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Thread Topic: Outsourcing over seas
Topic Originator: Cindy
Post Date August 15, 2005 @ 2:19 PM
Outsourcing over seas

August 15, 2005 @ 2:19 PM Reply  |  Email Friend   |  |Print  |  Top

I'd like everyones opionion on this subject.  Personally, I'm against it.  How do you feel?

August 15, 2005 @ 2:28 PM Reply  |  Email Friend   |  |Print  |  Top

Well after calling many help lines like Dell to get my PC fixed and having all the calls answered by people in India who struggle to speak English. I would not hand over my business to them.

Though a friend of mine is in Computers and he said their IT skills in India are good and a lot cheaper than here in the US. He recommends it if you can find a creditable company.

Then there is another post for this forum. How do you find a creditable company in India or oversea's


August 15, 2005 @ 2:57 PM Reply  |  Email Friend   |  |Print  |  Top

True.. My issue isn't whether they are good over there or not. My issue is taking work away from our own country..  Thanks for reponding :-)

September 25, 2005 @ 1:57 AM Reply  |  Email Friend   |  |Print  |  Top

Hi cindy,

My name is Sugan and writting from Chennai, India.   I read your concern and do agree with your Concern, but I would like to put forht my opinion.  Outsourcing to Countries like India, is actually increasing the US Companies Potentiality and developing the business.   If you look much deeper into this issue, you would definitely realize that the Companies that Outsource the business needs do send only the non-core or non-vital things, and the core-competencies of the US Companies remains with them only.   By this way, the US-Comapny do get more time and their executives where freed from dealing with issues that are non-vital but important to the company.  This additional time will help them to develop their core-competancy and there-by increase the company's business-base.

We are one of the leading company who is handling many outsourced busienss from USA.  

Please do reply if you disagree with me.


October 3, 2005 @ 2:43 PM Reply  |  Email Friend   |  |Print  |  Top

I am also against outsourcing overseas.  As an end-user I have seen first hand the poor customer service, inaccurate answers, and language barriers with DirecTV, Dell, and United Healthcare.

In addition, I agree with the first post that we should try to keep our jobs here in this country.

Steve Verno
January 5, 2006 @ 5:41 PM Reply  |  Email Friend   |  |Print  |  Top

While there is nothing wrong with outsourcing to an offshore company, the provider must consider many factors when doing so rather than looking at the so-called savings that might happen.

1)  Is the offshore company have people trained and certified in medical billing and coding?  Based on my experience with the on-line forum with the Medical Association of Billers, we've recently seen an influx of people from India and Pakistan asking many questions that make us wonder if these people know what they're doing.  Questions such as "What is a PPO and what is an HMO" or "What is denial code 344 and how do we appeal it"  You aren't given any more info than that.  Or, "What is an EOB", "We Bbilled CPT XXXXX and YYYYY and Medicare denied CPT XXXXX.  How do we appeal this. Turns out they are unbundling codes, billing codes that are mutually exclusive and billing procedures such as giving blood in an outpatient office.  It's very clear to me and other members of the forum that these people have no training in medical billing or coding.  If the doctor or billing company hired these people did he check to see if these people were trained?  Two companies in India asked me to come to India to train their people.  The catch to this was, I had to recruit the doctors first and then train their staff on live data.  Actually in the end, all they wanted me to do is recruit doctors for them.

2)  Billing Companies outside of the US are not subject to US laws.  Two years ago, a doctor contacted me.  She hired a company in India to help save money.  After a period of time, the India company wanted more money.  Actually, they wanted an increase that matched what she would have paid a billing company in the US.  She said no to their demands and they informed her that if they didn't get their increase they would release the patient information all over the internet.  She went to the regulatory authorities and they told her they cannot help her because of the fact that US laws are not enforceable outside the US, even a company that sets up a front here in the US.

3)  What is happening with the information you send?  Last week, we had a visitor from Pakistan visit our forum.  He started asking simple questions such as how does Medicare assign a suffix to a patient ID number, and how can he overturn claims denials from NJ BCBS.  Then he started asking us for detailed info on HIPAA and ERISA and he didn't want any links to the regulatory sites.  He wanted this so he could cut and paste it as if he was developing an SOP.  Then he went to a government website and had a long list of denial codes.  He wanted to know what each meant and he wanted a detailed appeal for each one.  When we asked him about his requests, he lied to us by saying he was gathering information as a prelude to taking a medical billing course.  He also lied by stating he does not do medical biling and he does not do billing outside the US.  We showed him his previosu posts where he said he does medical billing.  We then found several of his websites.  In several, he tells people he's 20 years old, he is born and raised in Pakistan and he attends a Pakistani government school.  On another website, he has his resume where he has his Pakistani address and the name of the US Billing company he works for and has worked for as a "Billing Executive" since he was 17 years old.  The kicker is his website deducated to Islam and the Pakistani Military.  When I called the billing company about this person they refused to speak with me.  How is it that they can hire a 17 year old child, with ties to the Pakistani government?  So my question is, how secure is the information we are sending to these companies?  Think about what we send. We send the patient's name, the social security number, the patients address, home or cell numbers, the employer, employer address, employer phone, all insurance information,  and medical history.  Let us not forget credit card information if they pay by CC.  We complain when the airlines wants to give just our names to the TSA to help prevent terrorism and here we're sending everything to a 17 year old in Pakistan, a country rich with terrorist organizations.  How do we know these companies aren't a front for terrorist activities and they are using the doctor to gain information on people in that geographical area?  Consider a doctor who has a practice in downtown Manhatten, just blocks from Ground Zero and some of his patients are the NYC Chief of Police, several members of the NYC fire department, members of the NY Stock Exchange, members of the TSA, located in Manhatten and more.  Can you imagine what someone could do with the information we are giving to another country?  Who's to say this billing company isn't selling this information to terrorist?

I for one do not feel comfortable knowing that my personal information is being sent to a company outside of the US without my knowledge because how many doctors or billing companies tell their patients that they are using an offshore company in India, Pakistan or some other country?  How do we know about the training of the staff of these companies.  Based on what I have seen, some of these people don't know anything about coding or billing.  So what does this do to the doctor when his claims are denied due to coding issues such as unbundling or billing procedures that he does not normally perform, or how much is the doctor losing due to massive denied claims which the offshore company does not know how to appeal?  Is there a real cost savings?

Director of Reimbursement, Compliance Director
Medical Association of Billers

Steve Verno
January 5, 2006 @ 6:01 PM Reply  |  Email Friend   |  |Print  |  Top

With my previous post, please ignore the minor spelling errors.

In regards to Sugan's post, I know it is a little old, but I do want to respond.

My doctor outsourced to a billing company in the US.  Last February, unknown to us, the billing company outsourced the coding and billing to an offshore company in India.  We found out because in 30 days, we noticed a huge decrease in revenue. The claims were improperly coded.  Procedures that were performed, in addition to the visit, were not being billed as they were in the past.  Claims were being denied for timely filing.  Incorrect modifiers were being used.  Instead of modifer 25, someone was using modifier 59.  The coding also keyed a Medicare audit.  The first in 25 years.  My doctor was fined and was ordered to undergo training and was told if the coding continued, he would be sanctioned.

Naturally the company in India was terminated and we spent the last year fixing their mistakes, so as a result of this, my doctor, my billing company and I could not devote our time to what Sugan states in his message.  The billing company had to hire new coders and billers because the ones they fired would not come back and work for this company.  Last month we terminated the billing company and my doctor has a lawsuit against them due to the audit and the money lost as a result of the incompetence of the offshore company.  Last I heard, the owner of the billing company just sold it to someone else and has gotten out of the business.

January 7, 2006 @ 8:24 AM Reply  |  Email Friend   |  |Print  |  Top

Good Evening all of you!!

Wish you all a Very Very Happy New Year!

I read through the earlier 2 posts, and I could understand the frustration that has caused you Guys to think, that Indians are doing Billing without any Knowledge.  I hope you Guys would admit to me, that there would be people across the World to find out easy and quick way of making money in any business, and they intend to do it without any professionalism in it, which in turn brings a bad name for the entire crowd.    It is unfortunate that the Negatives Look bigger always, and it cannot be erased out by mere words.    I would say with 100% confidence  that there are GOOD/PROFESSIONALs in India, who could even collect the OLD/ARs by their dedicated and hard-work.   I know it is difficult to change the Opinions just by reading unless and untill you see an experienced Biller way in Chennai who does a perfect Job for you.  

As a Challenge, I can say, if you are ready to give me a pilot job of OLD-AR Collections, we can do Our best to prove ourselves, after which the Trust Level will automatically go-up.   The Selection of the Offshore Service Provider is a very very critical fact, and I am sure you should be having your own screening tests, to decide on this factor.  

I am ready to Prove Ourselves,  if an Opportune is given..

Thanks Everybody


Steve Verno
January 7, 2006 @ 11:08 AM Reply  |  Email Friend   |  |Print  |  Top


Did you even read my post before you took offense at it and sent me a private e-mail stating the following:

"I would like to talk to you and clarify as many things as possible, because this is an Opinion raised against our Nation which I feel is wrong!!"

Look at the beginning of my first post:  I clearly stated that there is nothing wrong with using an offshore billing company.  How can you take offense at that??????  How is that an opinion raised against your country??????

Look at #1 in my post.  This is a factual statement that doctors need to take training of the staff into consideration when hiring an offshore company.  Is this not true that the doctor needs to ensure that the people are trained??  How is this offensive against your nation?  Are we to assume that the company has trained people working for them?  Sugan, it is a fact that on my forum we have had an influx of people from your country.  We can tell based on their IP address and the fact that they used the name Manjul, Vinodgopal, Vipul Prajapati or Nigam.  One person said she was from the city of Ahmedabad.  is this not a city in India?  So how is it that when I stated we have visitors from India and I can prove it, this is offensive to your nation?

Let me ask you Sugan, what would you think when someone asks this question:  we are getting rejection for 97110 and they are giving rejection code 364, we dont have explanation of 364 so provide me information for that   Sugan, that is all they asked.  Who is the insurance company? They have a rejection from an EOB.  Did they even look at the EOB to see what this code meant?  Did they call the insurance company to ask them what this meant?  NO!  This same person asked this question:  We have been receving rejections for 82962 from BCBS stating ' Kit does not require physician's RX or order'
when billed with office visit.  We have been adjusting the amount as there is no patient liability stated in the EOB. How should we get paid. Should we add a modifier or any changes required while billing????

This tells me this person does know coding and doesn't know billing.  This is a procedure that should not have been billed.  Adjusting amounts will not get this paid.  Using modifiers won't get this paid.  

Here's another question from the same person:  could you explain me in detail as to how ppo discount in medical billing works.  Anyone that has taken a basic medical billing course learns this.  Did you notice that this person wants a detailed answer rather that a simple answer we provided.  

How about this one:  I have billed 93307, 93320 and 93325.   am getting rejections.  The reason for rejection is not medical necessity. But I am entering diagnosis 401.9 as per LMRP. So can u tell me why Medicare is rejecting my claim?

This person is picking a diagnosis from an LRMP   Medicare is telling this person the service is not medically necessary.  So, why ask us why Medicare is denying the claims.  It's right there in black and white.  

If you saw these questions, would you not agree that this person is lacking training in medical billing?  First, to show you we hold no animosity towards these people, we answered their questions.  We could give a rats fanny if they are from India, Pakistan, or Binghamton New York.  We respond and give them help.  We did asked this person if they had any training.  Guess what they did.  Instead of thanking us, instead of responding to our questions to her, she deleted her EZ Board account and she created a new one, using a different name and began asking more denial questions.  We knew it was her due to her IP address.  When we confronted her with her new identity, she left and deleted that account too.  So, Sugan, how would you feel about being used by one of your countrypersons? Is it an offense to your entire nation that this person, from your country does this to not only me, but a group of medical billing and coding people that just wanted to help?  She wouldn't even respond when we asked her for more information so we could give her a better answer.  But when you ask for a detailed answer to a rejection code, how can we answer this without more info???  Would you not agree that these people do not know what they are doing?  What was so harmful in wanting more info to give a proper answer???? Was my question offensive when I stated that did this doctor check out this person's billing company before he hired them?  This is a rhetorical question that does not require an answer.  Is that also an insult to your nation, Sugan????

When I mentioned the two companies from your country asking me to help them build their billing company and train them, this is a fact.  Two companies, from India sent me e-mails and called me on my phone.  They said they were starting their billing company and they heard about me and they wanted me to provide them with information on starting their billing company infrastructure to writing their policies and procedures, then coming to Mumbai and training their staff in coding and billing.  I saw no problem with this because, as I stated, there is nothing wrong with using an offshore billing company.  So, I sent them examples of policies and procedures, I sent them appeals letters I created, I sent them information on how to set up a billing company infrastructure.  When it came time to do the training, I was told that training would only be done when I recruited doctors for them.  Once I signed these doctors, then I would train their staff on live data. All these people really wanted is for me to recruit US doctors for them.  These people never paid me for my time in developing their infrastructor, never paid me for the time I put into developing their policies and procedures, and never paid me for my appeals.  Sugan, they said if I wanted my money I would have to sue them in India.  Let me ask you Sugan, was this ethical for your countrymen to use me and my knowledge?  Was this ethical to promise me with income and then deny me payment for my work?  They knew I couldn't sue them in US court, so is this an insult to your nation when I mention the fact about what your countrymen did to me???????

Look at #2 of my post:  It is a fact, Sugan, that companies outside of the United States are not subject to US laws.  It doesn't matter if this offshore company sets up a US based company in New jersey or Indiana.  The people violating the law would be outside of the US and there is nothing that can be done to them.  Just the people in the US site but the money is also offshore, so what will happen?  Nothing.  It is also a fact that this doctor was threatened with the releaee of her patient information if she did not comply with the offshore companies demands.  I met this doctor and she was in tears.  She went to the California authorities and they told her they could do nothing.  So how is this an offense against your nation??????  

Look at #3:  Exactly what IS happening with the information we send offshore?  It is a fact that we had a visitor from Pakistan.  He was 20 years old.  His resume stated he has worked in medical billing since he was 17.  Who, in Pakistan trained this person, in medical billing, at the age of 17?  How is it that a billing company hires a child to be a billing executive? In the US, a 17 year old is still a minor, a child.  Evemn at the age of 20, this person is still going to school, so where is he finding the time to be a billing executive for a billing company in New Jersey.  Did the billing company check this kid out when they hired him?  He lied to us when he said he didn't do billing outside of the US, yet, he lives in Pakistan and he says he is going to a Pakistan government school.  When you look at his website, he devotes it to Islam and the Pakistani Military.  So, what is behind this person????  How is it an insult to your nation when I mention what this person did to us?  He isn;t even from your country.  Let me ask you Sugan, is it possible that there is a company out there, that could be a front for a terrorist organization?  Is it possible that an offshore company is using the information we are sending them as a means of gathering data for their terrorist organization??  

Look at my last paragraph.  Am I NOT entitled to my personal opinion about having my personal information sent to an offshore company without my knowledge?  After all, my name, my address, my phone numbers, my employer's name, my employers address, my employers phone, my social security number, my insurance information, my policy numbers and my medical history are being sent offshore.  Is my information secure?  What am I going to do if this company is a front for terrorism?  They have everything they need to start a terrorist act such as sending a biological agent to my home, to my employer, as well as access my bank accounts or create a false identity for financial gain.  So, how is it my rhetorical questions, questions that people should be asking as a means of protecting the doctor, the staff, and the patient. be an insult to your nation???

Lets look at my last post.  How is it an insult to your nation when my medical billing company hires an offshore company in India to do the coding and billing for them?  How is it an insult to your nation when this offshore company bungles the job and costs my doctor millions of dollars in lost revenue and thousands of dollars in operating expenses to clean up the mess made by this company????  My doctor and his staff wasn't able to gain more time and freedom from dealing with issues that are non-vital.  We spent the better part of the year fixing this incompetent companies mistakes.  Sugan, this was not the nation of India that did this, this was one company that did this.  Their people did not know what they were doing.  It's as simple as that.  My doctor friend in California was not able to gain more time and freedom, she was terrified of her patient's information after being extorted for more money.  Was this the nation of India doing this?  NO!  It was one company.  

Sugan, it doesn't matter if a company is in India, Pakistan, Egypt, or anywhere else, if they cannot do the job, they are no good to the doctor.  What I stated is that doctors need to be cautious as to who they hire.  Doctors need to check out anyone they want to hire.  Billing companies that want to outsource need to verify the company that want to use.  Is this not good business or is this too an insult to your nation????

Sugan, when you privately e-mail me and tell me you want to talk about how my "opinion" raised against your nation is wrong, you better read what was posted.  There was no opinion raised against your nation that was wrong.  First, this is America and I have the rights guaranteed to me by the Constitution and the Bill of Rights to say what I want and where I want.  My posting is protected under the First Amendment to the Constitution.  I spent 20 years of my life, defending my nation so I can speak my mind.  

What I presented were facts.  Did I say that everyone from India was uneducated  and untrained, so don't use them?  NO!!!!!!!  I said there is nothing wrong with using an offshore company.  Do I not have the right to be angry at "some" of your countryment for using me and abusing my doctor and a friend of mine who is a doctor?  Note I said some of your countrymen, not an entire nation!!!!  

I've been in this business for more than 30 years Sugan.  I take my training and education to help those in need of help.  I could care less where you are from.  If you don't like what I posted, that is your right and you have the right to rebutt what I posted, in an intelligent manner as I did.  But to come to me in private and tell me what I posted is an opinion raised against your nation is wrong and is an insult to me and I take affront to you as a person, not your nation.

January 8, 2006 @ 12:36 AM Reply  |  Email Friend   |  |Print  |  Top

Good Morning Mr. Stephen

At the Outset I apologize for having hurting you.  My age is Lesser than your # of years experience and I think that made me write a reply back immedately...  I am SORRY!.   What offended me yesterday is your points on the Terrorist, but after reading the point on the biller from Pakistan, I could understand, what made you write so.  

Mr. Stephen I accept the hard-fact that many billers/physicians in US do have a bitter experience of giving their business to India, and have faced many losses too.   But I as an individual will not be able to change it by mere words.   I need to prove and show.  We are in this Business for about 6-Years, and till this moment not even one single Client of us have got a bitter experience.    Me and my Team believe in 100% Client-Satisfaction, and we know in this industry, we would be able to do that, only by giving the maximum retruns for their Service, which ofcourse is possible only by staying in TOP of all the industrial publications, Bulletins, Magazines, and consistently undergoing all the Training that is required to collect the Money.    

But as you have written there are many billers in India who posts questions in the forum which make even us feel bad..

I would end it like this...  Outsourcing will be definitely beneficial to you.. but it depends on "WHOM" and "HOW" you select your Business Associate in India or Pakistan.

I am SORRY again...


Steve Verno
January 8, 2006 @ 1:32 PM Reply  |  Email Friend   |  |Print  |  Top


Thank you for your reply and apology.  It takes courage and honesty to apologize and that are traits I admire in a person.

In regards to terrorism, there are at least 21 known terrorist organization operating in India.  That is a fact.  For example, the Nagaland Rebels have been in existence since 1948. You have the United Liberation Front of Asom since 1979. There are terrorist organizations in the US.  The KKK for one and Jamaat ul-Fuqra for another,  Terrorism is not new, it has been taking place since the beginning of time.  One could argue that Moses was a terrorist.  After all, look at the plagues instilled against the Egyptians.

Doctors and billing companies need to ensure that information that is sent to someone else is secure and will not be used for illegal means.  That is common sense business.  

Sugan, there are a few bad apples out these.  Not just where you live, but everywhere.  These are people that try and manipulate the system and to use our good nature for their benefit.  This doesn't just relate to people from India.  There are doctors that try and manipulate the system as well. Look at the number of physicians that are caught with their hands in the cookie jar.  But, the number of good, and honest doctors, coders and billers, far outweight the bad ones.  I worked for a doctor that went through 6 billing companies and 7 collection agencies.  These billing companies were what I call, "Code it, Bill it and Forget It" companies.  They had tons of doctors as clients, but these doctors were losing tons of money because accounts sat and rotted away because no one at the billing company did anything about it.  The collection agencies - they all embezzled or cherry picked rather than work for their money.  Now my doctors have a good billing company and an excellent collection agency.

When you make a statement about osshore billing, be careful on what you say.  This is because it could come back and haunt you when several people who have used offshore companies, had bad experiences.  I get letters every day, from billers, asking me to use their services.  Most are thrown away because they all say the same thing... Use Me and You will save money!!!  "You will save money by using is to send your claims electronically!!!"  Really?????  Well, due to HIPAA most doctors are sending electronically anyway, so how will using your company save me money???  Not one company I called could prove to me that using them will save me money.  Actually I proved that using them will cost me money.  I would have to hire a staff person to photocpy the medical records.  I would spend more time and money on toner and repair costs and copying costs.  I would spend more money on postage sending them records, EOBs, payment documents and other correspondence.  Am I really saving money?  To be honest, using your company is theory.  IT has to be proven and the only way to do that is to try you out and that is what you are asking.  Am I going to save time once I ise you?  Not really, because as a good business person, Ihave to keep an eue on what you are doing.  The key to using your services is......... How much money will you bring me with the minimal of costs.  That is the answer to oursourcing. Not just to you, but to anyone.

Here are rhetorical questions I will ask:

If I use you, what type of training does your staff have?  Are your billers and coders trained and certified?  If so, what agency and how long ago was their training and certification?  Are you bonded?  Does your billing staff know my State Laws, do they know the Medicare rules and my State Medicaid regulations?  Can they look at my contracts and know what I am to be paid and how to appeal a denial?  If I get a denial, why did I get it?  Does your staff know the difference between an ERISA plan and Non-ERISA plan and how to deal with each one?  What will you do with my unpaid claims over 60 days old?  What will you do with insurance companies I am not contracted with?  How wil you handle patient complaints, especially ones that are Risk management Oriented.  What safeguards dio you have in place to protect my information?  How will you handle patient, insurance and attorney calls?  What will you do with class action lawsuit settlements?

See?  These are just a few questions I require answers to.  

I have no doubt that you could do the job you state.  Just remember that you are in competition with every coder and biller out there and to get the job, you have to stand out and be better than anyone else.  Just because you are in India doesn't mean bupkiss.  You have the same chance as me at getting the assignment from a physician, physician group or hospital.  You want the job, tell the doctor how you will get him/her their money with the minimum of costs.  

MY doctors hired me because I have the training, I have the certification, I have the experience and I have an aggressive attitude.  I never give up and I never surrender.  I just got Aetna to agree to settle my doctors claims for 6 figures.  Naturally, he was very happy. I also got my doctors excellent contracts with superior reimbursement rates and clauses that protect my doctor.  Another doctor hired me to work his A/R.  It was 7 figures in the 120+ column.  I eventually got him more than 75% of his money.  The 25% was unrecoverable due to bad data obtained by his former staff.  Why do I do what I do?  Again, Training, Certification, Experience and Aggressiveness to get my doctors their money.  That is how you will be successful.

My best wishes for your success in this business.

January 9, 2006 @ 8:31 AM Reply  |  Email Friend   |  |Print  |  Top

Good Day Mr. Stephen

Thanks for reply.  I would like to take your personal advice on few of the questions that you have raised.  Will you allow me to come-in PRIVATE and discuss with you as a Friend?   Will you accept my friendship, and allow me to talk to directly on few things, rather than everything being discussed through Forum.


Steve Verno
January 9, 2006 @ 12:50 PM Reply  |  Email Friend   |  |Print  |  Top


Of course we can be friends.  My hand is always open to friendship and I am always ready to help others in our business.  After all, I don't want to see them make the same mistakes I made.

Besides, you and I are on the BC editorial board together.

January 10, 2006 @ 4:59 PM Reply  |  Email Friend   |  |Print  |  Top

Hi There!

It's a good experience for me to see something which is very much required.I have also seen some practices in US itself which frequently changes there billing co. just because of the fact "revenue loss".Due to unprofessionalism shown by few of the Indian Co. entire units have been closed.I would like to say that in any business trait its very much required that whomsoever you are going to work or to join hands you should have a perfect strategy to safeguard the rights and security of every individual & services going to be shared in the co. specially in service sector.

Good forum!!

Renato Pereira
March 13, 2006 @ 2:12 PM Reply  |  Email Friend   |  |Print  |  Top
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July 12, 2006 @ 9:49 PM Reply  |  Email Friend   |  |Print  |  Top

Review your e-mail. My point is, it includes many grammatical errors which is important to serving clients. I understand your position but most disagree with you. Please take a proper English class.

June 6, 2007 @ 7:14 AM Reply  |  Email Friend   |  |Print  |  Top

Depending on the company you are outsourcing in India too, Nothing. I worked for a large medical billing company that decided to outsource to India to save $$ however, it ended up with me getting 30+ emails a day to respond to, insurance complaining about the accent, and then telling them how to correct denials when they are suppose to know this.

I do not believe in outsourcing to India just to save $$. There are companies here in the USA who are more qualified and can save you money as well and have the credentials to back them up.

I have to ask. Those that outsource to India, do you inform your patient's that their personal information is being sent to another country? Probably not.

Tiffany Pietrowski, CMRS

July 6, 2007 @ 8:36 AM Reply  |  Email Friend   |  |Print  |  Top

I believe by and large there is a school of thought that is against Outsourcing overseas because

a) They see their jobs going away.
b) Outsourcing overseas can mean a lot of complexities in terms of compliance, regulatory mechanisms etc.
While both are valid concerns, they are more emotional in nature than technical/legal.
Unless a law is passed prohibiting information from being disclosed to those based overseas, there is no reason why any company in the world cannot compete for medical billing assignments.
THAT said,
"saving money" cannot be the only USP of any company, whether Indian, Australian or American.
They need to be professional, competent, ethical and ofcourse efficient. Just like anyone out there.
It is upto the physician or the facility to weigh the pros and cons of outsourcing or offshoring and make a business decision.

Also, is it required by law to inform that patients that their information is being accessed by someone overseas? or for that matter by a 3rd party billing agency based in the US?

Sugan, no one said they are against Indians or Pakistanis. They were just worried that a) their jobs are being taken away. b) they have to put up with bad customer service c) their information can be misused.
Maybe it is a lot of negative and misplaced perception, but thats the way it is.

October 28, 2007 @ 12:55 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Cindy...I wd like to share my personal experience here with you.  We are a NY based medical billing company.  We took the decision to outsource some of work to other country so that we cd offer better services to our client and can take care of our employees in better way. Outsourcing is working for us.  Our employees are happy and our business is growing too and growing business means growth of our economy...Tks

November 9, 2007 @ 4:56 PM Reply  |  Email Friend   |  |Print  |  Top

Outsourcing overeseas is just wrong.  Why take jobs away from fellow Americans and give them to third world countries?  It just doesn't make sense!  They have their own doctors, let them bill for them.  I am finding it very hard to find a coding job in my area due to most of the practices around are outsourcing to other countries, when I ask them if they are happy, most of the employees respond no they are not, but there is nothing that they can do.  It is not their decision. When I ask my peers what they would do if they found out their information was sent to other countries without their knowledge they responded that they would be furious and immedietly change their physician.  I am an American citizen, I am a Medical Coder, RMC certified training for my CPC-P certification.  Am I wasting my money?

November 9, 2007 @ 11:37 PM Reply  |  Email Friend   |  |Print  |  Top


Outsourcing overseas is wrong just for you. When the practices are outsourcing to other countries, that's just because it's CHEAPER to do so.. They do not care if you have a job or not!

When you say the outsourcing companies can bill their own doctors, not every country works with insurance companies in their healthcare system.

It works for both sides in the way the unemployed persons from those countries find a job and the practices spend less on the billing.....

November 9, 2007 @ 11:59 PM Reply  |  Email Friend   |  |Print  |  Top

Kristen, I am not trying to say it is good or not to outsource and I know it is sad for all the competent coders and billers for not to have their jobs,..I was also wondering if there is any kind of federal or states laws regulating outsourcing. As long as nothing is illegal, the practices will keep doing it.

November 12, 2007 @ 11:40 AM Reply  |  Email Friend   |  |Print  |  Top

It was my opinion.  There are no laws saying it is illegal.  I am obligated to my opinion no matter what anyone else thinks of it.  I believe it is wrong, when you have perfectly good coders in your own country, to outsource to another country.  That is one of the problems with the world today, everybody wants things CHEAP, you want cheap that is the kind of service and value you will receive.

November 12, 2007 @ 11:50 AM Reply  |  Email Friend   |  |Print  |  Top

Let me rephrase my last line:  If you want cheaper serivices, do not be surprised when you get the same type of cheap service and product that you pay for.  Since HIPPA laws do not apply to third world countries, the only person who really gets screwed in the end is the patient from the outsourced, non US billing company posting their names, ss#, DOB, address, phone number, employer, etc. all over the web because the provider wants to terminate the contract for the CHEAP service that he paid for.

November 12, 2007 @ 10:36 PM Reply  |  Email Friend   |  |Print  |  Top

I understand what you mean, a kind of blackmail.. but you can not generalize.. you can't prove all the outsourcing companies are acting that way, have failing products and all the practices either billing companies are unhappy with that method.

It's up to the practices ( or medical billing companies) to weight the pros and cons of outsourcing before they do. And as long as outsourcing is not illegal, practices either co will keep doing what they think is better for their business.

Steve Verno
November 13, 2007 @ 10:55 AM Reply  |  Email Friend   |  |Print  |  Top

To jump in,

Sometimes providers outsource is because they used a coder or medical biller and that person was doing such a terrible job that the cost of using that person was too much.  That person, normally untrained and inexperienced, caused too many claims to be denied, revenue to be decreased, and audits to happen. Sometimes we have our own selves to be blamed for the problem.

Remember this.... the provider gets what they pay for.  Companies overseas do not have staff that is properly trained either.  These offshore companies don't have certified coders or billers.  The offshore employee finds themselves in a situation where they don't know what to do, so what do they do?    The come to the medical billing forums such as the Medical Association of Billers, The American Medical Billing Association and BC Advantage and we gladly help them with fixing the problem.  

Why else do providers send their business offshore to untrained coders and billers?  You mentioned it.. CHEAP!  This is because the provider isn't making any money and can't afford a certified coder or biller.  Why aren't they making any money?  They signed contracts with the HMOs without really reading the contract and they agreed to stupid and very low reimbursement rates, so the provider is giving away all his reimbursement and gave away all of his rights.  So the insurance company pays the provider about 20% of his charges and applies the payment to the patients deductible but the doctor doesn't collect this either.  So, the blame can be placed partly on the doctor themselves.  I see too many doctors living on credit cards because they gave away everything just to be contracted.

When I hear, "we can't do anything about it"  I say BS.  We can do what we want to do.  We choose not to do something.  Nothing says you can't terminate your contract with the offshore company.  Nothing says you can't collect at the time of service.  Nothing says you can't hire someone with training and certification.  We choose our own actions.  We also read how someone expresses their displeasure at the current situation.  Everyone is entitled to their opinions and we must respect their opinion, whether we agree with it or not.  

I see first hand at how someone uses an offshore company and gets screwed.  I also see how someone uses someone in this country and also gets screwed.  The answer is simple.  Respect our profession as a legitimate profession and not allow anyone without training and certification to become a member of our profession.  Too many people think you can code or bill with no training.  You want to be a coder - go to school and become certified.  You want to be a biller - go to school and become certified.  Doctors need to stop hiring people with no training and no certification. This includes people here in the US and offshore.  That is my opinion and I am sticking to it.

November 13, 2007 @ 1:08 PM Reply  |  Email Friend   |  |Print  |  Top

About legitimate our profession .. we would need the federal government or whichever entity to require billers and coders to be trained and certified or licensed. Physicians and nurses can only practice if they are licensed in their states, why not us?

November 13, 2007 @ 2:08 PM Reply  |  Email Friend   |  |Print  |  Top

I did not generalize, I did not say ALL of the outsourcing co's act that way.  I said I do not believe it is right to outsource to other countries when we have our own billers here. period.  I said if you want cheap don't be surprised if you get cheap, which was not mentioned as being generalized to outsourcing in other countries.  It was a just a general statement "If you want cheaper serivices, do not be surprised when you get the same type of cheap service and product that you pay for.", period.

Coders are office staff, they are not in there poking and proding you, in the surgical suite cutting you open, or able to think in a split second how in the heck there are going to get that axe out of your head without killing you.  Dr.s and Nurses are not "certified"  they are licensed with PH.D, MD, etc., they paid GOOD money to go to school and spent MANY years in school; most of the time to several different institutions, many many long hours.  They need to be licensed, inspected, insured, not to mention all of thier CEU's, etc.

Don't get me wrong, coding isn't a barrell of monkeys (I'm a coder I know this), you have to have your training, certification, CEU's, experience, etc. but no where near the amount that a Dr. or RN have to endure.  The state needs to be sure that these people know what they are doing to prevent DEATH or terminal injury, and not inflict DEATH or terminal injury.

In the end, the only one the Coder/Biller hurts is the Physician's, RN's or facility's pocket. No death worries involved here except when the provider of services hires a bum coder/biller. j/k

The Provider of services needs to step up to the plate and say, "I will only hire and allow Coders/Billers that are certified, keep up to date with their certification and CEUs, go to seminars and be knowledgable and up to date on all new provisions and laws, and show proven experience in MY specialty to TOUCH my patients records or have any affect on my income."

November 13, 2007 @ 6:05 PM Reply  |  Email Friend   |  |Print  |  Top

Just unhappy because somebody else ( who is not american) has the job you should have. I understand that.

November 13, 2007 @ 6:07 PM Reply  |  Email Friend   |  |Print  |  Top

No more comments because this is a very hot subject. Peace.

Steve Verno
November 13, 2007 @ 9:44 PM Reply  |  Email Friend   |  |Print  |  Top


In the end, the only one the Coder/Biller hurts is the Physician's, RN's or facility's pocket.

A coder/biller affects more than the physician, the RN or the facility's pocket.  A coder/biller affects the insurance company when an incorrectly coded claim is sent to the insurance company or when we send a claim is incomplete, erroneous, or invalid information on the claim.  The insurance company has to process our mistakes which increases administrative costs, then we have to spend more money trying to fix our mistakes on the back end.

It affects the office staff such as the receptionist and anyone else working in the facility.  If the claim has coding or billing errors, then no payment comes in AND we spend additional monies in administrative expenses.  If nothing comes in, no one gets paid and people are let go because the provider or facility can't pay anyone.  

It affects the patient.  A coder that codes incorrectly has the patient paying more in out of pocket expenses.  If the code was really a 99283, but the coder coded the claim as a 99285, then the patient pays more in coinsurance and deductibles.  If the claim was sent out with incorrect information such as someone inputting the wrong carrier, incomplete policy number, or other wrong info, the patient gets the denial from the insurance company and has to spend time and money trying to fix the problem and appealing the denied claim.  Not to mention the increases in insuranc premiums due to carrier administrative expenses.

It affects the employer who provides health benefits to the employee.  Carelessness in coding and billing drives up the insurance companies expenses which raises the premiums paid by the employer.  

It affects every coder and biller.  If a coder or biller can't do their job because of the lack of training, then we are all affected.  Doctors can no longer trust us.  Regulatory agencies begin looking at the claims practices such as the overuse of modifier 59 and modifier 25.  The coder or biller that is trained has a harder time trying to get hired and when they do, they spend a ton of time and money fixing the mistakes made by the untrained coder or biller.

Doctors and nurses undergo many hours and years of training.  None of it is any good if they are out of work because we didn't do our jobs correctly and the practice, clinic, or hospital had to close because of no revenue.  We are in charge of more than $2,000,000,000,000 in health care dollars, not to mention the billions lost due to waste, fraud and abuse because someone wasn't trained and certified to do the job.  So, it affects all of us, doctors, nurses, cleaning crew, receptionists, technicians, coders, billers, and anyone else involved with patient care and treatment.  Like I said, our profession, Coding and Billing deserves more respect that it is receiving.  It should be taken more seriously by demanding training, certification, and licensing.

November 14, 2007 @ 10:06 AM Reply  |  Email Friend   |  |Print  |  Top

I stand corrected!  I didn't put a complete prospective on what I said, and you are right, we coders deserve more respect.  Thank you for opening my eyes, I guess I am just disgruntled because of the lack of coding jobs in my area.  I just don't understand how when I was looking into becoming a coder, I did my research, called physians offices, searched the want ads to see if there was a good demand for billers and coders.  Once I finished my certification, it seemed all of those jobs just disappeared!  I have called offices to inquire on office positions with the possiblity of promotion to a coder or biller position, just to come to their office as an intern, they don't want any part of it.  I hear the position is already filled, I am RMC certified, they want CCS or CPC certified.  I just started the course for CPC, however to get state certified I need at least 2 years experience, how do I obtain experience when no one will take me on their team, even as an intern?  I was contemplating starting my own coding & billing office, but I would really love to have some more experience under my belt as well as varied certification and specialty training.  Why is the RMC title not held as high as the CCS or CPC?

November 14, 2007 @ 11:06 AM Reply  |  Email Friend   |  |Print  |  Top


Do not give up, do not be disappointed, it might exist a place for you to work, keep searching... start by friends or knowledge who might know somebody else in the healthcare industry, look at on yahoo hotjobs,, databases and post your resume. Visit your state workforce commission, respond to all medical-clerical ads of your local newspaper ( even not for coding positions just for to put your foot in the door). While you are on website, click on forum, put the world coding in the search box then go under on the discussion "Is it possible to find entry level coding jobs?" you may find helpful information in searching the job you want.

I wish you the best.

June 27, 2008 @ 8:21 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Steve,

I read that you believe in outsourcing....

We are a full service medical billing company. We provide outsourced medical coding services and mainly work as a vendor for the medical billing companies in teh US. Using our offshore center in India helps in greatly reducing the costs and improves turnaround time.

Bikham's management team has an extensive experience of more than 5 years in the healthcare industry.                                                                                                                                                                                                                                                                                              

·      We currently service 65 providers spread all over the US in about 10-12 different states.

·      We provide services for 16 specialties and have certified coders (CPC) on staff who helps bring any new specialty.

·      Super bills, EOBs and patient's payments are entered into the system after the closing of business hours and claims  are ready to be submitted next business morning.

·      We work on your billing system by accessing it remotely for entry and for insurance follow up.

·      First two weeks of service are no charge to you.

·      All services are HIPAA compliant.

We are located in Chandigarh , India and can address any issues promptly and personally.

We look forward to working with your esteemed organisation. Pl. Direct any queries to

Sonia Dhawan
425 905 1279

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