JOIN US The US healthcare industry went through a massive transformation in the past month with the implementation of ICD-10, which is the tenth revision of WHO’s International Classification of Diseases.
As of the first three weeks since October 1, when it was first implemented, it has seen over 13 million institutional and physician ICD-10 claims valued at over $25 billion, according to RevCycleIntelligence.com’s report on recently released data from RelayHealth Financial. Such reported claims were processed across 2,400 hospitals and 6,30,000 healthcare providers, the report said.
Implementation of ICD-10 implies that the number of medical codes which used to be around 18,000 as per ICD-9, has now gone up to around 1,40,000. Medical codes are numeric or alphanumeric codes assigned to diagnosis codes and procedural codes. These codes are used by insurance companies for billing and reimbursement.
“Most regions including Europe, Australia, New Zealand, Canada, Japan and even India are already on ICD-10. Only the US heavily uses it for reimbursements. Other countries mostly use it for gathering and tracking data,” said Gopi Natarajan, CEO, Omega Healthcare, US-based offshore provider of healthcare outsourcing services.
“The ageing population and Obamacare in the US has caused an increase in the number of people that go in for medical treatments here,” said Tony Mira, CEO, Ajuba Solutions, a Michigan-headquartered provider of healthcare revenue cycle outsourcing services with three delivery centres in Chennai. These conditions have given ground for companies in the space to scale up operations to cater to the rise in demand.
Second-largest pool
India has the second largest pool of medical coders after the US with an estimated 15,000-16,000 coders. The US is believed to have over 2,50,000 coders. Although a far second, India exhibits great potential. Some of the companies in India that offer healthcare outsourcing services include Omega Healthcare, Ajuba Solutions, Genpact, Cognizant, etc.
“The US still has a significant amount of medical coders, but in terms of trained and certified medical coders India stands way apart,” said Mira. “For one, the ageing population in the US means that coders are also aging. They are resistant to change, and learning new codes,” he said. “Whereas in India, there is an inherent talent for coding, backed by strong basics in maths and biology.”
Natarajan notes that about 70 per cent of the coders in India are already trained in ICD-10. He believes that with the inception of ICD-10, “The number of medical coders in India is set to double in the next two-three years.” “And, going by those standards, the industry stands to generate yearly revenues of $400 million in the next three-four years,” he says.
“But most of the coding that is done in India is based on physician billing. Hospital billing, which is a much larger pie, is still nascent here. Ajuba Solutions has been doing hospital coding in India only for the past two years,” says Mira.
Earlier this year, the CMS (Centers for Medicare and Medicaid Services, a federal agency within the United States), announced a grace period of one year for ICD-10. Further, lawmakers have allowed another six months from October 1, where claims “shall continue to be processed and paid, as applicable, if submitted with ICD-9 codes”. This presents a great opportunity for Indian service providers, who have penetrated only a quarter of the US market.
Winning code
ICD-10 codes are used by insurance companies for billing and reimbursement.
Ageing population and Obamacare in the US has increased the number of patients there
India has the second largest pool of medical coders after the US with an estimated 15,000-16,000 coders
The industry stands to generate yearly revenues of $400 million in the next three-four years