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Thread Topic: Government regulations
Topic Originator: henry
Post Date September 2, 2005 @ 5:16 PM
Government regulations

September 2, 2005 @ 5:16 PM Reply  |  Email Friend   |  |Print  |  Top

I recently read an article about a company in India advertising their outsource business.

They had this on the advertisment:
"Guarantee 95-98% accuracy and compliance with all government regulations."

Now does this mean compliance with India's gov regulations or US?

Interesting Henry

Lisa Paoli, CMRS
September 2, 2005 @ 8:44 PM Reply  |  Email Friend   |  |Print  |  Top

US not in India, it's bad enough billers have to work for very little pay, but outsourcing to India is the worst, NON compliant way to hand over your billing.  I get about 5 calls a week to "be my partner" calls from India, and NOW they are saying they are based in the US because they've already partnered with a biller and they are using that billers name to get them more "partners".   I tell them to take me off their list and leave me alone, I need a partner like that like I need a hole in the head.  Just my opinion.

Lisa Paoli, CMRS

September 2, 2005 @ 11:19 PM Reply  |  Email Friend   |  |Print  |  Top

I know I'm going to step on some toes, because at least half the people who post here are clearly from India.  But maybe if I, and the rest of us, start stepping on some toes, things will begin to change.

In the first place, all you have to do is read the posts on billing and coding website to see how much "knowledge" and "experience" these people have.  Some of them don't even know the BASICS, such as Medicaid is ALWAYS secondary to Medicare, or what the difference is between a CPT code and an ICD code.  BASICS.   At least I THINK that's what they're asking, the English skills are so poor in many circumstances you can't always tell what it is they don't know.  And these are the people you want to hand your practice's financial health over to?

Secondly, like Lisa mentioned, they think the only thing they have to do to be a "US Company" is to stick a sham "home office" in some storefront in New Jersey, or "partner" with someone in the US.

Thirdly, like Lisa pointed out, they aren't even bothering to do their own marketing - instead they're wanting us existing services to just hand our clients over to them.  I'm not so stupid as to have done that, but I've heard from people who did do it when the "fad" first started, so they had no way of knowing yet that it was a stupid thing to do, and they got taken, each and every one of them.

Fourthly, supposedly the reason outsourcing to third world countries is becoming so popular is because it saves American businessowners and stockholders money since the labor is so cheap.  Guess what?  INDIAN-BASED MEDICAL BILLING SERVICES CHARGE EXACTLY WHAT THE US ONES CHARGE.  All the literature I've gotten from these people when I was still employed by a provider, and all the literature I've gotten from these people since putting up a billing website quote figures around 8-10%, which is the standard rate range of US billing services. (Actually, very many of them don't even charge that much and provide excellent, professional service.)  Of course, they still pay their employees in India PENNIES per hour whereas the US ones pay their American employees in the $10-20 dollar range, depending on geographical region and experience..  Way to take advantage of your countrymen, huh?  I refuse to be a party to exploitation.

People in the medical billing business are afraid to say anything.  They are afraid of being called a xenophobe.  They are afraid of being blacklisted by the many Asian physicians practicing in the US.  They are afraid of being accused of being a jingoist.

But in my opinion it is time to take a stand.  If these businessmen from India actually offered a fair cost AND paid their employees the exact same wage the US billing service pay their employees, OR charged a significantly lower fee more commensurate with their overhead, I would not be saying such harsh things.  Or if these Indian businessmen would get out and pound the pavement for clients, like I have to do to get mine, instead of tricking unsuspecting honest US businessowners into virtually handing their clients over to them, I would be singing a different tune.  Or if they would get rid of their sham "home offices" and be honest about the origin of the business and what country the processing would actually be taking place in, I would shut up.  Or if these businessmen could actually DEMONSTRATE that their employees are as trained and as knowledgable as the employees and owners of US billing services, this would not be a sore subject.

But I have YET to see an Indian billing service that (1) charged a LOWER fee than a US company to correspond with their low overhead, (2) gains business in an honest manner and (3) have rigorous traning programs.

And, back to your original question:  The USDHHS only has authority over "covered entities", which, of course, would not be a billing service.  The billing service is only required to adhere to the "business associate" agreement.  If that agreement is breached, it's up to the country's laws where the breach occurred as to whether or not the agreement can be enforced, or if the covered entity (the medical provider) can seek any kind of remedy against the business associate (billing service).  That's fine if the billing agent is in the US - but when they are India, you will basically be out of luck.  Even assuming the laws will allow you to prevail, the cost of flying to India to appear in court will negate any (negligible if any) savings you gained from outsourcing.  And, of course, you will also have to fly to India on a regular basis if you want to keep tabs on whether or not they actually have PHI safeguards in place.  At least if your billing agent is in the US you can drop by their offices relatively cheaply, or rely on references.  And remember, it's not just HIPAA, it's your state's insurance and credit and collection laws that you would not be assured of being enforced, either.  (Heck, from what I've seen on board postings, few Indian billers have even caught on to the fact that Medicaid is a government program, individually administered by the states.)  This could mean that a state law in your favor, such as filing, appeal, or recoup deadlines, are probably not even being taught to the employees working in India.

Anyway, that's my story and I'm sticking to it.  If my comments get me banned from this board, so be it.  At least I would have said my piece.  If my comments make the people who post on this board who reside in India angry, so be it.  Maybe it will generate a little self-examination of your motives and abilities.

Like Lisa said, this is already a pitifully low-paying business, and it's a very overcrowded one - the last thing us professional, dedicated billers and coders who have demonstrated our excellent abilities need is someone who can't even speak English and who doesn't even know what "CPT" is taking what few jobs there are away from us.  And the US providers surely don't need it - most of them don't even realize their "US" billing service is really an Indian billing service.

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