Medical Outsourcing: Second comeback & Legal Outsourcing

Legal Outsourcing: The Newest Opportunity

Legal Outsourcing Facts

* Legal services outsourcing could be worth $US3 - $US4 billion for India.
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Less than 3% ($US60 - $US80 million) of the potential market has so far been tapped.
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Global spending on legal services is estimated to be worth over $US250 billion.
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The US alone accounts for more than 65% of the market for these services.
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35,000 US law jobs are projected to move to countries like India by 2010 and this number is likely to reach 79,000 by 2015. By 2004, no more than 12,000 legal jobs had been outsourced from the US to offshore locations, according to Forester Research).
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NASSCOM estimates at least 60% to 70% is likely to come to Indian companies as they offer the best on the skill-price matrix.
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Billing by Indian lawyers to US firms just for in-house work ranged between $US5 million to $US15 million last year.
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The total employee base engaged in providing high end legal business process outsourcing (BPO) services from India is estimated to be 600 to 700 employees and growing fast.
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Billing rates for legal BPO in India vary between $US12- $US90 per hour, depending on the nature of services provided.
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Significant portions of these services are delivered from offshore locations achieving cost savings of 30-70%.

Outsourced Legal Services

We make no claim of the list of services being either complete or comprehensive. Information is based on secondary online and offline research, people we meet, and e-mails messages we receive.
The primary focus of US Law firms (and Corporations) outsourcing legal functions:

* Document / Patent drafting by lawyers
* Legal research
* IP legal work
* Review of discovery documents
* Paralegal services
* Administrative and secretarial support services

The secondary focus of US Law firms (and Corporations) outsourcing legal functions:

* Digital dictation (Legal Transcription)
* Offshore litigation support coding
* Copy / mail-room services
* Bookkeeping functions

Legal Outsourcing Companies

Three major US firms are taking thoughtful decisions to move back-office functions to India. This trend offers costs saving through outsourcing and is growing in acceptance across US firms. Milbank Tweed Hadley & McCloy, Chad-bourne & Parke and White & Case are all pursuing such moves. The move follows similar initiatives at UK firms including Allen & Overy and Eversheds, which both began outsourcing word processing and document production to India in 2003. More than 25 Legal Outsourcing Companies offering services to global law firms operate out of India.

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The KPO opportunity

Knowledge Processing is complex work that required consistent churning of data into information and then knowledge. The product thus derived is used for strategic business decisions.

The global Knowledge Process Outsourcing industry (KPO) is expected to reach USD 17 billion by 2010.

The global Knowledge Process Outsourcing industry (KPO) is expected to reach USD 17 billion by 2010, of which USD 12 billion is expected to be outsourced to India. The Indian KPO sector is also expected to employ more than 200,000 KPO professionals by 2012, a number that is significantly lower today at 20,000. Highly specialized skills, domain experience and quality delivery are hallmarks of the business, which is diametrically opposite to the usual outsourcing, based mainly on cost benefits.

Knowledge process outsourcing is predicted to be next big opportunity. The global KPO market is expected to grow at a cumulative annual growth rate (CAGR) of 42 per cent, from $1.1 billion in 2003 to $16 billion in 2010. Compare this with the prediction for the low-end outsourcing services market. This is expected to have a CAGR of 24 per cent, from $ 7.5 billion to $38.4 billion in the same period.

The high-end KPO opportunities are increasing by the day. Take for example intellectual property research and one realizes that drafting and filing of patent applications in the US is quite expensive. A typical application costs about $9,000 to $14,000 to draft and file with the United States Patent and Trademark Office. Cost savings from off shoring easily save up to 40 per cent of the cost for the end client. Many reputed law firms have already set up offices in India, and quite a few others are joining hands with Indian companies to save by the present opportunity.

Off shoring R&D in pharmaceuticals and biotechnology is another area where there is enormous potential for KPO. India offer significant cost in the areas of contract research and clinical trials.

Some Indian companies have recently set up drug discovery centers at low-cost destinations to offshore R&D activities. Chip design and embedded systems is another critical area. All major integrated design manufacturers such have set up offshore design centers to save on enormous skill costs in the west. In India an experienced engineer with an advanced degree costs the company as low as $1000 when compared to the same in the US at $6000 or more.

Medical Outsourcing: Second comeback

Medical Outsourcing Facts :

Medicine is a highly emotional topic, and is highly regulated. There is an almost unlimited market to medicine (as examplified by the thousand dollar full body scan and the $17,000-a-month Erbitux cancer drug). Given patients with an unlimited capability to purchase medicine (either with their own or someone else's money), there is almost an unlimted amount of health care that can be bought. Governments are faced with rationing health care by what individuals can pay, or by providing socialized health care with rationing based on "reasonable health care measures," generally determined by a committee and not the person facing imminent death. In most socialized medical regimes, this means long waits for non-emergency procedures. Or you can have a two-tier system, as in the US, where the government provides nearly half of every health care dollar. Those who can afford to can "jump the queue."

The British National Health Service has been having spending rises of 10% per year, and has been able to reduce wait time maximums for operations from 18 months to "just" 9 months over a five-year period. This does not include the time spent waiting to see a hospital consultant after an initial referral, which can be as long as 17 weeks. Canada, which tries to have 100% socialized medicine, has recently seen an upswing in private clinics making use of quasi-legal loopholes to provide privately paid health care. Some Canadian politicians are even seeking a two-tier public/private system to end the waiting problem. A nationwide poll found that 51% of Canadians favour moving to a two-tier system. In the US, Native Americans set up gambling casinos under their limited legal autonomy, a no-no for non-natives in most states. In Canada, Native Americans are considering setting up for-profit health clinics.
Perhaps part of the answer is medical outsourcing. The BBC has a story about a woman who went to India for shoulder surgery to avoid a painful nine-month wait. Indeed, the Indian state of Maharashtra is trying to become a destination for medical tourists. There are also efforts to outsource radiology reading. India's National Association of Software and Service Companies (Nasscom) expects $800 million in medical outsourcing by 2005.

Medical Billing

Medical billing is the process of submitting claims to insurance companies in order to receive payment for services rendered by a healthcareprovider. The same process is used for most insurance companies, whether they are private companies or government-owned (see Medicare). The billing process begins with the office visit. After the provider sees the patient, depending on the service provided and the examination, the doctor creates or updates the patient's medical record. This record contains a summary of treatment and demographic information related to the patient. Upon the first visit, the provider will usually give the patient a diagnosis (or possibly several diagnoses), in order to better coordinate and streamline his/her care. The treatment, diagnosis, and duration of service combine to determine the procedure code that will be used to bill the insurance. The doctor then either provides this information to a medical coder or other billing specialist. From this, a billing record, either paper (usually on a standardized form called an HCFA) or electronic, is generated. This form includes the various diagnoses identified by numbers from the current ICD-9 manual.

This billing record or claim is then submitted either to a clearinghouse that acts as an intermediary for the information (this is typical for electronic billing) or directly to the insurance company. Based on the amount negotiated by the doctor and the insurance company, the original charge is reduced. The amount that is paid by the insurance is known as an allowable. For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, so a $30 reduction would be assessed. The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the doctor would be paid $45 by the insurance. The doctor is then responsible for collecting the out-of-pocket expense from the patient. If the patient had a $500.00 deductible, the patient would have to pay the contracted rate of $50 ten times until the deductible was met, at which point the insurance would begin to cover a portion of the charge. A coinsurance is a percentage of the allowed amount that the patient must pay. It is most often applied to surgical and/or diagnostic procedures. Using the above example, a coinsurance of 20% would have the patient owing $10 and the insurance company owing $40.


Medical Coding

FAQ's

What is a medical coding specialist?
Medical coders are responsible for assigning codes to diagnoses and procedures in order to insure proper financial reimbursement from insurance companies and government agencies

What do medical coding specialists do?
Medical coders, also called insurance coders or claims specialists, use a universally recognized coding system and must insure correct code selection for compliance with federal regulations and insurance requirements. The information compiled by the medical coders is used to prepare statistical reports for private clinic use and public health reasons. Knowledge of both the medical and business sides of health care are essential in this detail-oriented field.

Where do medical coding specialists work?
Coding specialists work in health care facilities such as hospitals, clinics, physician practice groups, surgery centers, long-term care facilities, and home health care agencies. Coders are also employed by consulting firms, coding and billing services, insurance companies, governmental agencies and computer software companies.


What kind of training will I need in order to become a medical coder?
In addition to having your GED or high school diploma, you'll need to complete a six-month to one-year medical coding certificate program. In the training programs, you'll learn how to evaluate and interpret health records and reports in order to accurately code diagnoses and procedures according to recognized classification systems. Course work will likely include medical terminology, anatomy, physiology, pathology and pharmacology.

Do I need to be licensed in order to do medical coding?
Certification is optional, but highly recommended. The American Health Information Management Association (AHIMA) offers certification in two areas—hospital coding and physician office coding. Coders who pass the national exam become Certified Coding Specialists (CCS) or Certified Coding Specialist—Physician (CCS-P). The American Academy of Professional Coders (AAPC) also offers entry-level certification through its Certified Professional Coder (CPC) and Certified Professional Coder-Hospital (CPC-H) certification exams Medical Transcription


Medical Transcription:

Medical transcriptionists listen to dictated recordings made by physicians and other healthcare professionals and transcribe them into medical reports, correspondence, and other administrative material. They generally listen to recordings on a headset, using a foot pedal to pause the recording when necessary, and key the text into a personal computer or word processor, editing as necessary for grammar and clarity. The documents they produce include discharge summaries, history and physical examination reports, operative reports, consultation reports, autopsy reports, diagnostic imaging studies, progress notes, and referral letters. Medical transcriptionists return transcribed documents to the physicians or other healthcare professionals who dictated them for review and signature, or correction. These documents eventually become part of patients' permanent files.

To understand and accurately transcribe dictated reports into a format that is clear and comprehensible for the reader, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms. To help identify terms appropriately, transcriptionists refer to standard medical reference materials—both printed and electronic; some of these are available over the Internet. Medical transcriptionists must comply with specific standards that apply to the style of medical records, in addition to the legal and ethical requirements involved with keeping patient information confidential.Experienced transcriptionists spot mistakes or inconsistencies in a medical report and check to correct the information. Their ability to understand and correctly transcribe patient assessments and treatments reduces the chance of patients receiving ineffective or even harmful treatments and ensures high quality patient care.Currently, most healthcare providers transmit dictation to medical transcriptionists using either digital or analog dictating equipment. The Internet has grown to be a popular mode for transmitting documentation.

Many transcriptionists receive dictation over the Internet and are able to quickly return transcribed documents to clients for approval. Another emerging trend is the implementation of speech recognition technology, which electronically translates sound into text and creates drafts of reports. Reports are then formatted; edited for mistakes in translation, punctuation, or grammar; and checked for consistency and possible medical errors. Transcriptionists working in areas with standardized terminology, such as radiology or pathology, are more likely to encounter speech recognition technology. However, use of speech recognition technology will become more widespread as the technology becomes more sophisticated.Medical transcriptionists who work in physicians' offices and clinics may have other office duties, such as receiving patients, scheduling appointments, answering the telephone, and handling incoming and outgoing mail.

Medical secretaries, discussed in the statement on secretaries and administrative assistants elsewhere in the Handbook, may also transcribe as part of their jobs. Court reporters, also discussed elsewhere in the Handbook, have similar duties, but with a different focus. They take verbatim reports of speeches, conversations, legal proceedings, meetings, and other events when written accounts of spoken words are necessary for correspondence, records, or legal proof.


Employment:
Medical transcriptionists held about 101,000 jobs in 2002. About 4 out of 10 worked in hospitals and another 3 out of 10 worked in offices of physicians. Others worked for business support services, offices of other health practitioners, medical and diagnostic laboratories, outpatient care centers, and home healthcare services.


Certifications available :
Employers prefer to hire transcriptionists who have completed postsecondary training in medical transcription, offered by many vocational schools, community colleges, and distance-learning programs. Completion of a 2-year associate degree or 1-year certificate program—including coursework in anatomy, medical terminology, legal issues relating to healthcare documentation, and English grammar and punctuation—is highly recommended, but not always required. Many of these programs include supervised on-the-job experience. Some transcriptionists, especially those already familiar with medical terminology due to previous experience as a nurse or medical secretary, become proficient through on-the-job training.The American Association for Medical Transcription (AAMT) awards the voluntary designation, Certified Medical Transcriptionist (CMT), to those who earn passing scores on written and practical examinations. As in many other fields, certification is recognized as a sign of competence. Because medical terminology is constantly evolving, medical transcriptionists are encouraged to regularly update their skills. Every 3 years, CMTs must earn continuing education credits to be recertified.In addition to understanding medical terminology, transcriptionists must have good English grammar and punctuation skills, as well as proficiency with personal computers and word processing software. Normal hearing acuity and good listening skills also are necessary. Employers often require applicants to take pre-employment tests.With experience, medical transcriptionists can advance to supervisory positions, home-based work, editing, consulting, or teaching. With additional education or training, some become medical records and health information technicians, medical coders, or medical records and health information administrators


Job Outlook:
Job opportunities will be good. Employment of medical transcriptionists is projected to grow faster than the average for all occupations through 2012. Demand for medical transcription services will be spurred by a growing and aging population. Older age groups receive proportionately greater numbers of medical tests, treatments, and procedures that require documentation. A high level of demand for transcription services also will be sustained by the continued need for electronic documentation that can be easily shared among providers, third-party payers, regulators, and consumers. Growing numbers of medical transcriptionists will be needed to amend patients' records, edit for grammar, and identify discrepancies in medical records.Contracting out transcription work overseas and advancements in speech recognition technology are not expected to significantly reduce the need for well-trained medical transcriptionists domestically. Contracting out transcription work abroad—to countries such as India—has grown more popular as transmitting confidential health information over the Internet has become more secure; however, the demand for overseas transcription services is expected to supplement the demand for well-trained domestic medical transcriptionists.

Speech-recognition technology allows physicians and other health professionals to dictate medical reports to a computer that immediately creates an electronic document. In spite of the advances in this technology, it has been difficult for the software to grasp and analyze the human voice and the English language with all its diversity. As a result, there will continue to be a need for skilled medical transcriptionists to identify and appropriately edit the inevitable errors created by speech recognition systems, and create a final document. Hospitals will continue to employ a large percentage of medical transcriptionists, but job growth there will not be as fast as in other industries. Increasing demand for standardized records should result in rapid employment growth in offices of physicians or other health practitioners, especially in large group practices.