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This project deals with research on telepsychiatry in US and its aaplication medical billing
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SUMMER INTERNSHIP PROJECT REPORT
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
Submitted to
SIES COLLEGE OF MANAGEMENT STUDIES
NERUL, NAVI MUMBAI
Submitted by
Shalvi Vartak
Roll No: 29
Program: PGDM
Batch: 2011-2013
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 Medpro’s 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 web-
interfaces.
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.
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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.
2
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 industry’s 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 provider’s details.
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1.2: Outsourcing medical billing service to India.
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
Outsourcing to India has many advantages
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
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CHAPTER 2: MEDPRO SERVICE PRIVATE LIMITED
Office (US):- Boalsburge, Pennsylvania-16827
Office (India):- Lonkhandwala, Andheri(W).
Director:- Mr. Paresh Sheth
Website:- www.medproservice.com
2.1: About Medpro service
MedPro Service is a HIPAA compliant service provider in the health-care industry. They cater
to all the medical billing requirements. Being one of the forerunners in the industry, Medpro
service ensures that their clients receive the best and most economical business solutions. Over
the years, they have partnered several healthcare professionals outsource their medical billing
processes for maximizing efficiency. Along the way, they have accumulated invaluable
experience and expertise and built an impeccable goodwill. Medpro’s satisfied clients are a
testimonial for their skill, commitment and the ability to get things done!
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.
2.1.2: Guiding Light
We strive to improve accessibility and efficiency by servicing the peripheral tasks related to
medical billing. Acting as a catalyst for facilitating better and quicker healthcare services and
simplifying the process of health insurance administration.
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2.1.3: Outsourcing to Medpro service
Outsourcing will help the physicians build efficiencies around their core function, without
adding overheads for allied activities. Their services assist in an uninterrupted, speedy and error-
free billing management process, enabling them to concentrate all their resources towards what
they do best. Medical Billing is Medpro’s 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. Medpro’s 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
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2.2: Medical billing Process
Medpro service’s 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 doctor’s appointment diary, match it with the patient’s
demographic profile and ascertain the eligibility through an online process - thereby reducing the
chances of rejections.
Patient Demographic Entry:
At this stage, Medpro’s medical billing specialists scrutinize and enter the patient’s details, as
provided at the time of the visit. This includes details like, patient’s 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:
Medpro’s 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,
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verifies and validates these codes to confirm that there are no glitches while ‘up-coding’ or
‘down-coding’, which may lead to unnecessary denials.
Charge Entry:
Medpro’s 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:
Medpro’s 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 client’s office for submission.
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Reporting:
Medpro service also customizes client’s reports to suit their requirements.
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2.3: MEDPRO’S COMPETITIVE STRATEGY
Marketing strategy is a process that can allow an organization to concentrate its limited resources
on the greatest opportunities to increase sales and achieve a sustainable competitive advantage.
The marketing strategies serve as fundamental groundwork of marketing plans designed to reach
market and achieve market objectives. Being a new company in the medical billing service
market, Medpro service is taking slow and steady steps towards its growth. To start with, the
company is using a Porter’s 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.
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CHAPTER 3: THE PROJECT
3.1: Marketing and business development of medical billing services for
Medpro in United States
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
do’s and don’ts for direct email marketing through my experiments.
3.2: Objective of this report
The primary objective of this project was to market the medical billing services provided by
MedPro service and also provide them with a business development model.
The first and the foremost task were to create awareness about the company in the
healthcare industry.
The awareness about the service was created through direct email marketing wherein first
the database for the medical billing companies and the psychiatrist practicing in three
states was to be collected and then the email templates were to be sent out.
The second important objective of the project was developing and implementing growth
opportunities (Business development) for Medpro service.
The project that was identified for the growth opportunities was Telepsychiatry. A pilot
project is to be set up soon.
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3.3: NEED AND SIGNIFICANCE OF THE PROJECT
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. The significance of this project
was to help Medpro service achieve this objectives.
3.4: SCOPE OF THE PROJECT
There is so much to do for a physician practicing medicine these days. Besides meeting with
patients and rendering the appropriate services, he/she has to institute, upgrade and make perfect
all the billing procedures involved in the processing of insurance claims. The physician will also
have to remain up-to-date on all the new medical coding requirements, HIPAA rules and the
insurance company’s standards. It can be really annoying when you have to find ways to stay
compliant with all the new HIPAA privacy and security policies without completely disrupting
your facility and re-designing your processes! It’s almost needless to mention completing the
paperwork on each and every one of your patient, which can be estimated to take an average of
thirty minutes per patient.
Out sourcing Medical billing services
Quite recently, the state and federal regulations necessitate the need for experienced and
effective billing and coding professionals. Private practices, clinics and hospital facilities, simply
cannot afford coding mistakes and this has prompted a majority of healthcare providers to opt for
outsourcing their medical billing services to a third-party company. This helps reduce the work
that one has to do with submission of insurance claims and patient bills. Quite naturally, as the
standards and expectations for appropriate billing and coding procedures become more stringent,
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medical billing service providers are rapidly becoming a vital segment of the entire healthcare
industry. And this is so much so, that traditional medical staffing faculties are taking measures to
expand their suite of services to include medical billing services.
In addition to that, publicly traded companies are already
consolidating medical billing services through the
acquisition of smaller players, and that too in a quick
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.
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3.5: MARKETING OF MEDICAL BILLING SERVICE
As mentioned earlier Medpro service is still in the nascent stage of its medical billing service.
Though it has some of the well known clients in the healthcare industry, for the growth of the
company it still needs to expand its business by acquiring more clients from the niche segment.
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-to-
action. 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 organization’s 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
15
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.
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
16
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.
3.5.1: Email marketing
A] Email marketing campaign to the medical billing companies
Step 1: Drafting of sales letter to the medical billing companies in Pennsylvania
The objective of this sales letter was to pitch in to the medical billing companies in
Pennsylvania, New York and New Jersey to outsource their clients medical billing needs to
Medpro service in India. By outsourcing to medpro service for their clients medical billing needs
they could be assured to save on and earn more profits by:
Controlled operating cost
Time zone advantage
Increased productivity and efficiency
Skilled expertise
Improved customer service
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.
17
Step 3: Mailing
A company email id was created for me purely for the email marketing purpose
([email protected]). 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
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.
B] Email marketing campaign to the psychiatrist
Step 1: Drafting of sales letter
The objective of this sales letter was to pitch in to psychiatrists practicing in Pennsylvania, New
York and New Jersey to outsource their medical billing needs to Medpro service in India. By
outsourcing their medical billing needs to Medpro they can reduce their operating expenses,
concentrate on the patient care and also reduce the rejections from the insurance companies.
Considering the objective a sales letter was drafted and then designed into a template. The sales
letter template design was taken from the website mailchimp.com. (See annexure 5.2)
Step 2: Collection of the database
The database collection for the psychiatrists was not an easy task since these psychiatrists rarely
had their websites and email addresses listed on the internet. The only possible way to obtain the
email ids was through the members directory on American psychiatric association. There was a
huge database available for the Psychiatrists practicing in Pennsylvania, New York and New
Jersey. The database collection was a time consuming task since each psychiatrist’s name and
email address was to be recorded into the excel sheet one by one.
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Step 3: Mailing the psychiatrists
Again the process of testing of sales mail was done before mailing the template to the
psychiatrists. This time due the precautions that were taken during designing of the mail the
template did not get filtered in the spam/trash folder. The mailing process took a considerable
time since I customized each mail according to the psychiatrist’s name just to increase its chance
of being opened.
Step 4: Outcome
The response rate this time was around 2-3% of which only 0.01 percent was positive.
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3.6: BUSINESS DEVELOPMENT
Business development comprises a number of tasks and processes generally aiming at
developing and implementing growth opportunities. The growth opportunity for the company
that the director of the company saw was Telepsychiatry. Telepsychiatry is a booming business
in United states. The vision that we had for this project was to set up Telepsychiatry unit by
hiring the psychiatrists and then billing the insurance companies in the United States for these
services. The task wasn’t 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.
3.6.1: Overview on Telepsychiatry
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.
Tele-psychiatry gives a lot of flexibility to mental health providers. It makes the most efficient
use of the time. If the psychiatrist spends a lot of time commuting, why not try telecommuting?
If he generally provides services to multiple clinics in his town, he can stay put and see patients
at an offsite clinic using Tele-psychiatry. Or if he has multiple state licenses, he can pick up extra
days without having to travel.
All that is needed for connection is a PC with Internet access, a webcam and a microphone.
There is no start up cost associated with using the Tele-psychiatry platform unless you need to
purchase a webcam and microphone. On average both can be purchased for less than a total of
$200. The telemedicine market is expected to grow upto $690 million by 2012.
Tele-psychiatry has a variety of sub-specialties based on different applications of service
delivery.
For example,
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1. Forensic tele-psychiatry is when an inmate is connected to a remote psychiatrist or nurse
practitioner for psychiatric evaluations, medication consultations, suicide watch, required
pre-parole evaluations and more. Forensic telepsychiatry significantly cuts down
correctional facilities costs because inmates no longer need to be escorted and transported
to distant off site appointments and psychiatric interventions.
2. Home-based telepsychiatry, is another sub-specialty where the patient is in his or her
own home (or office), accessing the physician by a webcam and high-speed Internet
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.
3.6.2: Applications of Telepsychiatry
The possible applications of videoconferencing technology in clinical psychiatry are many and
they are in a state of constant evolution as new technologies are introduced and they become
more readily available. Applications of telepsychiatry include
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
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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.
3.6.3: SWOT analysis for Telepsychiatry
Strengths
Ideal in a rural setting (location and time).
Telepsychiatry could be used in areas such as consultations, diagnostics, therapeutic,
Pharmacology management, training, and meetings.
A medical follow up tool.
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 doctor’s 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.
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Telepsychiatry represents a more efficient use of existing medical resources, a way to
attract patients living outside a hospital’s 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.
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 one’s
own was highlighted as an impediment to the adoption of telemedicine.
Few patients are actually being seen through the telepsychiatry for medical purposes.
The government’s 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, funder’s (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.
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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.
3.6.4: Medical and legal consideration in Telepsychiatry
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 state’s 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.
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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 California’s 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.
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 patient’s medical records and keep their treatments confidential. Storage of
25
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
patient’s 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
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
26
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);
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.
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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);
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
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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.
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 99241—99275)
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
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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
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
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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
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 PC’s
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 Association’s 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:
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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
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.
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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
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
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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
technicians into a live meeting with consumers for the purpose of training or answering tech
support questions.
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3.6.8: The pilot project setup
Billing for
facility fee
Medical billing for
Physician fee
Submitting claims to insurance
company
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
35
Distant site
The psychiatrist Secure tele-health meeting room
Originating site
The patient
Medpro service
Or any other medical billing company
Medicaid/Medicare/Private insurance company
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 high-
quality 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
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. Breakthrough’s 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
36
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 session’s amount for using the
platform.
37
CHAPTER 4: LEARNINGS AND RECOMMENDATIONS
The summer internship gave me a great opportunity to learn and actually experience the working of a company and the knowledge about the medical billing service business in United States. Medical billing service industry was a totally new concept for me until I read through the literature review and spoke with the mentor. Some of the models, the theories that I learnt in my first year of management were practically put to use during this project. The project involved email marketing and business development. Email marketing is not as easy as it seems and I experienced it during my internship. Not only the mail has to be interesting and convincing but also it has to pass through the spam filters that are responsible to filter out the sales mail. The mail has to then modified and tested so that it does not get filtered in the filtering process. Thus I got to experience and to an extent learn some of the aspects of Email Marketing.
The other half of the project involved business development, one of the projects that we figured out was Telepsychiatry. This involved lot of online research and emailing the respective people to enquire about it. One skill that I developed during this project was writing emails. I learned 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 company’s website to also include the cost structure. Some of the images used on the company’s 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 don’t deceive the clients.
38
39
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.
40
CHAPTER 5: ANNEXURE
5.1 Sales email to Medical billing companies
Forward to a Friend
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 can be
41
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
Now don’t just reduce your medical billing costs but also increase your revenuejust 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 today’s 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.
42
What better way to understand the impact our services have
on clients than to hear it from the clients themselves!
• Dr Nitin Sheth (MD)
"We have been associated with MedPro for our medical
billing requirements for over a year. Their proficient team
members and managers have proved to be a great
extension of our in-house teams. Working with them is truly
wonderful."
• Debbie Goldberg (Psychotherapist)
"We rely on MedPro's comprehensive medical billing
services for supporting our administration and billing
departments. They understand our business and offer cost
effective services."
• Solutionz,LLC.
"Thanks to MedPro, we can now concentrate our resources
on the tasks that really matter without having to worry about
peripheral processes like medical billing. We pass on the
savings to our clients, who value us for that!"
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.
43
forward to a friend
Copyright © |2012| |MedPro service|, All rights reserved.
Our mailing address is:[email protected]
Address Details140, Round Hill road,Boalsburge,Pennsylvania-16827.USA.Tel.:215-550-5292
Visit us on: www.medproservice.com
44
5.2 Sales email to the Psychiatrists
Lower your expenses by sub-contracting to us for your clients medical billing needs.
Email not displaying correctly?View it in your browser.
Reduce your COSTS by 50% - Just by sub-contracting to MedPro for your clients medical billing needs.
45
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 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.
Why MedPro?
As a medical billing company, you undoubtedly know that there is nothing worse for a business than ever increasing overhead costs, operating expenses, competition and decreasing profits and
Testimonials
• Solutionz, LLC."Thanks to MedPro, we can now concentrate our resources on the tasks that really matter without having to worry about peripheral processes like medical billing. We pass on the savings to our clients, who value us for that!"
• Dr Nitin Sheth (MD)"We have been associated with MedPro for our medical billing requirements for over a year. Their proficient team members and managers have proved to be a great extension of our in-house teams. Working with them is truly wonderful."
46
customer base. But you may also appreciate the extent of opportunity you may have for additional profits.
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:[email protected]
Address Details140, Round Hill road,Boalsburge,Pennsylvania-16827.USA.Tel.:215-550-5292
Visit our website:www.medproservice.com
References:
Books:
Marketing management by Philip Kotler
Marketing management by Rajan Saxena
Links:
Medical billing in US- www.wikipedia.com
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Sales mail template- www.mailchimp.com
Tele mental health network provider comparisions-http://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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