Professional Documents
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SUBMITTED IN PARTIAL FULFILLMENT FOR THE AWARD OF POST GRADUATE DIPLOMA IN MANAGEMENT (PGDM)
On Marketing and business development of medical billing service for Medpro in United States
TABLE OF CONTENTS
EXECUTIVE SUMMARY............................................................................................................1 1. INTRODUCTION........................................................................................................................03 1.1 A brief insight: Medical billing industry in United States 1.2 Outsourcing medical billing services to India 2. THE COMPANY: MEDPRO SERVICE PVT LTD ................................................................ 06 2.1 About the company 2.1.1 Mission 2.1.2 Guiding light 2.1.3 Outsourcing to Medpro service 2.1.4 Services 2.2 Medical billing process 2.3 Medpros competitive strategy 3. THE PROJECT........................................................................................................................... 12 3.1 Marketing and business development of medical billing service in US 3.2 Objective of the project 3.3 Need and significance of the project 3.4 Scope of the project 3.5 Marketing of medical billing services 3.5.1 Email marketing 3.6 Business development 3.6.1 Overview of Telepsychiatry 3.6.2 Applications of Telepsychiatry 3.6.3 SWOT analysis 3.6.4 Medical and legal considerations in Telepsychiatry
3.6.5 Privacy, security and confidentiality 3.6.6 Reimbursement 3.6.7 Technology 3.6.8 The pilot project setup 3.6.9 Competitors 4. Learning and recommendations.............................................................................................38 5. Conclusion..............................................................................................................................39 6. Annexure................................................................................................................................40 5.1 Sales email sent to medical billing companies 5.2 Sales email sent to the Psychiatrists 6. References.............................................................................................................................45
EXECUTIVE SUMMARY
The United States has the largest healthcare services market in the world, representing a significant portion of the U.S. economy. In 2010, the healthcare services industry accounted for approximately $1.75 trillion in revenues and employed over 14 million people, or nine percent of the U.S. workforce. Medical billing forms one of the integral part of the healthcare industry since the healthcare professionals are reimbursed by the Medical insurance companies like Medicaid, Medicare and other private insurance companies. Medical billing & coding is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. For several decades, medical billing was done almost entirely on paper. However, with the advent of medical practice management software also known as health information systems it has become possible to efficiently manage large amounts of claims. Several companies offer full portal solutions through their own webinterfaces. The aim of the project was marketing and business development of medical billing services in United States. The target group that the company was focusing on for its medical billing services were the Psychiatrist practicing in United States. The company Medpro service is located in India from where they are outsourced by the healthcare providers in US. Outsourcing the medical billing process has many benefits like cost advantage, time factor, cost effective skilled labor etc. The company presently is in the nascent stage and is exploring new ways to expand its company. The company is looking forward to expand its customer base by providing medical billing services to the psychiatrists practicing in Pennsylvania. My project involved marketing the company by creating awareness about its service in the Healthcare industry. The best cost effective option was Email marketing. I collected the database of Psychiatrist required for Pennsylvania, New York and New Jersey. The next step that followed was the sales email template. The write up and the designing of the template was then done by me after researching about the industry. The objective of the mail was to create awareness and introduce the company to the prospective clients.
The other half my project involved helping the company with the research involved for business development. The company had figured out Telepsychiatry as a field to enter for its business development. Tele-psychiatry is the practice of psychiatry conducted via a video conference connection. A live, secure video connection is established between an offsite location (a clinic, doctor's office or home office) and a mental health facility. A typical psychiatric office visit is conducted except that the physician and the patient are not in the same physical location. Telepsychiatry is a budding industry in United States. After the research we found that this was a lucrative field to enter. This telepsychiatry project will involve tie-ups with the nursing homes located in Health professional shortage areas and hiring the psychiatrists. These psychiatrists will then provide psychiatric consultations through video conferencing software. The medical billing will then be done by MedPro. Also the company will co-ordinate between the psychiatrists and the nursing homes. A pilot project on this is to be set soon.
CHAPTER 1: INTRODUCTION
1.1: A brief insight on the medical billing industry in United States
The United States is a world leader in healthcare services and an innovator in cutting edge diagnostics and treatments. The United States has the largest healthcare services market in the world, representing a significant portion of the U.S. economy. In 2010, the healthcare services industry accounted for approximately $1.75 trillion in revenues and employed over 14 million people, or nine percent of the U.S. workforce. The U.S. Bureau of Labor Statistics estimates that growth in the industry will yield 3.2 million new jobs between 2008 and 2018. The medical billing industry evolved from the medical industrys need to outsource tedious and complex-billing procedures to specialized firms. Billing firms gather patient information, such as procedures and insurance coverage, and then submit this information to insurance companies for reimbursement. These firms track the payment process from submission to final payment to ensure payment is actually received. Since insurance companies deny payments for many minor problems, such as a wrong procedure code, this follow through alleviates a major labor intensive, and error prone, activity for most medical facilities. For several decades, medical billing was done almost entirely on paper. However, with the advent of medical practice management software also known as health information systems it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Several companies also offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training. Medical office personnel may obtain certification through various institutions which may provide a variety of specialized education and in some cases award a certification credential to reflect professional status. The Certified Medical Reimbursement Specialist (CMRS) accreditation by the American Medical
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Billing Association is one of the most recognized of specialized certification for medical billing professionals. In many cases, particularly as a practice grows beyond its initial capacity to cope with its own paperwork, providers farm out their medical billing process to a third party known as a Medical Billing Service. These entities promise to reduce the burden of paperwork for medical staff and recoup lost efficiencies caused by workload saturation, paving the way for further practice growth. A recent trend towards outsourcing in countries such as India has shown a potential to reduce costs, but it is not clear if this trend will continue or decline as a result of customer concerns over privacy. The medical billing field has been challenged in recent years due to the introduction of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a set of rules and regulations which hospitals, doctors, healthcare providers and health plans must follow in order to provide their services aptly and ensure that there is no breach of confidence while maintaining patient records. Since 2005, medical providers have been urged to electronically send their claims in compliance with HIPAA to receive their payment. Title I of this Act protects health insurance of workers and their families, when they change or lose a job. Title II calls for the electronic transmission of major financial and administrative dealings, including billing, electronic claims processing, as well as reimbursement advice. Medical billing service providers and insurance companies were not the only ones affected by HIPAA regulations, many patients found that their insurance companies and health care providers required additional waivers and paperwork related to HIPAA. As a result of these changes, software companies and medical offices spent thousands of dollars on new technology and were forced to redesign business processes and software in order to become compliant with this new act. This was in part because providers who inadvertently released Protected Health Information to the wrong entity would now be exposed to litigation under HIPAA. The main requirement is to maintain privacy of both the patient's personal or demographic details as well as providers details.
Healthcare outsourcing bridges two healthcare companies, there is a platform for sharing the technological and subject matter expertise for mutual benefits. Moreover, due to the necessity for reducing the expenses in U.S healthcare industry, healthcare outsourcing has increased to a great extent. With the benefits provided through healthcare outsourcing, healthcare companies can be more productive and successful. Organizations choose to outsource medical billing, as it is the smartest way to get benefited! Researches and surveys prove that medical billing outsourcing has become a global trend these days. Mushrooming of the medical billing outsourcing service providers is evidence to the fact that medical billing outsourcing is much preferred and widely accepted. Usually physicians and billing companies outsource medical billing due to several main reasons:
When the work load is heavy and it is inevitable to outsource medical billing To cope with the increasing need to save operations and administrative costs To help with new implementations in industry like ICD10 To aid with clearing heavy backlogs
Cost-effective: save up to 50% on operating costs! High-quality services Time zone advantage: operate 24X7 Highly skilled work force High-end technology and infrastructure Latest software and technologies Quick turnaround time
Office (US):- Boalsburge, Pennsylvania-16827 Office (India):- Lonkhandwala, Andheri(W). Director:- Mr. Paresh Sheth Website:- www.medproservice.com
2.1.1: Mission
To create a hassle-free, speedy and rewarding insurance claim process for medical practitioners as well as patients. We endeavor to create a seamless claims reimbursement process, by connecting medical practitioners and insurance companies through an expert and professional team, backed by state-of-the-art technology. Our customer-centric approach will guarantee that medical practitioners can focus on their core functions while patients receive unruffled treatments and services.
free billing management process, enabling them to concentrate all their resources towards what they do best. Medical Billing is Medpros strength, the 100% transparent and technology driven processes ensure that clients retain real-time access to their data stored on a secure platform. They assure unparalleled support across a comprehensive list of medical billing requirements, at every stage of the claims reimbursement process.
2.1.4 Services
MedPro Services is more than a claims processing center; we offer top-class patient support along with the best possible return on your claims. Medpros services address the entire ambit of medical billing, which includes the following:
Fee structuring - Analysis and Recommendations Eligibility and Insurance Verification. Patient information - Collection and Analysis Quick Rendering of Individual Claims - Professionally, Accurately & Electronically Persistent Follow-up Prompt Payments Posting patient statements - Generation and Mailing Personal Reply to Patient Billing Queries Collection of Outstanding Receivables - Effective, yet Courteously Customized Monthly Statistical Reports and Spread Sheets
Medpro services top-quality services are designed to enrich clients business by taking away the hassles and facilitating a smooth and efficient medical billing process. They meticulously manage every phase of the claims processing, to support an error-free and accurate outcome.
Pre-certification & Insurance Verification: They first check the data from the doctors appointment diary, match it with the patients demographic profile and ascertain the eligibility through an online process - thereby reducing the chances of rejections. Patient Demographic Entry: At this stage, Medpros medical billing specialists scrutinize and enter the patients details, as provided at the time of the visit. This includes details like, patients name, date of birth, address for correspondence, insurance details, medical history, guarantor details, etc. In case of existing patients, records are validated on the practice management system; changes, if any, are updated. CPT and ICD-9 Coding: Medpros AAPC certified and highly qualified coding team has over two years of experience in multi-specialty coding, allowing us to accept superbills with diagnostic notes with or without ICD and CPT codes. In case, the superbill is accompanied by the codes, our expert coding team, verifies and validates these codes to confirm that there are no glitches while up-coding or down-coding, which may lead to unnecessary denials.
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Charge Entry: Medpros billing specialists make certain that once the fee schedules are pre- loaded into the practice management system, CPT and ICD-9 codes are entered into the system. Post this, they methodically confirm that the claim contains all the necessary details and is ready to be filed. Claims Submission: Medpro then accept claims in both electronic as well as paper format. A senior billing expert scans your claim and scrutinizes it thoroughly. After the quality assurance process is complete, the claim is submitted. In case the claim is rejected, we obtain the report from the clearinghouse, incorporate the suggested changes and resubmit your claim. Payment Posting: Medpro maintain the integrity of your data by collating the electronic data and scanned EOBs with the bank data on a daily basis. Account Receivables Follow-up: The filing limits and the age of the claims are reviewed and prioritized as soon as they are entered into the system. A periodic follow-up with the insurance company, online and/or via phone/email, is carried out to get an updated status of the submitted claim. Denial Management: Medpros senior medical billing specialists carefully analyze the denials and partial payments. They contact the relevant individuals (payers, patients, providers, facilities and others) in case of denied/underpaid/pending/improperly processed claims. If the provider authorizes them to directly elicit data like the ID# from the patient, they directly contact them and update the COB (Coordination of benefits) with their insurance companies. In case of secondary paper claims, we process the necessary documents and send them to the clients office for submission. Reporting: Medpro service also customizes clients reports to suit their requirements.
market, Medpro service is taking slow and steady steps towards its growth. To start with, the company is using a Porters generic focus strategy wherein it is focusing on a narrow market segment. Medpro service follows this niche strategy and is concentrating all its resources on the niche market segment in the healthcare industry i.e Psychiatrists practicing in Pennsylvania. It has been providing medical billing services to some of the well known psychiatrists in Pennsylvania.
My project consisted of marketing of the medical billing service and business development of the same. Medical billing service is a huge business in the United States. My work for marketing involved collecting database and cold calling through emails to medical billing companies and the psychiatrist practicing in three states namely Pennsylvania, New York and New jersey. I also design ned the write up and the template for email marketing. Direct email marketing was very new to me and I had absolutely no knowledge about its working. I learnt the techniques, the dos and donts for direct email marketing through my experiments.
which in turn would help Medpro in increasing its business. Simultaneously they plan to expand their area of business and venture into a new project i.e Telepsychiatry which in turn will also provide them with more clients for their medical billing service. The significance of this project was to help Medpro service achieve this objectives.
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In addition to that, publicly traded companies are already consolidating manner! With all these, we can be sure of a vast growth in the field of healthcare and medical billing services and this will provide healthcare providers with choosing the best medical billing company for their billing needs. medical billing services through the acquisition of smaller players, and that too in a quick
Since the psychiatrists were located in a different country than my project location the options that were available was direct email marketing. Direct marketing is a channel-agnostic form of advertising that allows businesses and nonprofits to communicate straight to the customer, with advertising techniques such as mobile messaging, email, interactive consumer websites, online display ads, fliers, catalog distribution, promotional letters, and outdoor advertising. Direct marketing messages emphasize a focus on the customer, data, and accountability. Characteristics that distinguish direct marketing are: 1. Marketing messages are addressed directly to customers. Direct marketing relies on being able to address the members of a target market. Addressability comes in a variety of forms including email addresses, mobile phone numbers, Web browser cookies, fax numbers and United States and international postal addresses.
2. Direct marketing seeks to drive a specific "call to action." For example, an advertisement
may ask the prospect to call a free phone number or click on a link to a website. 3. Direct marketing emphasizes traceable, measurable responses from customers regardless of medium. Direct marketing is practiced by businesses of all sizes from the smallest start-up to the leaders on the Fortune 500. A well-executed direct advertising campaign can prove a positive return on investment by showing how many potential customers responded to a clear call-toaction. General advertising eschews calls-for-action in favor of messages that try to build prospects emotional awareness or engagement with a brand. Even well-designed general advertisements rarely can prove their impact on the organizations bottom line. A recent study by the Direct Marketing Association reports that in 2010, marketers commercial and nonprofit spent $153.3 billion on direct marketing, which accounted for 54.2% of all ad expenditures in the United States. Measured against total US sales, these advertising expenditures generated approximately $1.798 trillion in incremental sales. In 2010, direct marketing accounted for 8.3% of total US gross domestic product. Also in 2010, there were 1.4 million direct marketing employees in the US. Their collective sales efforts directly supported 8.4 million other jobs, accounting for a total of 9.8 million US jobs.
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Direct marketing is attractive to many marketers because its positive results can be measured directly. For example, if a marketer sends out 1,000 solicitations by mail and 100 respond to the promotion, the marketer can say with confidence that campaign led directly to 10% direct responses. This metric is known as the 'response rate,' and it is one of many clearly quantifiable success metrics employed by direct marketers. In contrast, general advertising uses indirect measurements, such as awareness or engagement, since there is no direct response from a consumer. Measurement of results is a fundamental element in successful direct marketing. The Internet has made it easier for marketing managers to measure the results of a campaign. This is often achieved by using a specific website landing page directly relating to the promotional material. A call to action will ask the customer to visit the landing page, and the effectiveness of the campaign can be measured by taking the number of promotional messages distributed (e.g., 1,000) and dividing it by the number of responses (people visiting the unique website page). Another way to measure the results is to compare the projected sales or generated leads for a given term with the actual sales or leads after a direct advertising campaign. Sending marketing messages through email or Email marketing is one of the most widely used direct-marketing methods. One reason for email marketing's popularity is that it is relatively inexpensive to design, test, and send an email message. It also allows marketers to deliver messages around the clock, and to accurately measure responses. Thus email marketing was the most feasible and cost effective tool to experiment with for this project. Email marketing is directly marketing a commercial message to a group of people using electronic mail. In its broadest sense, every email sent to a potential or current customer could be considered email marketing. It usually involves using email to send ads, request business, or solicit sales or donations, and is meant to build loyalty, trust, or brand awareness. Email marketing can be done to either cold lists or current customer database. Direct email involves sending an email solely to communicate a promotional message. Companies usually collect a list of customer or prospect email addresses to send direct promotional messages to, or they can also rent a list of email addresses from service companies.
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This would have led them to cut their costs on the operating expenses which in turn would have increased their profits. Keeping this objective in mind, a sales letter was drafted and then designed into a template. The template design was taken from the email marketing website Mailchimp.com. (See annexure 5.1) Step 2: Collection of the database The next logical step that followed was collection of database for these medical billing companies in Pennsylvania, New York and New Jersey. The database was collected from the internet from the websites of these medical billing companies. There were approximately 84 medical billing companies in these 3 states whose email address was available on their websites.
Step 3: Mailing A company email id was created for me purely for the email marketing purpose (shalvi@medproservice.com). Before mailing it to the medical billing companies we tested the sales letter mail on some inter mail addresses. The problem that I encountered was that the mail kept going in the spam/trash folder. Had I mailed it to the companies this would have reduced
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my chances of the mail being opened. To rectify this problem I changed some of the words and sentences which were triggering the spam filter followed by checking the mail through a spam content checker software. By error and check method I was able to solve this problem. After thoroughly checking the sales letter mail again, the mailing to the medical billing companies was started. Step 4: Outcome There was zero response from this email marketing campaign.
Step 4: Outcome The response rate this time was around 2-3% of which only 0.01 percent was positive.
services. The task wasnt as easy as I had thought. There were many hurdles in form of reimbursement, Legal, technological issues etc. But I am glad that with the research and brain storming sessions with the director we found our way out of these hurdles. And a pilot project based on the research and the market analysis is to be set up soon in Pennsylvania.
service. This sub-speciality raises questions of security and possibly HIPPA violations, so while an increased number of individual psychiatrists are adopting this method with willing, interested patients, larger telepsychiatry service providers focus on delivering telepsychiatry to formal facilities where secure video links can be established thus avoiding legal privacy issues.
Assessment and diagnosis Treatment Consultation Case conferencing and management Education continuing education and supervision Support Forensic and legal assessments Administration and transfer of data Research Psychological testing.
Many suggest consultation as the primary model for telepsychiatry, rather than the provision of direct patient care or treatment from a distance. Certainly we are aware of clinicians working in the treatment mode, but there are legal and practical implications that must be considered which are beyond the scope of this document (see Medical Legal Considerations). It is expected that the ability to provide treatment from a distance will continue to evolve and become more common. By working in a consultative way, the consultant addresses issues of duty of care and does not accept responsibility that would be impossible to carry out. This model supports the consultee who is working at a distance in an underserviced area. It does this by providing expert knowledge that would otherwise not be available, thereby multiplying the influence of the consultant beyond what would be provided through direct patient care. In this model, the agency or clinician requesting the consultation retains primary case responsibility with the patient/client/parent, and control over which suggestions to implement.
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Weakness Rapid technological changes, reliability of Communication channels, the ability of the technology to provide accurate and high-resolution images and clear voice. Shifts the doctors focus from one-on-one practices to one-to-one, via television screens. Work related hazards resulting from working long periods with video or screen based consultations. Expensive technology and requires some technical expertise.
Opportunities Telepsychiatry could help health providers in supplying quality, fast, and economical medical services to rural patients and hence, saves doctors and patients valuable time wasted in commuting large distances and hence, increases patient retention in rural areas. Specialists could utilise this saved time in seeing more patients at the main hospital. Telepsychiatry represents a more efficient use of existing medical resources, a way to attract patients living outside a hospitals normal service area, a way of bringing international healthcare dollars. Rural doctors could seek a second opinion from a specialist over the telepsychiatry technology. Could video-record session for legal and judicial reviews in case of forensic telepsychiatry. Meeting/Training rural doctors.
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Less waiting time for rural patients. Reduce turnover of medical staff at rural areas they feel isolated from the outside world. Meeting rural managerial staff and conducting managerial training. Promote other services through their telepsychiatry network.
Threats Surgeon syndrome which is conservatism towards all other technologies than ones own was highlighted as an impediment to the adoption of telemedicine. Few patients are actually being seen through the telepsychiatry for medical purposes. The governments tough position on reimbursement of telepsychiatry consultations. Justifying cost and sustaining a profitable business model. Matching technology to medical needs. Legal (e.g., restrictions of medical practices across state lines (licensure) and issues of liabilities. Other legal issues relating to operating a telepsychiatry network including corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, funders (e.g., Medicare and Medicaid) payment, fraud and abuse, medical device regulation, and antitrust (price fixing). Social issues (e.g., changing physician behaviors and traditional practices and workflow). Scheduling of the telepsychiatry encounters and sessions is another problem where a proper protocol needs to be introduced and accepted. Some doctors may view telepsychiatry negatively as they may risk losing a supplementary income paid by the hospital to visit rural areas. Others working in environments characterized by overload and stress will most likely perceive implementing telepsychiatry as an additional burden.
The most important principle is always act in the best interests of the patient. Apart from the licensure barriers other challenges are HIPPA regulations, initial visit requirement in-person in some states and prescription of schedule 1 drugs. Current Trends in Physician Licensure The U.S. Constitution delegates to each state the power to adopt laws to protect the health, safety, and general welfare of citizens. It is under this police power that the authority for licensing physicians is delegated to each states board of medical examiners. According to the Federation of State Medical Boards (FSMB), in 2010, 77 percent of physicians had only one active license to practice medicine granted by a state medical or osteopathic board, 17 percent had active licenses in two jurisdictions, and 6 percent had active licenses in three or more jurisdictions .With the advent of telepsychiatry, it is anticipated that more psychiatrists will wish to be licensed in more than one jurisdiction to increase accessibility to mental health care across state lines and address the national shortage. With per-state licensure registration fees averaging $339, however, practicing across state lines can become costly. Currently Doctor would need to obtain separate state licenses to practice telepsychiatry in addition to his license in state. Aside from the expense, the current process is time-consuming; physicians must apply for licenses and acquire continuing medical education credits, the requirements for which vary among states. However, several promising alternative models for licensing and credentialing currently exist, such as consulting exception, licenses by endorsement, licenses by reciprocity, mutual recognition, license registration, limited licensure, and national licensure. The adoption of a national medical license would allow physicians and patients to realize the benefits of telepsychiatry and telemedicine in general. The biggest hindrance to national licensure is regulatory. Medical licensing boards for the 50 states and the U.S. territories each have rules that govern the ability of physicians to practice medicine and the ability of the board to discipline physicians who violate the rules. State boards such as Californias have policies that require those who treat in-state patients via telephone or videoconferencing to be located within the state. The American Telemedicine Association (ATA) is the first major association advocating for national physician licensure in the United States.
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3.6.5: Privacy, Confidentiality and Security The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 (Pub. L 104-191). Congress sought to streamline electronic health record systems while protecting patients, improving health care efficiency, and reducing fraud and abuse. The HIPAA Administrative Simplification provisions required the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. Under the Health Insurance Portability Act of 1996, HHS adopted administrative simplification standards, applicable to any entity that is a health care provider that contains certain transactions in electronic form (referred to as covered health care providers), a clearinghouse or a health plan. Individuals, businesses and agencies providing healthcare services need to carefully assess whether their practice falls into one of these three categories in order to determine the applicability of HIPAA to their practice. If the person, business or agency furnishes, bills, or receives payment for health care in the normal course of business and transmits any covered transaction electronically, then the person or agency is a Covered Health Care Provider covered by HIPAA. Issues regarding privacy and confidentiality in the medical realm are not necessarily different in telemedicine. As with conventional medicine, a telemedicine clinician has the same duty to safeguard a patients medical records and keep their treatments confidential. Storage of electronic files, images, audio/video tapes etc., needs to be done with the same precaution and care ascribed to paper documents. One unique challenge for telemedicine is to balance the requisite expansion of manpower to manage an electronic system with the increased number of people who have potential access to a patients records. Telemedicine, at least at present, will require a technical staff to run the system that is completely independent from the medical team. Additionally, because of technological constraints, the transmission of information over communication lines lends itself to hackers and other potential exposure. Protocols must be scrupulously followed to ensure that patients are
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informed about all participants in a telemedicine consultation and that the privacy and confidentiality of the patient are maintained, as well as ensuring the integrity of any data/images transmitted. Patients may also be skeptical about the use of video images and the idea of unseen persons during their exams. Additionally, fears about the reliability of the technology and the potential devastation that loss of the information would cause, leave some wary of telemedicine. However, these concerns over the technology can be addressed through a combination of legal, technical and administrative security measures and patient education.
3.6.6: Reimbursement
Medicare: Medicare provides reimbursement for telemedicine services, however, it is limited.
Medicare will pay for a limited number of Part B services that are furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter. Originating Sites An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a rural health professional shortage area (HPSA) or in a county outside of a Metropolitan Statistical Area(MSA). Entities that participate in a Federal telemedicine demonstration project approved by (or receiving funding from) the Secretary of the Department of Health and Human Services as of December 31, 2000 qualify as originating sites regardless of geographic location. The originating sites authorized by law are: The office of a physician or practitioner; Hospitals; Critical Access Hospitals (CAH); Rural Health Clinics (RHC);
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Federally Qualified Health Centers (FQHC); Hospital-based or CAH-based Renal Dialysis Centers (including satellites); Skilled Nursing Facilities (SNF); and Community Mental Health Centers (CMHC).
Distant Site Practitioners Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are: Physicians; Nurse practitioners (NP); Physician assistants (PA); Nurse midwives; Clinical nurse specialists (CNS); Clinical psychologists (CP) and clinical social workers (CSW) (CPs and CSWs cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for Current Procedural Terminology [CPT] codes 90805, 90807, and 90809); and Registered dietitians or nutrition professionals.
Tele-health Services As a condition of payment, an interactive audio and video telecommunications system must be used that permits real-time communication between the physician or practitioner at the distant site and the beneficiary at the originating site. Asynchronous store and forward technology is permitted only in Federal telehealth demonstration programs conducted in Alaska or Hawaii. The current list of Medicare telehealth services includes: Consultations (CPT codes 99241 99255); Office or other outpatient visits (CPT codes 99201 99215);
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Individual psychotherapy (CPT codes 90804 90809); Pharmacologic management (CPT code 90862); Psychiatric diagnostic interview examination (CPT code 90801); End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment (CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961); Individual medical nutrition therapy (Healthcare Common Procedure Coding CPT only copyright 2008 American Medical Association. All rights reserved. system
[HCPCS] code G0270 and CPT codes 97802 97803); Neurobehavioral status examination (CPT code 96116); and Follow-up inpatient telehealth consultations (HCPCS codes G0406, G0407, and G0408). For ESRD-related services, at least one face-to-face, hands on visit (not telehealth) must be furnished each month to examine the vascular access site by a physician, NP, PA, or CNS. Billing and Payment for Professional Services Furnished Via Telehealth Distant site physicians and practitioners submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, via interactive audio and video telecommunications system (e.g., 99243 GT). By coding and billing the GT modifier with a covered telehealth procedure code, the distant site physician/practitioner certifies that the beneficiary was present at an eligible originating site when the telehealth service was furnished. By coding and billing the GT modifier with a covered ESRD-related service telehealth code, the distant site physician/practitioner certifies that one visit per month was furnished face-to-face, hands on to examine the vascular access site. Billing and Payment for the Originating Site Facility Fee For telehealth services, originating sites are paid an originating site facility fee (as described by HCPCS code Q3014). The originating site facility fee is a separately billable Part B payment. Physician and practitioner offices that serve as telehealth originating sites bill the Medicare Carrier or A/B MAC for the originating site facility fee. Hospitals, CAHs, RHCs, FQHCs, hospital-based or CAH-based Renal Dialysis Centers, SNFs, and CMHCs that serve as Medicare telehealth originating sites bill the FI or A/B MAC.
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Medicare Eligible CPT Codes for TeleHealth Effective January 1, 2009 Only the codes mentioned below are eligible for reimbursement from the medicare: 1. Consultations (CPT codes 9924199275) 2. Office or other outpatient visits (CPT codes 99201 99215) 3. Individual psychotherapy (CPT codes 90804 90809) 4. Pharmacologic management (CPT code 90862) 5. Psychiatric diagnostic interview examination (CPT code 90801) Effective March 1, 2003; 6. End Stage Renal Disease (ESRD) related services (HCPCS codes G0308, G0309, G0311, G0312, G0314, G0315, G0317, and G0318) Effective January 1, 2005; 7. Individual Medical Nutrition Therapy (HCPCS codes G0270, 97802, and 97803) (Effective January 1, 2006); and 8. Neurobehavioral status exam (HCPCS code 96116) (Effective January 1, 2008). Use the Telemedicine modifier GT In January, 2010, The list of Medicare telehealth services was expanded to include: 9. HCPCS Code 96150 (Initial Assessment): 10. HCPCS Code 96152 (Intervention - Individual): 11. HCPCS G0425 (Problem Focused): 12. HCPCS G0426 (Detailed): HCPCS G0427 (Comprehensive): 13. HCPCS G0406: Follow-up inpatient telehealth consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth; 14. HCPCS G0407: Follow-up inpatient telehealth consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth; and 15. HCPCS G0408: Follow-up inpatient telehealth consultation, complex, physicians.
Medicaid: While CMS has not defined telemedicine for Medicaid, at least 27 states have
implemented their own definition and included some form of reimbursement for telemedicine. A study of state Medicaid reimbursement in 2005 revealed 24 states to be reimbursing for telemedicine services. Regarding who receives reimbursement, all of the 24 sates reimbursed
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physicians and most nurse practitioners. Reimbursement for hub and spoke sites varied by state in terms of both physician payment and facility fees.
Private payers: Private Insurance reimbursement for telehealth varies from state to state.
Twelve states require private insurance companies to reimburse for telehealth (Maine, Oregon, California, Colorado, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Texas, Oklahoma, Virginia).
3.5.7: Technology
A web-based, encrypted, video conferencing service is required to provide telepsychiatric sessions. The service is used to connect a physician in one location with a consumer in a clinic in another location, which may be hundreds of miles away. Psychiatric evaluations and med checks and other services are conducted remotely. Many tele-conferencing companies provide HIPPA compliant video conferencing software. This software can be used instead of SKYPE, Yahoo etc since they are not HIPPA compliant. The company providing video conferencing software figured out by us for our telepsychiarty pilot project was Secure tele-health. About Secure tele-health: Secure Telehealth provides a high-quality, web-based, encrypted, video conferencing service to the behavioral health community using cloud computing. Secure video conference sessions may be safely conducted from any location. No firewall changes are necessary, so the solution is portable. Sessions may be conducted from anywhere that a laptop is connected to the Internet. How it Works: A Secure Telehealth meeting room is purchased for $300/month. A web cam ($57) and a special microphone ($133) are installed on each endpoint computer. Physicians invite staff at participating clinics to join them in their meeting by sending a link via email containing the URL and password for the meeting. The first time the recipient clicks on the link, the software is automatically installed. Then the participants click Join. At this point the two participants can see and hear each other through the computer. Typically, physicians schedule clients every 30 minutes. Fifteen minutes are spent with the client on camera, and fifteen minutes are spent typing
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patient notes into the EHR software program and ePrescribing. The physician may stop his/her camera while typing, but leaves the audio on so he/she can hear when the next patient has entered the room and is ready to start. The physician may type patient notes while the patient is on camera, but he/she must exercise good judgment by not appearing to be distracted. Base Pricing: The base software package (one meeting room) costs $300/month. This is a flat fee. A customer who purchases the meeting room may do the following: 1. Install the software on any number of PCs 2. Conduct any number of one-on-one sessions between any two computers. 3. See patients in multiple facilities. The monthly fee includes ongoing training, support, and assistance with development of administrative, clinical, and technical processes which are outlined in the American Telemedicine Associations Practice Guidelines. Each of your endpoints has unlimited direct access to our tech support. Quality Control: Consistent high-quality audio and full-screen video (640X480) (30 frames per second) is maintained under the following conditions: 1. Windows PC processor 2.4 Ghz or faster (dual-core processor) PC Ram 2 Gigabytes or more 2. Internet Connection Speed Consistent 750 kb/sec upload and download. Either share your existing Internet connection or spend $50 per month on a dedicated broadband Internet connection to support the video conferencing computer. 3. Room lighting your image is improved if you are facing a window or light source. 4. Room Background a plain wall behind you reduces the amount of data sent by the camera. HD Quality (1280x720) is available to all Secure Telehealth customers simply by choosing the HD option on the Video screen. HD consumes 3x more Internet bandwidth and requires a dualcore PC. Other than that, there is no additional charge for running in HD mode. Encryption Specifics: Secure Telehealth provides the best encryption available anywhere. 1. Certificate exchange between endpoints (PKI validation) is done with 1024 bit encryption
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and AES 256-bit cipher. 2. Data payload (audio + video + shared documents) is encrypted with DHE RSA AES128 w/SHA encryption. 3. Secure Telehealth complies with the federal government requirement for encryption (FIPS 140-2) 4. Users cannot defeat the encryption mechanism. It is built-in to the software. 5. Secure Telehealth does not depend on any outside device for encryption, so we are safe to use anywhere (even in physicians homes). Hardware Firewalls are not required. Private T-1 networks and IT configuration are not required. Some room settings (such as observing children at play) require specialized cameras and microphones. Secure Telehealth supports such options with specialized equipment. Software Support is Included in the monthly fee. Secure Telehealth software is easy to use and reliable. It does not require any firewall configuration by IT. Unlimited software support is provided free of charge with your meeting room.
Procedures/Documentation: Secure Telehealth provides written procedures for end users and meeting administrators. Procedures guide the users/administrators through the process of setting up meetings, inviting participants to meetings, joining and conducting meetings, and terminating meetings.Secure Telehealth maintains documentation for each configuration. This allows us to provide better remote support. We help you develop processes and procedures required by ATA Practice Guidelines published in December, 2009. ATA guidelines incorporate best practices for videoconferencing-based mental health services. The guidelines describe roles, responsibilities, communication, and procedures to insure a high standard of care. These guidelines help you develop: a. Technical specifications for quality and redundancy b. Staff Roles/Responsibilities
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c. Physical location/room requirements d. Privacy requirements e. Standard Operating Procedures/Protocols f. Quality improvement process g. Consent requirements h. Cultural competency requirements and accommodations for special groups. Training: Included in the monthly fee is video-based training covering the following: 1. Managing meetings (startup activity - video conferences are recurring, standing meetings which get re-used as long as necessary) a. Scheduling including privacy controls b. Inviting 2. Conducting meetings a. Joining/Terminating b. Adjusting audio and video c. Using different video formats d. Sharing handouts and other files e. Chats 3. Camera skills + etiquette a. Maintaining eye-contact b. Projecting your voice c. Engaging your client d. Reducing potential client anxiety 4. Maintaining privacy HIPAA Business Associate Secure Telehealth is a HIPAA-compliant service. Upon request, we will sign a HIPAA business associate agreement with our customers. The BAA allows us to interact with clients via video (if necessary for training or tech support). The customer may choose to invite Secure Telehealth
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technicians into a live meeting with consumers for the purpose of training or answering tech support questions.
For the pilot project the psychiatrist would only consult patients seeking consultations from the nursing homes of the health professional shortage areas in Pennsylvania. There are approximately 103 nursing homes located in these health professional shortage areas (HPSA) in Pennsylvania. Of which only the nursing homes located in the Mifflin county would taken into consideration for the pilot project. The psychiatrist from a distant site will meet the patient located in the originating facility through telehealth meeting room. After the telepsychiatry session is completed the psychiatrist would taken down the notes on the EMR software and then the rest would taken care by Medpro service. Medpro service will then bill the insurance company for the telepsychiatry encounter. Similarly the originating facility will bill the insurance company for originating facility fee separately. A brochure was drafted and designed that would be mailed to the nursing homes for the marketing of the telepsychiatry services.
3.6.9: Competitors
Some of the competitors in the telepsychiatry industry are: 1. Breakthrough.com Breakthrough connects people with mental health providers anywhere, anytime for highquality online counseling and psychiatric care. They help people connect with mental health providers anywhere, anytime for high-quality online counseling and psychiatric care. With over two million covered members and health plan partners including Blue
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Shield of California and Magellan, Breakthrough is the leading online counseling and psychiatry service. Cost model: Contracts with the Insurance company. No cost is incurred by the provider and patients. Breakthroughs costs are taken care of by the insurance company. Providers are reimbursed with same rate as face to face sessions. Billing process is almost similar. Provider will be responsible for collecting co-payment from the patient through credit card or pay pal or account transfer. 2. E-Mental health center E Mental Health Center is a state-of-the-art online mental health center designed by mental health experts with you in mind. The story behind its creation follows: Dr. Carvajal, the founder, was looking for an online psychotherapist to provide services to a family member who did not have time to see a therapist face-to-face due to her busy schedule. Upon attempting to find an online mental health professional that could provide face-to-face online therapy, he became frustrated after encountering online therapy websites that were difficult to navigate, crowded with information, poorly designed, and full of distressing colors. Due to the preceding reasons, the founder decided to create a considerate, convenient, confidential, and comforting online therapy space. This in turn became the mantra summarizing the mission of E Mental Health Center. Cost model: E-mental health center works on out of pocket model where the patient has to incur the expenses of the telepsychiatry session and pay the psychiatrist through paypal or credit card. E-MHC will charge the psychiatrist 25% of sessions amount for using the platform.
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how to write emails to different people from sectors of the healthcare industry in US as I was the point of contact between these people and the company.
Recommendations:
A profitable cost structure has to be designed to stay ahead of the competition. Re-designing of companys website to also include the cost structure. Some of the images used on the companys website are also used by one of the competitor Medusind, the images should either be copyrighted or replaced by other copyrighted images so that they dont deceive the clients.
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CONCLUSION
The United States is a world leader in healthcare services and an innovator in cutting edge diagnostics and treatments. The United States has the largest healthcare services market in the world, representing a significant portion of the U.S. economy. Medical billing service is one of the contributing factors to the US economy. Several companies offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training. Medpro service is one the medical billing company which provides medical billing service to the psychiatrists practicing in United States. MedPro Service is a HIPAA compliant service provider in the health-care industry. They cater to all the medical billing requirements. Medpro service was established a few years back with the objective of helping Dr. Nitin Sheth, a practicing psychiatrist in Pennsylvania with his medical billing. They developed their software to do the billing and submit the medical claims to the insurance companies. Today after acquiring expertise in this area Medpro has acquired some of the well known clients in the healthcare industry. Now they wish to increase their client base and acquire few more medical professionals which in turn would help Medpro in increasing its business. Simultaneously they plan to expand their area of business and venture into a new project i.e Telepsychiatry which in turn will also provide them with more clients for their medical billing service.
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CHAPTER 5: ANNEXURE
5.1 Sales email to Medical billing companies
Forward to a Friend
Now dont just reduce your medical billing costs but also increase your revenue just by outsourcing to Medpro service. Are you facing an increase in denials and operating costs, accompanied by a lower reimbursement than expected? Are you spending more time on your practice administration than patient care? In todays health care scenario, healthcare providers are facing challenges such as increasing regulations, increasingly complex coding, declining reimbursements and increasing operating costs. We at MedPro understand this and are here to help you with your administration. Our services assist in an uninterrupted, speedy and error-free billing management process at lower cost, enabling you to concentrate all your resources towards what you do best.
About us: MedPro service is one of the foremost HIPPA compliant medical billing company specialized in Psychiatry. Medical billing is our strength and with us as your medical billing partner, you can be sure of cutting down on operating costs, while reducing the number of denials. MedPro service not only reduces your operating cost but also helps you increase your revenue. We are based in India and by outsourcing to us you
What better way to understand the impact our services have on clients than to hear it from the clients themselves!
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can be assured that you save on costs and increase your revenue by: Controlled operating cost Time zone advantage Skilled expertise Improved customer service Increased productivity and efficiency Reduced delivery time Decrease in denials
By outsourcing to MedPro service you can gain access to high quality services at lower costs, thus reducing your costs by 50-60% and increasing your revenue. Make a decision to outsource medical billing services to medpro today and give your healthcare practice a competitive edge. Please feel free to contact us for any further details.
forward to a friend Address Details 140, Round Hill road, Boalsburge, Pennsylvania-16827. USA. Tel.:215-550-5292
Copyright |2012| |MedPro service|, All rights reserved. Our mailing address is: shalvi@medproservice.com
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Reduce your COSTS by 50% - Just by sub-contracting to MedPro for your clients medical billing needs.
Why MedPro?
About us We are MedPro service, universal outsourcing solution for medical billing, based in India. Medical Billing is our strength. We assure unparalleled support across a comprehensive list of medical billing requirements, at every stage of the claims reimbursement process. By outsourcing us you can be assured that you save and earn more profits by: Controlled operating cost Time zone advantage Increased productivity and efficiency Skilled expertise Improved customer service
Testimonials As a medical billing Solutionz, LLC. company, you undoubtedly know that "Thanks to MedPro, we there is nothing worse can now concentrate our for a business than ever resources on the tasks that really matter without increasing overhead having to worry about costs, operating expenses, competition peripheral processes like and decreasing profits medical billing. We pass and customer base. But on the savings to our you may also appreciate clients, who value us for that!" the extent of opportunity you may Dr Nitin Sheth (MD) have for additional "We have been associated profits. with MedPro for our medical billing requirements for over a year. Their proficient
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What distinguishes us from other companies is our 100% transparent and technology driven processes which ensure that you retain real-time access to your data, stored on a secure platform. Additionally we are HIPPA compliant and Act as a catalyst for facilitating better and quicker medical billing services.
team members and managers have proved to be a great extension of our in-house teams. Working with them is truly wonderful."
By outsourcing to MedPro service you can gain access to high quality services at lower costs, thus reducing your costs by 50-60%. We look forward to a successful working relationship in the future. For further details please feel free to contact us.
forward to a friend
Copyright 2012 MedPro service, All rights reserved. Our mailing address is: shalvi@medproservice.com
Address Details 140, Round Hill road, Boalsburge, Pennsylvania-16827. USA. Tel.:215-550-5292
References:
Books:
Marketing management by Philip Kotler Marketing management by Rajan Saxena Links: 44
Medical billing in US- www.wikipedia.com Sales mail template- www.mailchimp.com Tele mental health network provider comparisionshttp://www.telementalhealthcomparisons.com Telepsychiatry literature overview - http://priory.com/psychiatry/telepsychiatry.htm Telemedicine paid report- http://www.reportlinker.com Pennsylvania federally qualified health centers http://www.pachc.com/health_find.html Telehealth resource centre- http://www.telehealthresourcecenters.org Quick references CMS website http://www.cms.gov Report on telepsychiatry and case studies- PDF TelepsychiatryProgramsED.pdf Reports http://www.chcf.org/topics/telehealth Market research reports- http://www.marketresearch.com Data for HPSA facilities- www.datawarehouse.hrsa.gov Data for nursing homes located in HPSA http://app2.health.state.pa.us www.medicare.gov HPSA/PSA (Physician Bonuses) - www.cms.gov/hpsapsaphysicianbonuses Centre for telehealth and e-law http://ctel.org/ Residency Programs - https://www.residencyplace.com http://www.acgme.org https://nf.aafp.org
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