she talks about China all the time. I've never heard her in fairness, talk about (outsourcing) in the context of India," Terry McAuliffe, Chairman of Hillary Clinton's campaign and one of her closest confidant said in an interview to 'India Abroad' newspaper.

"... We are going to rid the tax code of these loopholes and giveaways. We're going to stop giving a penny of your money to anybody who ships a job out of Texas, Ohio or anywhere else to another country," Clinton had said during a recent debate with Obama at University of Texas in Austin.

McAuliffe, the former Chair of the Democratic National Committee also brushed aside the notion that Clinton was pandering to the labour unions on the issue of outsourcing.

"What she has said, is she will negotiate, she wants trade deals, she thinks they are important to build bilateral economic relationships. She will negotiate fair, but tough trade deals. She is a full believer that we've got to build jobs here, in this country," he said.

He said: "We've got to be competitive, but if people can come in or people that can bring products in and if it's a better product at a better price, then we have to be competitive, and that's not the fault of the country that's bringing it in.

The Health Insurance Mafia - Opinion

By JONATHAN KELLERMAN
April 14, 2008; Page A15, The Wall Street Journal.

Most discussions about the rising cost of health care emphasize the need to get more people insured. The assumption seems to be that insurance – rather than the service delivered by doctor to patient – is the important commodity.

But perhaps the solution to much of what currently plagues us in health care – rising costs and bureaucracy, diminishing levels of service – rests on a radically different approach: fewer people insured.

You don't need to be an economist to understand that any middleman interposed between seller and buyer raises the price of a given service or product. Some intermediaries justify this by providing benefits, such as salesmanship, advertising or transport. Others offer physical facilities, such as warehouses. A third group, organized crime, utilizes fear and intimidation to muscle its way into the provider-consumer chain, raking in hefty profits and bloating cost, without providing any benefit at all.

The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service.

Insurance is all about betting against negative consequences and the insurance business model is unique in that profits depend upon goods and services not being provided. Using actuarial tables, insurers place their bets. Sometimes even the canniest MIT grads can't help: Property and casualty insurers have collapsed in the wake of natural disasters.

Health insurers have taken steps to avoid that level of surprise: Once they affix themselves to the host – in this case dual hosts, both doctor and patient – they systematically suck the lifeblood out of the supply chain with obstructive strategies. For that reason, the consequences of any insurance-based health-care model, be it privately run, or a government entitlement, are painfully easy to predict. There will be progressively draconian rationing using denial of authorization and steadily rising co-payments on the patient end; massive paperwork and other bureaucratic hurdles, and steadily diminishing fee-recovery on the doctor end.

Some of us are old enough to remember visiting the doctor and paying him/her directly by check or cash. You had a pretty good idea going in what the service was going to cost. And because the doctor had to look you in the eye – and didn't need to share a rising chunk of his profits with an insurer – the cost was likely to be reasonable. The same went for hospitals: no $20 aspirins due to insurance-company delay tactics and other shenanigans. Few physicians became millionaires, but they lived comfortably, took responsibility for their own business model, and enjoyed their work more.

Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it.

A few highly technical and complex procedures that need to amortize the purchase of extremely expensive hardware will be out of reach for any but the wealthiest patient. For that extremely limited category, insurance might work. A small percentage of indigent individuals won't be able to afford even low-cost procedures. For them, government-funded county facilities are the answer, because any decent society takes care of the weakest among us. But a hefty proportion of health-care services – office visits, minor surgeries – would be affordable to most Americans if the slice of the health-care dollar that currently ends up in the coffers of insurance companies was eliminated.

When I was in practice as a psychologist, I discussed fees up front with prospective patients, prior to their initial visit. People appreciated knowing what to expect and my bad debt rate was less than 1%. That allowed me to keep my charges reasonable and, on occasion, to lower them for less fortunate patients. And I loved my job because I was free to concentrate on what I went to school for: helping people, rather than filling out incomprehensible forms designed to discourage me from filing them in the first place.

Physicians and other providers need to liberate themselves from the Faustian bargain they've cut with the Mephistophelian suits who now run their professional lives. Because many doctors are loath to talk about money, they allowed themselves to perpetuate the fantasy that "insurance is paying." It isn't. There is no free lunch and no free physical exam.

If substantial numbers of health-care providers shook off the insurance monkey on their back, en masse, and the supply of providers was substantially increased by opening more medical schools, the result would be a more honest, cost-effective system benefiting everyone. Except the insurance companies.

Bill would regulate billing for patients' lab tests

By Margaret Stafford
THE ASSOCIATED PRESS
Sunday, May. 04 2008

KANSAS CITY — A bill before the Missouri House would prohibit doctors from
marking up the cost of certain anatomical laboratory work — such as skin
biopsies and Pap tests — that are performed by outside laboratories.

The bill, which has been approved by the Senate and is awaiting floor debate in
the House, would prohibit what's known as "pass-through" billing.

That's when a doctor sends a patient's test sample to an outside laboratory for
analysis. The lab charges the doctor a discounted price for the work, but the
doctor bills the patient's insurance or the patient a higher amount.

The extra amount is profit for the doctor, and most patients don't even know
what has happened.

"It seems to me that we should protect the patient from being charged (by a
doctor) for a service that someone else is doing," said Rep. Kevin Wilson,
R-Neosho, who is sponsoring the bill.

Opponents argue that the bill gets the state involved in pricing decisions that
should be left to private practice physicians and could hurt services for some
patients, particularly the uninsured.

The bill would require doctors or laboratories that actually perform the
anatomical services to directly bill insured patients.

Doctors who send the tests to labs could bill uninsured patients for the
services but could not increase the charges. The doctors would have to tell the
uninsured patients who performed the pathology services and the cost.

Nineteen states have passed bills that either require direct billing or
prohibit markup of pathological services. Medicare and Medicaid already have
prohibited doctors from marking up the cost of the anatomical laboratory work
they don't perform.

And the American Medical Association's code of ethics says no physician should
be paid for a service that he or she does not perform, or charge a markup on
services performed by others.

The law would reduce the potential for abuse even as doctors are ordering more
tests than ever for their patients, said Dr. Joseph Lombardo, a pathologist who
is medical director of hospital laboratories in the St. Charles area.

Lombardo said tests for skin cancer and prostate cancer, as well as procedures
such as colonoscopies, had grown dramatically in the past 10 years.

"The general population has never been, on such a broad scale, subjected to so
much testing and put at so much risk for markup charges," Lombardo said.

He cited a 1993 study by the Center for Health Policy Studies that found two
states that didn't have direct billing laws had 9.6 percent higher costs per
test and ordered 28.3 percent more tests than two states that did.

"Patients waiting on biopsy results and wanting to know if they have cancer
should not be exploited by markups," he said. "They need to know the lab doing
the work wasn't chosen for cost rather than quality."

But Dr. Arthur Freeland, a family practice doctor in Kirksville, said the bill
was a solution looking for a problem, at least in Missouri. Freeland is a vice
president of the Missouri Academy of Family Physicians, which testified against
the bill in the Senate.

Freeland said before the session that pathologists could not provide the
academy with any specific examples of unethical markups by Missouri doctors.

"It was sort of, 'This is probably happening in (Los Angeles) or somewhere,'"
he said. "It was that kind of response: 'It must be happening somewhere.'"

Missouri private practice doctors and their patients, particularly those in
small towns, would be hurt by the bill because it removes physicians'
discretion on pricing, he said. Most of Freeland's anatomical lab work is Pap
smears, and he currently negotiates a volume discount for the anatomical
services from a lab about 100 miles from Kirksville.

That arrangement reassures the lab that it will get paid, while assuring
patients that they are getting a good price, he said. Freeland said he had
often reduced the price for some cash-paying patients who needed the tests but
were concerned about costs.

"The lab has no appreciation for who has insurance or who is paying cash, but
patients know I've represented them to get the best price," he said.

Freeland said the markups on his tests were not for profit but to cover his
risk that a patient might not pay a bill.

EMS billing write-offs concern City Council

Randy Hanson Hudson Star-Observer
Published Thursday, May 01, 2008

Billing write-offs by St. Croix Emergency Medical Services will be back on the agenda when the Hudson City Council meets Monday night.

The news this time is expected to be better than what the council heard at its April 21 meeting.

At the meeting, council members were alarmed by a report that the ambulance service’s bad debt write-offs had equaled its revenue for the first quarter of 2008.

City Finance Officer Betty Caruso said Tuesday that the report was incorrect.

She said that around $189,000 might still be received of the $330,000 reported as having been written off as bad debt.

That still would leave $141,000 in write-offs for the first quarter, however.

The majority of write-offs are the result of Medicare and Medicaid paying significantly less for services than what is charged, according to Caruso.

She said Medicare pays a percentage of the bills. Medicaid pays a flat amount for specific services that covers even less of the actual expenses than Medicare, she said.

Caruso was hesitant to give any numbers, saying she still had work to do to come up with actual figures that she will present on Monday.

"Truly, we still need to keep looking at them." she said of the ambulance service. "They are very much at a break-even situation, as far as I am thinking. It’s hard for them. The type of runs that they’ve been running are expensive, and we’re writing them off."

The per capita rate that municipalities pay to fund St. Croix EMS was increased for 2008 to try to keep up with the costs.

St. Croix EMS serves the city of Hudson, the village of North Hudson, the town of Hudson and part of the town of Troy.

How Does Medical Billing Help With Accounting?

Posted by EditorChoice
Thursday, 26 July 2007

Medical Billing. This is probably not the first time you've heard of this word and you pretty much have a basic idea what the phrase connotes. However, one thing you should know is that most people have the wrong idea of what is medical billing in reality.

Often, what is medical billing is equated with what is medical transcription or what is medical coding when in fact, the three are as separate and as distinct from each other as night and day. While its true that all three of them are somehow related and sometimes even their responsibilities overlap, it still doesn't change the fact that medical coding deals strictly with codes and medical transcription is strictly on transcribing doctors notes.

So, what is medical billing then?

Some people say it is the doctors key to getting paid for services rendered. Others say that it is a process of submitting claims to insurance companies. But these descriptions are vague. What is it really?

Perhaps, the question what is medical billing is better answered with this definition of the term:

Medical billing is practice management. It involves front office skills, with emphasis on billing and accounting, insurance claims processing, and making decisions concerning the financial aspects of a practice.

What is medical billing compared to medical coding and medical transcription?

Compared to medical coding and medical transcription, medical billing is wider in scope and broader in its range of responsibilities. Front office also means acting as an executive secretary to the practice, dealing in clerical work such as patient scheduling, clearing appointments, documenting patient visits, recording diagnostic and treatment procedures, and organizing medical records using a software program.

What is medical billing and what are its responsibilities?

The job of the billing professional starts with the office visit where you will handle everything from scheduling of the appointment to making sure that the patient makes it to his appointment. After the doctor sees the patient, depending on the services provided and the examination, he will then create and update the patients medical record.

The billing professional then organizes these records according to a system earlier adopted by the practice. This record contains a summary of treatment and demographic information related to the patient. The medical billing specialist will have to organize these records according to their contents to provide for easier access in case of another visit or some such circumstance and to create the billing record which is the document submitted to either a clearinghouse or an insurance company.

Article Source: 1ArticleWorld.com

Doctor’s fraud totals $3 million, prosecutors say

By Scott MacKay

Journal Staff Writer - The Providence Journal

PROVIDENCE — Federal prosecutors are seeking $3 million from Dr. Tarek W. Wehbe, an internist with the Renaissance Medical Group in Providence, who the federal government accuses of fraudulently billing Medicare, Medicaid and private insurers for services he did not perform.

Wehbe, who had his license suspended last week by Rhode Island Health Director Dr. David R. Gifford, is accused of billing for services he didn’t perform, inflating the type of treatment he provided and billing for days consisting of more than 24 hours.

The complaint filed in U.S. District Court in Providence asserts that Wehbe billed for visits and treatments that, if performed properly, would have taken more than 24 hours in a single day. For example, Wehbe billed for 87 patient visits on March 7, 2006, according to the complaint. According to federal standards, the time needed to see that many patients would have been more than 30 hours.

On other days, the complaint alleges, Wehbe billed for 28, 27 and 23.6 hours of visits in a single day.

Federal prosecutors also say that Wehbe fraudulently billed for infusion of the drug Remicade, which is used to treat Crohn’s disease and rheumatoid arthritis, and for treatments with drugs such as Paclitaxel and Gemzar, which are used to treat cancer.

According to the affidavit, between November 2001 and December 2006, suppliers delivered 22,890 units of Remicade to the Renaissance Medical Group, which Wehbe owns. He billed insurers for 39,239 units, or about 16,000 more than he received. The complaint states that from 2002 to 2006, Medicaid, Medicare and private insurers overpaid Wehbe $2.99 million, of which $1.8 million went for infusion drug treatments and $1.1 million for fraudulent office visits and treatments.

Prosecutors are seeking forfeiture of Wehbe’s property and bank accounts. The affidavit states that Wehbe has an account at Citizens Bank and owns real estate at 1630 Mineral Spring Ave., North Providence; 566 East Shore Rd., Jamestown; 6 Pine Tree Lane, Lincoln, 15 Dennell Drive, Lincoln; and 78 Farnum Pike, Smithfield.

Along with the U.S. Attorney’s office, other agencies involved in the investigation include the U.S. Department of Health and Human Services, the Internal Revenue Service, the U.S. Food and Drug Administration and the Rhode Island attorney general’s Medicare fraud control and patient abuse unit.

Wehbe, 43, has been under investigation by state and federal agencies for alleged health-care fraud and medical negligence since a raid at his office in December 2006. When the state suspended Wehbe’s license on April 7, Gifford, state health director, used his power to pull a doctor’s license without a hearing if a physician is deemed to be an immediate danger to the public.

That suspension was prompted by the discovery that Wehbe’s records of purchases of chemotherapy drugs did not match the amount he billed insurance companies. “In reviewing the records, it doesn’t appear that he could have given what he billed for,” said Dr. Robert S. Crausman, chief administrative officer for the state Board of Medical Licensure. “That could be just billing fraud but it leaves open the possibility that patients didn’t get what they should have gotten.”

Most of the affected cancer patients left Wehbe’s practice in December 2006 after he agreed to stop offering infusion therapy at his office after the investigation started, Crausman said. At the time, investigators were concerned about his treatment of patients who had rheumatoid arthritis, hepatitis C and fibromyalgia. When the cancer treatment issue came to light, the medical board considered the matter more serious and recommended that Gifford immediately pull Wehbe’s license, according to Crausman.

The state attorney general’s office is following up to determine if there was abuse of patients, said spokesman Michael Healey.

smackay@projo.com

Balanced Billing Destroys Capitalist Economy - Opinion

By: Alex Wawro

Posted: 4/9/08

If you have health insurance you ought to know what "balance billing" is. Balance billing and the ongoing attempts to outlaw it directly determine how much you pay for medical services.

Typically, if you have medical insurance (say, Kaiser Permanente), your provider will pay any medical fees above your standard co-payment. If Kaiser, however, only pays a standard allotment of $500 for a service a physician would normally charge $750 for (say, an emergency cardiac bypass), the doctor or hospital might send the patient a bill for the missing $250.

What this means for the average consumer is that not only do they have to pay their co-payment, they may receive a second bill for the remaining amount the insurance chose not to pay. Governor Arnold Schwarzenegger supports a bill that would outlaw balance billing.

The less money you have to pay the better, right?

Wrong. The legislation is blatantly unjust; worse, it undermines the foundation of free enterprise that our economy is built upon.

Think about it - when you sign up with an HMO like Kaiser, you agree to pay a standard fee monthly in exchange for a guarantee of financial aid if you need serious medical care.

In return, Kaiser receives monthly income and negotiates flat rates for services with a pool of physicians; those physicians give up the right to charge their own price in exchange for guaranteed business from Kaiser customers.

But if you, as a Kaiser customer, are brought to the ER for emergency surgery, there are no guarantees that the surgeon working is a Kaiser-approved doctor. If that surgeon saves your life, should he or she be forced to accept whatever percentage of the standard rate Kaiser chooses to pay him or her for the service? He does not receive the benefits of being a member of the Kaiser family; why should he be forced to abide by their restrictions?

Essentially, passing this bill destroys the basis of our capitalist economy in favor of a more socialist system in which the government regulates our freedom to spend and charge what we think is fair. By eliminating the practice of balance billing, Schwarzenegger forces all doctors to accept whatever healthcare providers think is fair payment.

Even worse, it makes the entire system of licensed physicians meaningless. A doctor who agrees to accept Kaiser's rates does so in exchange for receiving more business from the company. In essence, what he loses in individual sales he more than makes up for in volume.

If all physicians are limited to collecting only what Kaiser chooses to pay, why bother contracting with doctors in the first place?

Kaiser can pay a doctor whatever they believe they can get away with, and the physician has no choice but to take what he is given.

By removing a practitioner's ability to charge what he thinks is adequate for his services the government is sullying the principles on which this country was founded.

Though this legislation seems to benefit the consumer, in the end only the corporation wins.

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© Copyright 2008 Weekly Hornet

‘BPO is here to stay’

- An Article in The Hindu byD.Murali

The general perception is that the US slowdown will hit the software and BPO (business process outsourcing) industry. “I have a different view,” avers S. Shivakumar, CEO of iSource IT Enabled Services.

“US corporates can afford to hold on to and defer decisions on software projects. But BPO work ought to continue because it is an essential service,” he explains. “In fact, it will gather further momentum as the squeeze tightens on cost. More corporates will start thinking of outsourcing their administrative support services,” adds Shivakumar, during the course of a recent lunch-hour interaction with eWorld.

iSource is into services such as document management and accounts receivable management for media, market research and healthcare verticals. “Though we began by signing up customers in the US for search engine optimisation business — to help them generate leads and expand business presence — we decided to use our skills in order to build our own BPO business,” recounts Shivakumar.

At a time when the BPO industry is facing challenges such as rupee appreciation, unsustainable salary levels, high attrition rates, etc, any positive words offer solace.

“Innovation and experiments hold the key,” Shivakumar says. “We at iSource have decided to stick to our core strengths such as presales consulting, intensive online marketing, process migration from US to India, vendor management and quality control and sub-contract the rest to strategic delivery associates away from the company.”

“We get 90 per cent of the work done in the Tier-II and tier-III cities of India, the Philippines and Kenya. The fall in dollar value has made us look at the Philippines. In fact, besides beating the loss due to dollar slide, we are at gain as the rates in the Philippines are 25 per cent less compared with India,” he says. Excerpts from the interview:

On how it all began…

It was not easy in the beginning. Especially for a person like me who did not have a business background. We had a tough time finding the start-up capital. But with our being in the Web solutions market from the early stages, our expertise in online marketing and related opportunities came in handy.

What has been the impact of rupee appreciation?

The recent dollar turmoil made us innovate to stay competitive. We have ventured into near shore. We have made strategic investments in the Philippines and Kenya and managed to cut cost by 30 per cent. We also leveraged strength from our near-shore facilities.

On attrition.

As we do only the core jobs in-house, our headcount is kept low, which helps us in tackling attrition.

Among call-centre employees, most of the dropouts are women; and metros are becoming a nightmare for those commuting to office. Hence we have come up with a home-based working option, which will benefit women, in particular. What are the skill-sets you expect from women who opt for what you offer?

Good English and listening and comprehension skills. Initially, they will be expected to train themselves from home for about two months. They are advised to visit the office once a week for guidance. They would need a computer with broadband connection.

Within six months of getting into the job, people who put in eight hours of work can earn a minimum of Rs 15,000 a month.

What are the hurdles you faced as an entrepreneur?

Typically the same hurdles faced by any other small business in India. Let’s face it: the financial environment is not in favour of entrepreneurs, in spite of all the talk. When it comes to funding, entrepreneurs are still faced with collaterals that are required in the form of assets, the mandatory three-year audited financial statements, high interest rates, etc. Even companies that receive 100 per cent of earnings through foreign inward remittance are denied overdraft and other credit facilities by banks.

What growth areas are you working on?

We are looking to scale up presence in the US by opening more offices and adding more staff.

In India, we are looking to expand our medical billing business and set up offices in tier-two and tier-three cities such as Madurai and down South. We are also looking for strategic partners, who are looking to diversify into BPO.

Do you see a bubble in the BPO industry?

BPO is here to stay. Compared to software and dotcom businesses, BPO is critical for the day-to-day functioning of US businesses. For example, medical transcription is a regular task that needs to be done on a daily basis; not so with software development, which can even be postponed.

In my opinion, it will take another five years for the saturation point to be reached in the BPO business. After that there will be a price war, which only the fittest will survive.

Is there room for more entrepreneurs to hop on to the BPO bandwagon?

Despite big players ruling the roost, there is still room for small players in the BPO industry, provided the funding options are improved.

Venture capitalists, who mostly look at newer technologies, steer clear of run-of-the-mill BPO businesses.

Significant milestones?

A major point in our growth story was when we incorporated our company in California 18 months ago. It helps us compete with local American companies. We have served big and small clients, including the World Bank, Microsoft, CNBC, Harvard University and Nasdaq.

BPO workforce, journalists getting insomniac

Santanu Saraswati

Kolkata, May 18, 2007

Chandrika Chhetri is still fighting against depression at her Namchi residence, a small town in Sikkim. After completing her honours from a reputed south Kolkata college, Chandrika took up a tele-caller's job with a BPO company at Sector V.

Chandrika has to answer every question her company's client in Sydney, Melbourne and Toronto used to make over telephone. Sometimes, she has to hear all abusive language her clients used to throw from the other side of the telephone. "We didn't have any fixed work schedule. Sometimes, I have to reach my office by 4 in the morning, sometimes at 8 in the night. Just after a month, I started having fragmented sleeps. It was really taking toll on my health. To make myself awake, I started smoking and drinking at least 20 cups of coffee from the canteen. It was really a horrendous experience I had during my six months of job with that company," Chandrika said.

Chandrika had to undergo treatment under a well-known psychiatrist. She, still, has to visit his chamber once a month.

Anamitra Chakraborty has not slept for months properly. After every half-an-hour, his sleep breaks that has compelled him becoming an irregular employee of a BPO company operating at Sector V. "I used to drink 15-20 cups of black coffee at night just to make myself awake at the night. The company, I am serving, is having most of its client base in North American countries, and there is a time difference of more than 12 hours. So I have to work everyday from 7 pm to 7 am. But finally it landed me with the habit of taking sleeping peels regularly. First, I started with minimum doses, and after few months with 10-15mg of alprazolam. My employer served me show-cause notice and I had nothing to say except submitting my medical prescription. The doctor advised me three months complete medication," said Anamitra.

Anamitra is not the precedent. Some have lost their job as their competency in solving the clients' problem gradually witnessed a downward trend. Some, under doctor's advice, change their trade, just to go back to the normal life.

Piyush Goswami is now working with a multinational bank as a junior executive. Piyush was compelled to lose few years of experience of working with a software BPO having office at Infinity Building career after his doctor advised him to go back to his normal daily schedule for getting cured from acute insomnia. "I lost my sleep and my marriage was on the verge of breaking. Thanks to one of my friend who made me visiting the doctor," said Piyush.

City is having sleepless nights. At least for the past five years the city has witnessed a tremendous rise in psychogenic and physiological disorder caused due sleeping disarray and fragmented sleep. The worst hit of this disease are the business process outsource workforce, the healthcare employees, the medical practitioners and even the journalists who have either shifting work schedule or prolonged and continuous night shifts.

City doctors termed the disease as mainly -"BPO-genic". A recent survey on city's highly skilled workforce revealed that more than 80 per cent of them are suffering from insomnia, a major cause of depression, obesity, cardiovascular diseases, diabetes, decrease efficiency, acute abdominal pains and irregular periods, caused due to late-hours of watching television, attending late-night calls of the patients and shifting work schedules. Doctors, though blaming the changing life style pattern of the city, failed to find any solution other than changing jobs from BPO sector or changing profession.

"Depression caused due to acute insomnia has become a common phenomenon among the city's highly skilled workforce, especially working in the business process outsourcing companies. In the past five years, there has been 82 per cent rise in psychogenic and physiological disorder among people working in healthcare, BPO, multinational companies, electronic and print media. And 45 per cent of this are patients having perennial sleeping disorder, and the rest suffering from depression caused due to situational insomnia," said Dr Shiladitya Ray.

Ray is of opinion that fragmented sleep may even give rise to diseases like trigeminal neuralgia, burning skin, decrease efficiency and irregular period among women. Psychotherapist, Sunita Kumar, observed that there has been a steady rise in the number of her patients at Apollo Clinics, suffering from insomnia and depression. "When we start questioning our patients, in most of the cases, it is found that irregular sleeping hours or continuous nightshifts is what has made the patient vulnerable and feeling isolation. Except few hours of counselling and prescribing medicines, we don't have any other solution for these patients. And if the patient doesn't change profession and go back to normal life, chances of relapsing the disease is almost 200 per cent," said Kumar.

Not only depression or insomnia, Kumar observed that fragmented sleeps or sleeping disorder has given rise to high level of toxic anxiety and loss of appetite.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance. Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

The study also finds that fragmented sleep profiles, akin to individuals suffering from middle of the night insomnia, healthcare workers on call, and parents caring for infants, medical practitioners and even journalists, alter natural systems that regulate and control pain, and can lead to spontaneous painful symptoms, said Dr Tapan Basu. "Our research shows that disrupted sleep, marked by multiple prolonged awakenings, impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of chronic pain," said Basu, a pain-manager with Belle Vue Clinic.

Consultant psychiatrist, Dr Rima Mukherjee, observed that there has been a steady 10 per cent rise in the number of such patients at her clinics in West Bank Hospital and Arabinda Seva Kendra in the past one year. Mukherjee, even blames rise in accidents on city roads because of fragmented sleeps. "People are becoming susceptible to chronic psychomatic disorder and dependable on sleeping pills and alcohol. Because of fragmented sleeps, BPO and such-types of workforce are gradually losing efficiency and concentration," Mukherjee said.

Doctors suggesting immediate visit to clinics if fragmented sleeps persists for more than a week. "Otherwise, sleeping disorders will take its toll on city's health slowly.

According to Parikshit Bhaduri, head of US-based software development company, Connectiva Systems, there are cases, where sleeping disorder has finally taken toll on the efficiency of employees. "I found two of my very efficient colleagues doing mistakes, which were unlikely of them. When I started enquiring their details, it was found that both of them got the habit of playing on the computers, chatting with their friends in other parts of the world throughout the night. Finally I made them compelled of leaving their laptops in the office at the time of leaving for home. It worked wonders," Bhaduri said.

Psychoanalysts like Nandita Mukherjee, however, differ with the doctors regarding curability of this disease. Nandita suggests the best way to get cure is the willingness of the people suffering from such diseases. "Apart from counselling I always advice my patients to start yoga and reduce the amount of coffee or tea intake. Drinking tea or coffee, especially at night, causes immense harm on sleep. High intake of coffee or tea, even gives rise to loss of appetite apart from fragmented sleep. Counselling does help, but people suffering from depression out of sleeplessness could benefit from practising yoga. But I don't think, change of profession is really possible in our country where getting a fresh job is really very hard," Nandita said.

She even warns the students, who have the habit of studying at night and sleeping in the day. "Our body never allows change of schedule so easily. All these types of diseases are result of this. So it is always better to lead normal lifestyle what our climate and body permit," she added.

DATA OWNERSHIP ISSUES FOR THE PHYSICIAN PRACTICE AND A MEDICAL BILLING SERVICE

Article Date: April 4, 2008

Medical billing services assist physician practices in billing, coding, accounts receivables and management activities. By outsourcing to a medical billing service, a physician practice may realize increased profitability by decreasing the administrative time and expense involved in the billing process. The relationship between the physician practice and a billing service is an important and complex one. The issues are not limited to the billing service’s effectiveness in collecting payments. Both the physician practice and the billing service will benefit from a clear agreement, appropriately documented, as to all aspects of their relationship, including matters relating to data ownership of medical records and termination of the relationship.

Information technology systems are making it easier to rapidly transmit medical records and associated claims data while also reconfiguring and manipulating the data to exchange. To protect patient’s privacy and security, the American Medical Association (AMA) and the Healthcare Billing Management Association (HBMA) encourage physician practices and medical billing services to consider discussing, agreeing upon and including provisions in their contracts regarding software and proprietary information, claims data-ownership with respect to both original and copies of physician practice records and termination procedures. Physician practices are encouraged to consider the value the relationship will bring to the practice before entering into an agreement.

Typically, the physician practice will provide a medical billing service with a variety of records required for various billing, coding, accounts receivable, and management activities. A medical billing service may incorporate the records into proprietary forms, templates and other tools to prepare reports for the physician practice. This document will list topics for physician practices to consider addressing with prospective medical billing services prior to entering into an agreement.

Definition of Physician Practice Records

Typically, three categories of records belong to the physician practice: (1) patient records, claims, Explanation of Benefits (EOB)/Remittance Advice (RA) and other documents containing patient information, (2) managed care contracts, fee schedules and other proprietary information of the physician practice itself, and (3) final reports, such as accounts receivable (A/R) registers, prepared by the billing service for the physician practice.

Definition of Medical Billing Service Records

Typically, three categories of records belong to the billing service: (1) internal notes and work papers prepared by its employees, such as records of conversations with third party payers relevant to documentation needed for appeals, (2) papers relating to the billing service’s software and other proprietary or licensed tools, and (3) other proprietary information of the billing service, such as the forms and templates used to prepare reports furnished to the physician practice. The billing service may also have proprietary or confidential information regarding its operations.

Transfer of Documents and Electronic Records When Relationship Terminates

Prior to entering into an agreement, the medical billing service and the physician practice should agree on how to handle any termination of the relationship. Questions to consider include:

• What materials should be returned by the billing service to the physician practice or a successor billing service, subject to any transition agreement, for the practice or successor billing service to: (1) enter patient and charge data into its computer system, or (2) seek to collect pending billings on health plan claims for the physician practice.

• Who has custody of the documents relating to health care claims filed, which generally fall into three categories: (1) source documents, usually in the form of copies of visit or operative notes, (2) payer generated data, such as EOBs, and (3) reports that the billing service generates on billing and management activities for its clients. Occasionally, when discussing these questions, both the physician practice and billing service should realize that a billing service may have a legitimate need to retain copies of or at least a right of access to any records—even documents owned by the physician practice, as discussed above, in order to document their services, particularly if the billing service codes physician claims.

• What should the format and media for the return of physician practices records be?

• When and how will electronic records be returned to the physician practice?

(1) What information will be provided in file layout?

(2) What file codes and programming will be given?

(3) Which patient account data on the billing service’s computer system or software will be returned to the physician practice or sent to a successor billing service?

• Who will own documents that do not contain protected health information, such as the coding notes, and other work products of the billing service? Will it be the original or copies?

• Who keeps original records and who pays for any copies?

• Who pays the cost of locating or transferring hard copy or electronic records to the physician practice or to a successor billing service?

• Under what circumstance will the physician practice (or a successor billing service) have access to billing and claim denial notes and records made by the billing service as it provided services to the physician practice?

Record Retention and Access – Points to consider and discuss

At a certain point in time, retained records cease to be of any value, typically upon the lapse of the longest applicable statute of limitations for a third party payer audit or legal actions as to which the records would be relevant. In the case of patient records in the custody of a billing service, the patient records will be copies only, with the originals of the patient’s records at the physician practice or facility at which the underlying care was rendered. Some of the considerations in this section apply principally to original records.

• When the applicable time frame for retention of records in the custody of the billing service expires, will the records be destroyed or returned to the physician practice?

  • What are the state and federal laws pertaining to the period of time records are to be retained?

  • To the extent that the billing service is a business associate of the physician practice, a written HIPAA business associate agreement should be in place documenting among other things how protected health information (either in paper or electronic forms) must be either destroyed or returned to the physician upon termination of the agreement with the billing service. This language can also provide for other equally secure methods of protected health information management upon termination. Additionally, physician practices should ensure that the underlying agreement with their billing services provides for safeguards to the confidentiality, integrity and availability of the protected health information disclosed to the billing service and any other confidential information. These provisions should comply with any state law that is more stringent than HIPAA, and be consistent with guidance from the physician’s professional liability carrier.

• Due to the cost of storage of voluminous paper records, a billing service may scan original paper documents and store them electronically.

  • Will electronic copies of paper records be accepted as the original document?

  • Does the state the physician practices in accept a scanned medical record or other business record as an original as long as the accuracy of the scanned document can be reasonably substantiated?

  • Will the original paper records be destroyed after such records are scanned?

  • If, for some reason, electronic scanning is not permitted due to cost or availability, will the paper records be stored on the billing service’s premises or, especially after the termination of the agreement, in an offsite storage facility?

  • Will there be any costs charged to the physician practice for storage of paper records by the billing service during or after the termination of the agreement?

• Selection of offsite facilities. A storage facility off the premises of the billing service needs to be secure both for the integrity and availability of the stored records and for compliance with HIPAA and state medical records laws. Ultimately, this is the physician practice’s responsibility, although the selection may be delegated to the billing service.

  • Who will pay the cost of storage at offsite facilities during the term of the relationship?

  • After termination, will the physician practice be responsible for the costs of storage or scanning of records retained on behalf of the physician practice (as opposed to for the billing service’s own purposes)?

Audit and Litigation Assistance and Record Searches

Certain records searches and data assembly may be time consuming if the search requires manual review of stored records. This may be the case where, for example, a records search is conducted by date of service rather than by patient name. Physician practices should expect a reasonable level of support from their billing services during the term of the relationship as “part of the service”, but may also anticipate incurring additional costs for assistance which goes beyond that level.

• During the term of the relationship, the billing service and the practice need to determine if there is a component included in the basic service for searching records and otherwise assembling information for litigation or third party payer audits.

• For more extensive work, discussions should include the fee the billing company will charge for personnel and reimbursement for associated costs.

• For services during and after the termination of the relationship, discussions should include the fee and other costs that is the responsibility of the physician practice, such as if the billing service will be reimbursed for copies of records it provides to the physician practice.

For more information on medical billing services, as well as further questions that should be asked before contracting with a medical billing service, AMA members can visit the Private Sector Advocacy (PSA) Website at http://www.ama-assn.org/go/psatools and download the complimentary flyer “What is a medical billing service?”

Prepared by the American Medical Association, Practice Management Center, along with the Healthcare Billing and Management Association, December 2007.

Questions or concerns about practice management issues? AMA members and their practice staff can email the AMA Practice Management Center at practicemanagementcenter@ama-assn.org for assistance.

Contact the AMA-PSA unit:

• Call (800) 262-3211 and ask for AMA-PSA.

• Fax information to (312) 464-5541

• Visit www.ama-assn.org/go/psa to access the AMA-PSA Web site.

Contact HBMA:

• Call (877) 640-4262 and ask for HBMA’s Billing Resource Center

• E-mail requests to info@hbma.org

• Visit www.hbma.org

This educational flyer was developed through a cooperative effort between the Healthcare Billing and Management Association and the American Medical Association. © Copyright 2007 American Medical Association. All rights reserved.

Big Sentence for Medicare Fraudster

April 03, 2008 02:59 PM ET | Luke Mullins

Rita Campos Ramirez, a 60-year-old Miami resident, received a 10-year prison sentence for her role in a multimillion-dollar Medicare fraud scheme. The $170 million scheme is the program's largestindividual case of fraud ever. The sentence was announced Wednesday.

As part of her punishment, Ramirez will also have to hand over her three homes and a car. Plus, she was ordered to pay $105 million in restitution to the federal government.

"The sentence in this case dispels the myth that white-collar-crime defendants get off lightly," FBI Special Agent in Charge Jonathan Solomon said in a press release. "It reinforces the message that healthcare fraud—stealing from U.S. taxpayers—is a serious crime."

Details of the crime:

Campos pleaded guilty on Aug. 28, 2007, to one count of conspiracy to commit health care fraud and one count of submitting false claims to Medicare. As part of her plea, Campos admitted that between October 2002 and April 2006 she owned and operated R&I Medical Billing Inc., a medical billing company that specialized in submitting bills to the Medicare program on behalf of HIV infusion clinics. Campos admitted that she knowingly submitted approximately $170 million in fraudulent medical bills to Medicare on behalf of 75 HIV infusion clinics in Miami-Dade County that were part of the scheme. Infusion clinics serve HIV patients by providing prescribed medications intravenously.

The Medicare program paid approximately $105 million of the $170 million in fraudulent bills submitted by Campos, with Campos personally receiving $5 million for her role in the fraud.

Full press release is here.

‘Inpatient hospital coding, an emerging BPO vertical’

- An Article in The Hindu byD.Murali

Chennai: Coding, as commonly understood, refers to programming and writing a lot of lines of software. However, in the healthcare BPO (business process outsourcing) industry, ‘coding’ refers to the conversion of paperwork, such as patient-charts created by doctors and hospitals, for reimbursement purposes.

“What is currently emerging as a BPO vertical is inpatient hospital coding,” says Mr Gopi Natarajan, CEO of Omega Healthcare India Pvt Ltd. “As an offshored industry, India has been mainly doing outpatient coding for US hospitals and medical professionals. Now, the dearth of qualified resources in the US makes the offshoring of inpatient hospital coding a necessity.”

In terms of jobs that can be offshored, only about 6 per cent of the US healthcare BPO industry has been offshored, informs Mr Natarajan, speaking to Business Line. “With 1,400 employees, Omega has about 16 per cent of the market in terms of offshored healthcare BPO jobs.” The Bangalore-based company provides medical coding, billing, accounts receivable management, claims processing, and healthcare revenue management.

What does inpatient hospital coding involve? And how is it different from the outpatient work? Explains Mr Natarajan, “Inpatient hospital coding is more about the procedures that are done within the hospital, such as the use of beds, surgical equipment, and specialty care. These services are of much higher value in terms of dollars, compared to the outpatient category.”

Omega is working with its clients in the US to make a foray into inpatient hospital coding in the forthcoming fiscal. “We see this new vertical as a shift up the value chain,” says Mr Natarajan.

Offshoring: Where's the Value?

4/4/2008 --

New research shows that customers perceive little value in outsourcing.

ANN ARBOR, Mich.—U.S. companies that outsource business functions overseas may save money in labor costs but they also pay a price for unhappy customers, say University of Michigan researchers.

Firms are increasingly offshoring front-office functions such as customer service call centers and back-office functions like information technology to manage their operations and achieve strategic objectives, says M.S. Krishnan, professor of business information technology at Michigan's Ross School of Business.

"However, neither front- nor back-office offshoring are associated with an increase in perceived value," he said. "This suggests that firms may be reducing their costs by offshoring, but are either not passing on these savings to customers or not re-investing these savings to create a perceptible increase in value for customers."

Krishnan and colleagues Claes Fornell of the Ross School and Jonathan Whitaker of the University of Richmond examined 154 North American firms and business units that engaged in offshoring from 1998 to 2005. They used Fornell's American Customer Satisfaction Index to measure customer satisfaction and gleaned more than 50,000 news reports for information on the offshoring activities of companies.

The researchers found that front-office offshoring (sales and customer service call centers) results in lower customer satisfaction and a decrease in each of its primary determinants---perceived value, perceived quality and customer expectations.

Previous research has shown that nearly nine in 10 American customers have experienced some kind of problem when contacting overseas call centers, including lack of responsiveness, reliability and other variables of service quality.

"With the cultural, language, distance and time-zone differences inherent in offshore services, one or more of the (service quality variables) may not translate properly in the offshore service setting," said Fornell, professor of marketing at Michigan's Ross School of Business.

However, when it comes to offshoring back-office functions (those that support front-office functions, such as IT, human resources, finance and accounting, and research and development), customer expectations and perceived quality improves---despite a drop in perceived value.

Overall, the researchers suggest three primary implications of their study:

—Firms must carefully consider which functions are suitable for offshoring.

—Companies must ensure that their vendors overseas are properly equipped to provide high-quality service to customers.

—In addition to using offshoring as an opportunity to save on internal costs, firms must also use it as an opportunity to create additional value for customers.

The researchers say that offshoring activities of American companies can be successful if they manage the process properly.

"Companies often have a knee-jerk reaction," Krishnan said. "Why are we spending so much money? Let's cut costs and go to India or the Philippines or someplace. Most companies have a myopic view to blindly go out and outsource.

"But it's the process that matters. It's not about exporting jobs. It's about importing competitiveness."

For more information, contact:
Bernie DeGroat, (734) 936-1015 or 647-1847, bernied@umich.edu

Introduction

Hi Guys,

This is Karna from Chennai, India. I've been in the US Medical Billing Industry for some time now and thought of having an open channel of communication with people in the same industry. With this idea in mind, have created this blog titled Healthcare BPO News to enable people from different parts of the world who are involved in a similar industry to share any news, views, articles, information, ideas, thoughts and knowledge related to the industry...

Hope to have all your support...

Thanks,
Karna (கர்ணா)