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    28 views43 pages

    DocScanner Dec 20, 2023 13-41

    Uploaded by

    abhishek pandey

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    © All Rights Reserved
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    cam Kopel, Thane (1) — 400 068 Jeu 0 the Univeralty of Mumba Summer Internship Project Report Titled “TO STUDY THE FINANCIAL CHALLENGES FACED BY THE ORGANISATION IN PROCESSING THE INSURANCE CLAIMS.” In the partial fulfillment of the Degree of MMS By Ms. Rosemary. Thomas [Roll No. 48] Semester III & FINANCE Batch: 2021-23 Under the Guidance of Company Guide Ms. Neeti Priyadarshini (HR & Manager- Associate Lifecycle, Calibehr Business Support.) Faculty Guide Prof. Dr. Sampurna Mehta (Project Guide) 2021-23 EXCELSSIOR EDUCATION SOCIETY'S K.C. COLLEGE OF ENGINEERING AND MANAGEMENT STUDIES AND RESEARCH a Kopri, Thane (© (ed to the University of Mumbai) 400 063 CERTIFICATE This is to certify that Ms. ROSEMARY THOMAS a student of Class: MMS Semester: II] bearing Roll No. 48 has successfully completed the project titled, “TO STUDY THE FINANCIAL CHALLENGES FACED BY THE ORGANISATION IN PROCESSING THE INSURANCE CLAIMS.” > in the partial fulfillment of the Degree of MMS. Place: THANE Date: 21" Jan 2023, Prof. Dr. Sampurna Mehta Signature of the Project Guide: Signature Institutes Seal: HOD STUDENT DECLARATION Thereby declare that the project titled “TO STUDY THE FINANCIAL CHALLENGES FACED BY THE ORGANISATION IN PROCESSING THE INSURANCE CLAIMS.” is my own work conducted under the supervision of Prof. Dr. Sampurna Mehta, 1 further declare that no part in this project work has been plagiarized without proper citations and has not formed the basis for the award of any degree, diploma, associateship, fellowship previously. Rosemary Thomas Signature of the Student: QQesegess SSE calibehr Ref: HR/101206/22 Date: 2 July , 2022 Miss, Rosemary Thomas ‘Sub ; fixed term internship certificate RE: vour deputation as entry level Finance Analyst with our client Here Solution Private limited at Mumbai from 02 may With Reference to your application for internship in our organization we are pleased to appoint you in this location from the date mentioned above This is to certify that Mrs ROSEMARY THOMAS, student of K.C.COLLEGE OF MANAGEMENT STUDIES AND RESEARCH, THANE has successfully completed a summer internship with our organization at HERE SOLUTION as an entry level finance intern related to insurance claims, from 2 MAY, 2022-30 JUNE 2022 During her internship, she was exposed in insurance claims details and processing claim of the customers. Here we found her to be punctual, hardworking and diligent towards the work. We appreciated for completing internship with our organization for this period of time We wish her all the success in her academic endeavors and life. Warm Regards, For Calibehr Business Support Ser es Pvt. Ltd. Manager- Associate Lifecycle Narayan Galibehr Business Support Services PviLtd Regd Of: Abel Estate Put Lid Ground Bhargava Sorporate OM 7-361 6m Floor. Te park Floor. OF Saki Vinar Road. Opp John Grouss Fram ekay Sten Bulding C80 Belapur.Naw Geko. Ancner (eae, Raunbor-aCcO92 fumboi. Maherashira 40084 TO22-6i901dae TOsanvoneee eee Se 1 UL Iv, 10. 12, 13, TABLE OF CONTENT Title page Certificate from the company Certificate from the Institute Declaration Acknowledgement Introduction Industry overview Company profile Literature review Research methodology Objectives of the study Scope of the study Methodology + Data collection + Research Process + Tools for analysis Limitations of the study Data analysis and interpretation Findings ‘Suggestions and recommendation Bibliography UMMARY re process. It is all about emship was done in the medical billing hh tients in ion related to Suboureing the information and maintaining the records of the each patients information rela es. AS we know that India is a country where we have to outsource and wurance and its poli er it i out the Provide services to many business in worldwide range. The summer intem report is ab medical billing proce: The medical billing is the process of processing healthcare insurance and “nsuring the duly payment and refunding the finance which has been paid previously. Here we works as an ag "and a middle person between the patient and the insurance company. We work for the finance matters in the insurance, The main aim of the Project is to study how insurance claims works and how we outsource the information by Working as an agent. This study helps to find out the Giferent insurance system and how company earns profits by outsourcing the business. In e ting System medical transactions and patie information is maintained in the form of manual Feonds. In this process data is not accurate there are chances of losing data and retrieving old records is not possible. The United States has the targest heattheare services market i the world, rep Fesenting asignifieant portion of the U.S. economy. In 2010, the healtheare services industry sccounted for approximately $1.75 trillion in revenues and employed over 14 million people, or nine Percent ofthe U.S. workforce. Medical billing forms one of the integral part of the healtheare industry Medical billing & coding is the process of submitting and following up on claims to insurance companies in order eceive payment for services rendered by a healthcare provider. For Satirely on paper. However, with the advent of medical “are also known as health information amounts of claims, web- interfaces, NIRODUCTION £04 os a ys oer oat sree ATTN OD ‘The United States is a world leader in healthcare services and an innovator in cutting edge diagnostics market in the world,representing ‘and treatments. The United States has the largest healthcare servi 4 significant portion of the U.S. economy. In 2010,the healtheare services industry accounted for Approximately $1.75 wrllion in revenues and employed over 14 million people, or nine percent of the US: 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 industry's need to outsource tedious and complex-billing procedures to specialized firms, Billing {ths gather patient information, such as procedures and insurance coverage, and then submit this for reimbursement, These firms track the payment process from information to insurance compani submission to final payment to ensure payment is actually received. Since insurance companies deny hisments 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 decades, medical billing wa 's done almost entirely on paper. However, with the advent of ement sohware a sical practice mang so known as health information systems it has become caible to efficiently manage large amounts of claims. Many software companies have arisen » provide medical billing software to this particularly lucrative segment of the market. Several © panies also offer full portal solutions through their own web-interfaces, which negates the cost jndividually Heensed software packages. Due to the rapidly chan , health ins requirements by ance compenies, several aspects of medical billing and medical office management ine created the necessity for specialized training. Medical office personnel may obtain certification jough various institutions which may provide a variety of specialized education and in some aes award a certification credential to reflect professional status. The Certified Medical seimbursement Specialist (CMRS)accreditation by the American Medical Billing Association is one of ge most recognized of s pecialized certification for medical billing professionals. In many cases, anicularly as a practice grows beyond its initial capacity to cope with its own paperwork, oviders farmout their medical billing process to a third party known as a Medical Billing Service. hese entities promise to reduce the burden of paperwork for medical staff and recoup lost fficiencies caused by workload saturation, paving the way for further practice growth. A recent end towards outsourcing in countries such as India has shown a potential to reduce costs, but it is at clear if this trend will continue or decline as a result of customer concerns over privacy. The edical billing field has been challenged in recent years due to the introduction of the Health surance Portability and Accountability Act (HIPAA). HIPAA is a set of rules and ulations which hospitals, doctors, healthcare providers and health plans must follow in order to ovide their services aptly and ensure that there is no breach of confidence while intainit Patient records. Since 2005, medical providers have been urged to electronically send their ums in compliance with HIPAA to receive their payment. Title I of this Act protects health surance of workers and their famili msmission of when they change or lose a job. Titlell calls for the electronic f major financial and administrative dealings. including billing, 3 electronic claims Processing, a8 well as reimbursement advice. Medieal billing service providers and surance companies Were Not the only ones attected by HIPAA regulations, many patients found a their insurance companies and health care providers required additional waivers and paperwork seated 1© HIPAA. AS a result of these changes, software companies and medical offices aie thousands of dollars on new technology and were forced to redesign business processes a software in order {© 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 provider's details, Ousourcine medical billing service to India aring the Healthcare outsou: ‘althcare companies, there is a platform for shari is 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 healtheare 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 1o several main reasons: OTo help with new implementations in industry like ICD10 UTo aid with clearing heavy backlogs Outsourcing to India has many advantages UCost-effective: save up to 50% on operating costs! OHigh-quality services OTime zone advantage: operate 24X7 OHighly skilled work force Wigh-end technology and infrastructure Latest software and technologies 1Quick turnaround time aa jity and Insurance Verification, bility @ igi a ae Analysis il pau ck Rendering of Individual Claims . Professionally, Accurately & Electronically Sa Follow-up oP pt Payments Posting prem ot statements - Generation and Mailing papati onal Reply to Patient Billing Queries personal collection of Outstanding Receivables - Effective, yet Courteously Bs siomized Monthly Statistical Reports acu and Spread Sheets, try to clear Insurance claim and its process of clearing the claim is the main topic. We as ai agent try the insurance claim and resolve the claim by findi ng out who owes to pay the claim. Medical billing and coding '8 iS an important piece ‘th most admis have excellent attention to detail in the administrative puzzle that makes up the vast health industry. As wi Strative jobs, medical coding and billing ve an extremel: gar ueet OP GOGe or lemecumic stelericat can Reus Ge y professionals need to negative Medical billing and coding specialists usual appropriate documents are all used on contact with patients. Medical coders work gather and provide Medical billing is a payment practice with healthcare provider obtaining insurance ix ct following up on and appealing {iment were and prices are applied become certified by taking nif gnosis and Encouraged, but not required by law, ‘6 an exam such as the CMRS, Exam, RI HIA Exam, CPB ide a am!" and others, “tion schools are intended to Provide a theoretical Srounding for students enterin, the medical billing Ht Some community colleges in the United States offer certificates, or ev hse secking deg en associate es, in the field, Tained in medical coding or transcription or auditin; codin ig and may “or graduate degree in medical information science and technology, 5 : “ © to state rin 1 hve a CeTLCALON 4 ear tig, an Dilling practives vary from state to st ott 2 we ibility, check tne aval Iulling pees eles sation ot patients, verifying finanetal responsibil wv aad stechou of pauls, propane and ty prepare patient statements and follow up on py 2 payer adjudication, mitting clams, monitoring pay! Mitiont payments and settlement suovesstitl medical billing depends upon skilled handling tment posting fimetions, Krom statting tw the natural WorkMow ean cause and uel Y completion of the charge entry sal challenges tod © patient volume, any disruption complications and sig able solution For managing your billing c. You need nificantly impact your bottom line, You ni concems without breaking the bank. We hive and train certified medical bitte assigt accurate and rel : emographic di who provide accurate entry of patient demographit levant medical codes to the comprehensive services ne sure preeise charging for service delivered, and ensure p dered. IC all adds up to ek claims, proper’ billing, ePtcotHcecs" {8 ICD-9 Coding timely, reimbursement for you Patient Demographic we Entry | Verteaton Charge yey Entry Medical Billing Process | Reporting : ‘Claims, Submission ‘Denial Management ontraet Mana, wement bring power to the Regotiating table with data that transl hance SUF contracted rate ‘ate to higher reimbursements, W. form your conu with our healtheare contract may © can protect or ict negotiations. We ind software s gement services ‘olutions that track payments, time them, and help capture you more revenue. 6 heare payment lifecye Ne Payment lifseycte, yoy Need tools that quickly identify revenue + gars: Our analytics tools with predic a red performance, more accurately forecaste ™*lysis provide knowledge that guides you tow d proj v0 “ections, and improved bottom-line results. i ifeation 8 INSUINEE Verification, ee company Fist Check the data from tne doctor” and ascertain caucing the chances oF rejections 7 appointment diary, mateh it with the "s demographic profile Ws ‘he eligibility through an online Process - thereby i Demographic Entry: ‘ame, date of birth, address for correspondence, ete, surance details, medical history, Buarantor details, In case of existing patients, records are jaldated on the practice management ‘anges, if any, are updated. systein; ch - loaded into the cred into the system. Post this, they he necessary details and is ready to be filed. nior billing expert assurance process is complete, the Im case the claim is rejected, we obtain the Feport from the clea ringhou ""Porate the suggested changes and resubmit your claim poms 20H DORTES LEG es inte dete ee ; wm na : : ing levels are ti “ig workdls, EDCE than static Receables (AR) ad revenue even, ‘optimization chase En speci win » Wzet solution thu works sey data entry ueilitates detatted unlessly with your t UI fiveitin COSINE discover harge capture, and the amprshensive charge cap ' oir can directly impact YY and elimination of errors, ye So Pet ne Tal ea ‘what we bring to your practice nsec fi ’ as IE COmPLestics OF metic biting Wear ialty have esas. YOU epea refers deny ean f “ty of specialties and aneillary/allied We ices. Every specialty: Ind subspecy Unique challenges that we are ‘ndon smooth and ettective billing for your patients, pon as they are The filing limits ond the age of the claims are reviewed and Prlovitized as soon as they cnered info the system, 4 PeHiodic follow-up with thy MSurmce company, online and/or via Hlonelemail is carried out 16 get an Updated st Us OF the submitted claim, The senior medical biting Pevialists carefully analyze the denials and partial contact the reley, Paymeni ‘nt individuals (payers, They Patients, providers, fj cilities and others) ending/impropey * Provider authorizes the in case of and update the Cog (Coordination of tenets) with their insu HInce companies. In ¢ condary paper ASE OF se "essary documems ‘nd Send them to the chent’s oftice fap submis, on Mel bites ang ‘edieal coders usually Work nom, F Programs available in AU least an ial business. hours, Weekends. There ae sever With oce; "Wicmensinvoly ©, 4 Variety of different degree options, Most o ASsOciate degree, FendS 10 be the the industry Although an associane degiye eneral standard Postsecondary: egy HOM is a specialized 4 career school, 4 "CMa Vera medical biting rated $35,920 annuaty The lowest saary SMES MAKE ar ng 8 ‘ S2lannually PRS A ce ame et S into billing claim. LT nie] aa Loita bao eRe i td <5 lers. It is the i ST en for the se acces ees Do thats LS rere PATIENT FOLLOW up between r ee ring Mae sens in nt som. Afr rendered by providers and provider organization Joim to ensure the the medical biller follows the claim ae the provider performed. A imowledgeable medi i 2021 end is expected ieee oe eer pe ee 'R) of 12.6% from 2022 to 2030. New trends ban emerged dus 10 new technological solutions, bad debts, and bills, and expanding and changing regulatory requirements all of hich have contributed tothe inoreceea impact of healthcare claim outsourcing seattheare providers. Medical billing outsourcing improves cash flow, lowers software and equipment expenses, and reduces employee costs and size Duct the rising use of IT resources in the healthcar for medical billing outsourcing is prowing at a sub industrialized nations, have resulted in continuous '¢ business and steady government support. the market stantial rate. Increased medical costs, particularly in allowing for grecter adoption of modem technology devices and equipment, such a8 RCM software. The rising patient load and the need to a aR ee a Ps ote erste wets health practitioners. To counter such = siuation, hospitals are outsourcing the elinieal bil Hing process which is expected to drive the growth of the market for medical billing outsourcing, ofthe healthcare IT business. Due toa lack of expy management tools, Tre COVID-19 pandemic slowed down the market growth owing closure of various healthcare facilities due the outsourcing department of medical billing due to the reduced ‘ofinancial crises. The pandemic hampered ‘olume and solvency of patients oF services. "ovwever, an inerease in healtheare labor costs and a decline in health services revenue boosted the market ‘option among large healtheare systems, Technology is one of the k: ‘stems, including differemtiators in today’s healthcare localized healthcare systems that existed earlier. Di tal development accelerated by the ‘ant positive impact on the market 10 a fe i ising the z advent of advanced (echnology, time ang ‘Money savings, and labor cost savings are increasing Treuce for outsourcing healthenre billing by multiple preter rhe need for medical billing healtheare providers. The need f nereasing due to the ef sourcing services is forts of he os! yocurem iti , ychnse, maintenance, and software updates. po sparent process. Many Service providers hay tra al ¢ errors and intern ‘althcare providers to reduce costs, It increases revenue by sj ‘Santly saving time and money on payroll, infrastructure, “llestablished outsourcing companies offer a very © HIPAA complaints and a secure process to protect them from hackers. ‘re spread of the novel coronavirus has adversely affect ip Forinstanee, the World Health Organization ae unjcodes, which will come into effect in Jan 1 COVID- ‘ed the sector. New codes were created for CO’ the Intemational Classification of Diseases (ICD- Nar¥ 2022. The advent of new technological solutions, increasing and changing government Fequirements, and bad debt and uncollectible accounts have sparked a Es trend leading an increased preference foy ‘medical billing outsourcing by several healthcare providers. The outsourced segment dominated the market for medical billing outsourcing and held the largest revenue “ted (0 register the highest CAGR from 2022 to 2030, In-house the m tar of $2.5% in 2021. The segment is expe: ond outsourced are the major components of ‘arkel. It significantly reduces costs and proves a good fit forsmall and medium practices. Physician practices (acute care hospitals and clinics/physicians) are facing, dallenging times us reimbursements have declined and Costs are rising, and the newly introduced regulations have made business more complex. 1 is estimated that ay proximately 20% of physicians’ income willbe lst due to health billing errors, and on average, healtheare providers or businesses spend 30 to 40% oftieit revenue on the billing process, This ig boosting the segment’s growth. : ‘alWorks, a provider of medic ‘outbased revenue eycle management platform in 2018. In addition, Outsourcing reduces labor costs by stiminatng the need to hire an accounting eam. Also, the company do. stving additional costs snot have to train or stay up to date, lina Services SWOT Matrix / We ghted SWOT Analysis ‘Prportnities — Opportunities (SO) Suategies|Strength oe reciente: "[rireats brand recognition i Sseements — Htvesting into R&D to thy histuptors. (wr Opportunities (Woy Strategies|Weaknesses Threats ( nfo customer oriented servic, .cuss on growth are: 4ndGet out of the business and fo. g srensths of Billing Services are the firm's capabilites and resources tha sirengths can use to des . develop, and su ketplace in competitive camtage in th Suong band recognition - Billing Services pro usry. This has enabled the company to ef services industry, ‘ucts have strong brand reco nition in the Business Services harge Premium compare to its competitor sin Bus ness

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