Industry Voice

KPO: The Next Big Opportunity in Healthcare

India will capture more than 70 per cent of the KPO territory by 2010

Dr Pradeep Bhardwaj

After the success of Business Process Outsourcing (BPO) in India, it is now the turn of Knowledge Process Outsourcing (KPO) to make its presence felt. KPOs deliver high value to organisation by providing domain-based processes and business expertise rather than just process expertise.

The BPO success in India is encouraging overseas companies eyeing Indian market for outsourcing their high-tech knowledge-based jobs. Operational cost saving, pool of talented workforce, infrastructure improvement and favourable government policies are the major factors responsible for driving KPOs in India. This is coupled with a shortage of talent able to provide KPO services in the US. India fills this gap with its cadre of trained professionals in the field of education, law, finance, science, medicine, IT, engineering and various other competitive fields.

India: Preferred Destination

The Indian workforce is highly literate and they are well-versed with English language, thanks to Indian educational system. Every year, India is producing hundreds and thousands of English-speaking trained professionals in the fields of IT, engineering, education, law, science, finance, architecture and other competitive fields.

Survey reveals that 45 percent of Indian KPOs have the highest quality certification like Six Sigma.

Buyers of Healthcare KPO services

The healthcare outsourcing market can be primarily divided into three major blocks:

• Providers (hospital and physical groups).
• Payers (healthcare insurance companies and TPAs).
• Drug manufacturers and clinical research.

KPO Services in Healthcare

• Medical transcription.
• Medical coding.
• Medical billing.
• Healthcare insurance verification.
• E-Marketing.
• E-Learning.
• Legal services.
• Healthcare training and consultancy.
• Healthcare knowledge management.
• Patient research.

KPO in Medical Transcription

Medical transcription services are offered through KPOs, which connect and manage with an advanced internet-based workflow monitoring system. KPO is dedicated to provide timely, accurate medical transcription services with guaranteed turnaround times.

Reports handled through KPOs are:

• Operative note.
• Progress note.
• Discharge summary.
• Independent medical evaluation.
• Telephone consultancy.
• Consultation history.
• Physical exam note.

KPO in Medical Coding

In healthcare KPOs, most of the coders are certified by the American Association of Professional Coder (AAPC) and have to have a minimum four-year experience. A certified coder is extremely careful while coding for patient records. The coder determines the code to be used following each patient disease processes. Utmost attention is paid to quality to get reimbursement from the insurance company / TPA for the service rendered by the physician.

KPO medical coder are proficient with CPT, ICD - 9 coding, Insurance / TPA and Government regulations requirement and software like ENCODERPRO, CODERITTE and HCPCS.

Benefits

Why should your company invest in KPOs? The fundamentals of outsourcing apply to knowledge-based services as well. A shortage of trained professionals shoots up the cost of maintaining such services in the host country when the same job can be done with similar precision and quality and at less than half the cost abroad. The major KPO benefits are described below.

Outsourcing to KPO firms can provide the following benefits:

• Valuable cost savings that can be utilised elsewhere.
• Standard operational efficiency.
• Trained professionals at work.
• Savings in time and management energy for maintaining in house services.
• Increase in profits.
• Option to recruit a larger work force without raising costs.

KPO Skills Defined

The following skills form the basis of knowledge-based firms and their workforce.

• Analysing data and information to produce meaningful documents.
• Researching information from various sources.
• Converting raw technical data into presentable documents.
• Use of high levels of conceptualisation and theoretical knowledge.
• Proficiency with various advanced software and hardware devices.
• Maintaining workflow, meeting deadlines, and applying quality controls.

What KPO Can Deliver to You

With a good firm, you get the following:

• Good quality work.
• Lower costs.
• On-time delivery of services.
• Uninterrupted services.

KPO Company Advantages

• KPO company guarantees 95-98 per cent accuracy and compliance with all government regulations.
• Clean claims and fewer denials.
• Experience and technological innovations ensure optimal revenue.
• Clients receive regular feedback on coding changes, front-office documentation practices, and periodic reports, such as utilisation reviews, case-mix review, and coding-related denial analysis.

KPO in Medical Billing

Medical Billing include the following:

• Patient personnel detail entry.
• Charge Entry.
• Claim submission.
• Payment reconciliation.

Key Benefits:

• Improved hospital collection and cash flow.
• Faster payment recovery.
• Higher customer satisfaction.
• Quick response.
• Can easily handle new clients without adding staff or new infrastructure.
• Minimise claim denials.
• Accurately set patients coverage expectation.

Outsourcing KPO Services Provide

• Trained professionals at work.
• Possibility to appoint a larger work force without raising costs.
• Save time and management energy for maintaining in house services.
• Standard operational efficiency.
• Valuable cost saving that can be utilised elsewhere.
• An increase in profits.

Challenges in KPO

KPOs present substantial opportunities for players in the outsourcing business.

• Maintaining higher quality standards as the stakes for the clients are higher.
• Investment in KPO infrastructure.
• The lack of good talent pool for the execution of projects.
• Requirement of higher level of control.
• Higher level of confidentiality.
• Enhanced risk management.
• KPO operations are difficult because of difficulty in finding highly trained professionals and imparting continuous training.
• Identification of performance criteria.

Continuous monitoring, assessment, feedback appropriate coaching, mentoring and identification of the right career path are also challenging assignments for KPOs.

The Road Ahead

According to a report by Global Sourcing, the global knowledge process outsourcing industry is expected to reach USD 17 billion by 2010, of which USD 12 billion would be outsourced to India.

India will be a leader in this race. According to a report by Evalueserve, India will capture more than 70 per cent of the KPO territory by 2010. The number of KPOs professionally in India, which at present is 25,000, will increase to more than 25,00,000 by the year 2010. Apart from India, countries like Russia, China, Iceland and Israel are also expected to join the KPO industry.

The writer is Deputy Medical Superintendent Indian Spinal Injuries Centre New Delhi
Email. pradeepkb28@gmail.com