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Project Report on
Medical Transcription & Billing Company (Pvt) Ltd.
ii
Muhammad Shoaib Jamil
Roll No. 7957
Submitted in partial fulfillment of the requirementsFor the degree of Master of Business
Administration
At
National University of Modern LanguagesIslamabad, Pakistan
Dec 2009
© Copyrighted by: Muhammad Shoaib Jamil.
iii
iv
Faculty of Information Technology & Management Sciences
It is hereby certified that the report has been thoroughly and carefully read and
recommended to the Faculty of Management Sciences for acceptance of Final Internship
Report by M. Shoaib Jmail Roll No. 7957, Session Aug 2007 to Dec 2009 Morning, in
partial fulfillment of the requirements for the degree of Master of Business
Administration of National University of Modern Languages Islamabad.
Dated: ___________
Supervisor Name: _____________________________
Signature: _____________________________
Observer Name: _____________________________
Signature: _____________________________
Head of Department: _____________________________
v
ACKNOWLEDGEMENTS
All praise to ALLAH S.W.T who has enable me to fulfill my task within a short
period of time and bestowing me with a number of highly qualified faculty members.
Without ALLAH’s blessing and guidance I might never be able to complete any task at
all.
ALHAMDULILLAH
I am so much grateful to my parents and all my teachers whose struggle took this
long, May ALLAH S.W.T bestow peace and prosperity upon them in this world and
hereafter. I am also grateful to my parents who are always been a source of
encouragement for me throughout my life and from start to the end of my MBA as well
as this report. No sequence of works can express my sincere gratitude to our respected
Sir ABD-UR-REHMAN without whose valuable guidance, rich experiences, helpful
advice, useful suggestions, constructive criticism and comments. I could not have been
able to complete this piece of work titled as “Business internship”.
Thanks for all those who extend their cooperation for conducting the work of “Business
Internship”
vi
Muhammad Shoaib JamilMBA (Marketing)NUML IslamabadSession 2008-2009
“To my dear parents who taught me throughout my life”
vii
EXECUTIVE SUMMARY
Established in 1999, MTBC is one of the fastest growing medical billing companies in
America. MTBC provide Medical Billing and Transcription services to numerous
specialties including: Cardiology, Ear Nose and Throat, Internal Medicine, Nephrology,
OB/GYN, Pediatrics, Podiatry, Psychiatry and many more.
MTBC’s have a proven track record of business start up expertise. MTBC has helped
several hundred health care physician and practices to grow their businesses and
maximize their profits limits under minimum cost through its proficiency.
MTBC’s are focused on improving the position of health cares industry, ultimately,
helping them to reach the success that they are working.
MTBC’s services are online connectivity for Medical Billing recently enriched with
EMR and Transcription are a series of motivational activities those are organized to help
growing health care industry in America under AMA policies.
MTBC’s customer base includes health care physicians and practices those are interested
to outsource the medical billing and transcription.
Corporation specific niche of health physician has come to realized that outsourcing is
the best way to minimize the cost and increase the profits. This is due to the fact that the
in house billing is so much expensive and decreasing the efficiency and proficiency of the
practices. Due to this frustration most of the providers and practices are moving towards
the outsourcing specially the unique setup of MTBC.
MTBC will become the most efficiently run, IT-enabled Company in the Pakistan. Its’
client portfolio will surpass one thousand doctors, and monthly revenue will exceed one
million dollars.
viii
To provide health care specialists with ethical, cost effective and exclusive billing and
consulting services focused on achieving optimal reimbursements and increasing cash
flow for their practice. MTBC’s clients are its principal asset and its greatest source of
referrals.
Mahmud Haq is the founder and CEO of MTBC. Prior to founding MTBC, Mr. Haq
served as CEO and President of Compass International Services Corporation from 1997-
1999 (NASDAQ:CMPS). From 1985 to 1996, Mr. Haq served American Express as Vice
President of Global Risk Management.
David Rosenblum joined MTBC in 2003 as President and a member of the board of
directors. He is a graduate of the Johns Hopkins University and the University of
Pennsylvania Law School and has been practicing law for more than three decades. Prior
to joining MTBC, Mr. Rosenblum spent 25 years with a major Philadelphia law firm,
where he served as Managing Partner, and approximately three years as the interim
President, CEO and General Counsel of a publicly traded e-commerce incubator.
Stephen Snyder joined MTBC in 2005 as General Counsel, Vice President and Company
Secretary and was appointed Chief Operating Officer in January 2009. Prior to joining
MTBC, Stephen served as an attorney with a New Jersey law firm. He is member of the
New Jersey and New York bars, the American Health Lawyers Association and the
American Trial Lawyers Association and his writings on healthcare law and practice
management have been published in print and electronic media. Mr. Snyder graduated
magna cum laude from Montclair State University and received his Juris Doctorate from
Rutgers School of Law, where he served as a senior editor of a law journal.
Loraine Goetsch has been with MTBC since 2001. In September 2009, she was appointed
Vice President, Revenue Cycle after having served in various progressive senior
capacities. She is responsible for optimizing the revenue cycle management services
offered to MTBC's clients.
ix
Muhammad Chebli has been with MTBC since 2001. In September 2009, he was
appointed Vice President, Information Technology after having served in various senior
capacities. He is responsible for the direction, development, and delivery of technology
solutions in the advancement of MTBC’s mission to provide high value software and
services to healthcare providers.
Christine Salimbene joined MTBC in 2009 as General Counsel, Vice President and
Company Secretary. She is a member of the New Jersey bar and has more than a decade
of legal experience. She and her team focus on mitigating business risk and ensuring
compliance with all legal requirements.
x
Table of Contents
ACKNOWLEDGEMENTS_________________________________________________iv
EXECUTIVE SUMMARY_________________________________________________vi
Chapter no. 1____________________________________________________________1
Introduction of the Organization____________________________________________1
1.1 Introduction__________________________________________________________1
1.2 History of Organization_________________________________________________2
1.3 MTBC Management_______________________________________________________31.3.1 David Rosenblum -President___________________________________________________31.3.2 Mahmud ul Haq –CEO_______________________________________________________31.3.3 Howard Resnick -Vice President / Chief Financial Officer___________________________31.3.4 Stephen A. Snyder - Vice President / General Counsel______________________________41.3.5 Loraine Goetsch - Vice President / Operations_____________________________________41.3.6 Michael Menche - Vice President / Sales & Marketing______________________________41.3.7 Ata-ul-Hadi –GM Pakistan____________________________________________________4
1.4 Vision:___________________________________________________________________5
1.5 Mission:_________________________________________________________________5
Chapter no. 2____________________________________________________________6
Product & Services________________________________________________________6
Products________________________________________________________________6
2.1 Medical Billing Services____________________________________________________6
2.2 4¢ Medical Transcription Service____________________________________________7
2.3 MTBC Value Added Services________________________________________________8
2.4 Why MTBC______________________________________________________________92.4.1 Benefits___________________________________________________________________92.4.1.1 Improve and accelerate healthcare physician’s collections_________________________92.4.1.2 Free healthcare physician’s staff_____________________________________________92.4.1.3 Empower healthcare physician with technology_________________________________92.4.1.4 Reduce healthcare physician’s billing expenses_________________________________92.4.2 Compatibility______________________________________________________________102.4.2.1 No EMR (No problem!)___________________________________________________102.4.2.2 MTBC’s Integrated Solution: Free EMR & Billing Platform______________________102.4.2.3 Third-party EMR Interface________________________________________________102.5.1 Reasons to Choose MTBC___________________________________________________112.5.1.1 Bill smarter & get paid faster_______________________________________________112.5.1.2 Keep more of what healthcare physician earn__________________________________112.5.1.3 Eliminate data entry with enhanced services & reporting_________________________112.5.1.4 4¢ Medical Transcription__________________________________________________122.5.1.5 Take efficiency to the next level____________________________________________122.5.1.6 Minimize the impact of employee turnover____________________________________122.5.1.7 Improve collections______________________________________________________13
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2.5.1.8 Monitor healthcare physician’s practice's financial success_______________________132.5.1.9 Implementation of an EMR________________________________________________132.5.1.10 Paperless office__________________________________________________________14
Chapter no. 3___________________________________________________________15
Brief on Department Worked______________________________________________15
3.1 Medical Billing Process________________________________________________15
3.2 Healthcare Insurances_________________________________________________163.2.1 What is it?________________________________________________________________163.2.2 When is it used?____________________________________________________________173.2.3 What are the benefits of Medical Insurance?_____________________________________17
3.3 What are Super bills?__________________________________________________173.3.1 How super bills are received at MTBC?_________________________________________17
3.3 Types of super bill____________________________________________________183.3.1 Office Super bill___________________________________________________________183.3.1.1 What is it?_____________________________________________________________183.3.2 Hospital Super bill__________________________________________________________183.3.2.1 What is it?_____________________________________________________________183.3.2.2 When is it used?_________________________________________________________18
3.4 Provider Enrollment & Participation_____________________________________193.4.1 What is enrollment?_________________________________________________________193.4.2 What is a participating provider?______________________________________________193.4.3 Highlights:________________________________________________________________193.4.4 What is a non-participating provider?___________________________________________193.4.5 Highlights:________________________________________________________________193.4.6 Limiting charge:___________________________________________________________20
3.5 EOB (Explanation of Benefits)__________________________________________203.5.1 What is it?________________________________________________________________203.5.2 How is it received?_________________________________________________________203.5.3 ERA (Electronic Remittance Advice)___________________________________________20
3.6 Summary____________________________________________________________21
Chapter no. 4___________________________________________________________22
Company’s Analysis______________________________________________________22
4.1 Operational Analysis__________________________________________________224.1.1 Business Areas & Departments________________________________________________224.1.2 IT Department_____________________________________________________________224.1.3 Operations Department______________________________________________________234.1.4 Human Resource Departments________________________________________________244.1.5 Finance Department_________________________________________________________244.1.6 CSS Department___________________________________________________________254.1.7 New Account Setup Department_______________________________________________254.1.8 Transcription Department____________________________________________________25
4.2 Marketing Analysis___________________________________________________264.2.1 Price:____________________________________________________________________264.2.2 Place:____________________________________________________________________264.2.3 Promotion:________________________________________________________________26
4.3 Human Resource Analysis______________________________________________264.3.1 Recruitment Process________________________________________________________26
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4.3.2 Selection Process___________________________________________________________274.3.3 Orientation________________________________________________________________274.3.4 Socialization Process________________________________________________________284.3.5 Promotions /Job Rotations____________________________________________________284.3.6 Training and Development___________________________________________________284.3.7 Carrier Development________________________________________________________294.3.8 Compensation_____________________________________________________________29
4.4 S.W.O.T Analysis_____________________________________________________294.4.1 Strengths:_________________________________________________________________294.4.2 Weakness_________________________________________________________________304.4.3 Opportunities______________________________________________________________314.4.4 Threats___________________________________________________________________31
4.5 Competitor Analysis___________________________________________________32
4.6 P.E.S.T Analysis______________________________________________________334.6.1 Political Analysis___________________________________________________________334.6.2 Economical Analysis________________________________________________________344.6.3 Social Analysis____________________________________________________________354.6.4 Technology Analysis________________________________________________________36
4.7 Software_____________________________________________________________36
4.8 Hardware___________________________________________________________37
4.9 Connectivity_________________________________________________________37
Chapter no. 5___________________________________________________________38
Responsibilities Performed________________________________________________38
Billing Executive____________________________________________________________38
Chapter no. 6___________________________________________________________39
Problems, Recommendations & Conclusion__________________________________39
6.1 Problems/ Weaknesses_________________________________________________39
6.2 Conclusion___________________________________________________________40
6.3 Recommendation_____________________________________________________40
TERMS USED__________________________________________________________42
BIBLIOGRAPHY________________________________________________________43
xiii
Chapter no. 1
Introduction of the Organization
1.1 Introduction
Medical Transcription Billing Company (Pvt) Ltd is a proficiently run, IT- enabled, and
ISO 9000 certified medical billing company. Off-shore medical billing business was not
very well known when MTBC started its operations in Pakistan back in 2002. MTBC has
recently completed its 7th year of successful operation in Pakistan. MTBC headquarter is
located in Somerset New Jersey (USA). MTBC being the pioneer in the field has a
disadvantage that they don’t get the readymade billers, coder or transcriptions from the
market. Rather they have to train their staff and end up as first step organization for most
of the employees.
Currently MTBC has a full operational office in Rawalpindi Pakistan, a corporate office
in USA and its back office in Bagh Azad Kashmir. All the marketing activates are carried
out in USA and operational activities are carried out in Pakistan office.
MTBC’s 5% Medical Billing Service helps doctors bring efficiency and transparency to a
portion of their business that is generally obscured by antiquated software and
encumbered by numerous expenses. MTBC's medical billing service allows a medical
practice to focus its time and energy on patient care rather than paperwork while
providing a profitable and predictable cost structure. Our state-of-the-art web-based
software allows physicians to manage their practice remotely and they are empowered
with real-time access to information from any Internet ready computer. MTBC's medical
billing service allows healthcare practices to improve collections while reducing expenses
(Source: MTBC HR/ Operations department).
1
1.2 History of Organization
Established in 2002, MTBC is one of the fastest growing medical billing companies in
USA. We provide Medical Billing and Transcription services to numerous specialties
including: Cardiology, Ear Nose and Throat, Internal Medicine, Nephrology, OB/GYN,
Pediatrics, Podiatry, Psychiatry and many more. MTBC is a proficiently run, IT- enabled,
and ISO 9000 certified medical billing company. MTBC (Medical Transcription Billing
Company (Pvt) project was established in April 2002 at PAFWA Community Center
Islamabad. MTBC’s Head Office is located in the USA where all Marketing and related
work is carried out, while the operational and technological functions are managed
entirely in the back office in Pakistan. It was a project which had a very strong support
from our former Air Chief’s wife Mrs. Mushaf Ali Mir.
Basic purpose behind starting the office in PAFWA was to provide corporate office
environment introduction to children (especially female) of PAF personal so that they can
succeed in their future lives. We can conclude that MTBC is a first step organization by
intention. This first step organization concept has raised a lot of issues for MTBC which
we would discuss in the report further.
Initially 15 female employees were hired as Medical Billing Executive these female
employees were formally trained on Medical Billing Functions by the MTBC staff.
Presently, over 600+ personnel make up a diligent and courteous workforce at the Back
Office and providing services to 300+ clients. This number is likely to increase
proportionately with the enlargement of MTBC’s client-base. MTBC has recently opened
its backup office in Bagh Azad Kashmir. Back up office is operational since April 2008.
Medical Billing is the main line of business. Other products include Medical transcription
and EMR (Electronic Medical Record software). This two by-products support the main
line of business (Source: MTBC HR Manger Mr. Zaheer).
2
1.3 MTBC Management
1.3.1 David Rosenblum -President
Mr. Rosenblum is a graduate of the Johns Hopkins University and the University of
Pennsylvania Law School and has been practicing law for over 30 years. Before joining
MTBC, Mr. Rosenblum spent 25 years with a major Philadelphia law firm, where he
served as Managing Partner, and approximately 3 years as the interim President/CEO and
General Counsel of a publicly traded (OTC:BB) e-commerce incubator.
1.3.2 Mahmud ul Haq –CEO
Mr. Haq is a retired Vice President from American Express Bank .He was the initiator of
this project, his commitment and leadership skill took the company from 15 employees to
where they stand today with horizon as their destination. He is business graduate and has
30 years of banking experience.
1.3.3 Howard Resnick -Vice President / Chief Financial Officer
As CFO, Mr. Resnick has oversight responsibility for all financial functions of the
company. As a veteran in financial services, Mr. Resnick has experience in both public
and private corporations - from Senior Auditor at Ernst & Healthcare physicianng to
Chief Financial Officer of a privately held company. He received his B.B.A. in Public
Accounting from Pace University and is a New York State Certified Public Accountant.
3
1.3.4 Stephen A. Snyder - Vice President / General Counsel
Prior to joining MTBC, Mr. Snyder was associated with a law firm where he focused on
such areas as business litigation, insurance and transactional matters. Mr. Snyder
graduated magna cum laude from Montclair State University and received his Juris
Doctorate from Rutgers School of Law, where he served as a senior editor of a law
journal. Mr. Snyder serves as MTBC's Vice President and General Counsel.
1.3.5 Loraine Goetsch - Vice President / Operations
Ms. Goetsch has 12 years of experience in the medical services industry, managing a
physician's private practice as well as a large hospital setup. She specializes in delivering
MTBC's services to clients, and in working one-on-one with physicians to boost practice
efficiency. Ms. Goetsch also leads the stellar customer service program, which has
accounted for substantial company growth through word-of-mouth advertising.
1.3.6 Michael Menche - Vice President / Sales & Marketing
Mr. Menche, a graduate of Duke University, is responsible for business development and
further accelerating MTBC’s rapid growth nationwide. He has 20 years of experience in
promoting healthcare, legal and financial services, and in creating and executing diverse
business-to-business programs and actions.
1.3.7 Ata-ul-Hadi –GM Pakistan
Mr.Hadi is also from the banking back ground. He has his expertise in networking and
has handful knowledge of accounting and financing. He was given the responsibly of GM
4
when company was composed to 75 employees. Current success of the company has a lot
of contribution from Hadi’s efforts
(Source: MTBC HR manager Mr. Zaheer).
1.4 Vision:
MTBC will become the most efficiently run, IT-enabled Company in the Pakistan. Its’
client portfolio will surpass one thousand doctors, and monthly revenue will exceed one
million dollars.
1.5 Mission:
... to provide health care specialists with ethical, cost effective and exclusive billing and
consulting services focused on achieving optimal reimbursements and increasing cash
flow for their practice. Our clients are our principal asset and our greatest source of
referrals.
5
Chapter no. 2
Product & Services
Products
2.1 Medical Billing Services
a) 4% Medical Billing Service – Standard Plan
“Empowering technology and comprehensive billing and support—an unrivaled suite of
features at a remarkable price.”
Benefits
Improved collections
Accelerated payments
24/7 accessibility to healthcare physician’s data
Transparency throughout the revenue cycle
Full financial and practice management reporting
b) 5% Medical Billing Service – Premium Plan
MTBC’s 5% Medical Billing Service includes all of the features of MTBC’s 4% medical
billing service with many added benefits. MTBC’s premium billing clients enjoy
integrated solutions for the clinical as well as administrative aspects of patient care.
MTBC’s 5% premium billing clients enjoy the same daily billing and follow-up as
MTBC’s standard billing plan with added services for electronic prescribing, lab
connectivity, and EMR integration.
5% Medical Billing Solution includes:
6
All of the features and services of MTBC’s 4% medical billing service:
Full charge entry and payment posting
Daily submission and follow-up
Primary, secondary, and tertiary payer billing
Patient billing and call answering
Integrated online scheduling
Real-time financial reporting
Free EMR software
Real-time claims adjudication
Integration with third party EMR software
Toll free number of patient calls
Online insurance eligibility verification
MTBC’s Clinician:
E-prescribing
Lab connectivity
Medical transcription at 4¢ per 65-character line
2.2 4¢ Medical Transcription Service
MTBC's synergy of medical billing & EMR solutions is rounded out with our medical
transcription service.
Physicians who sign-up for MTBC's comprehensive medical billing solution are eligible
for discounted rates for medical transcription. Physicians who select MTBC’s 5%
Premium Package receive medical transcription services at 4¢ per 65-character line.
Physicians who choose MTBC’s 4% Standard Package receive medical transcription
services at 8¢ per 65-character line.
Physicians using MTBC's 4¢ per line transcription service record their dictations into a
handheld digital voice recorder. These recordings are then uploaded to MTBC's website
for transcription. Using MTBC's transcription service, physicians no longer need to
7
handwrite patient notes, or use complicated voice recognition software. Rather, they
dictate their patient notes directly into the digital voice recorder, allowing them to be
transcribed on-the-go without being tied down by phone lines or computer based
software.
The digital audio recordings are securely uploaded to MTBC and are available the next-
day as transcribed Microsoft Word documents.
Services Include:
Wireless flexibility
24-hour turnaround time
Online accessibility
Digital transcribing
Comprehensive customer support
Complete patient and provider confidentiality
Secure 24/7 access
Transcriptions on customized letterhead
Freedom from bulky tape recorders
2.3 MTBC Value Added Services
MTBC continually introduces innovations that further increase a practice's collections
and save office time. All these features are included at no charge in our Premium Plan.
Lab Connectivity
E-Prescribing
Touch-screen Patient Kiosk
Real-Time Insurance Eligibility
Web Pro
Appointment Reminders
8
Toll-free Number for Patients
Medical Transcription
Patient Education
2.4 Why MTBC
2.4.1 Benefits
2.4.1.1 Improve and accelerate healthcare physician’s collections
2.4.1.2 Free healthcare physician’s staff
MTBC relieves healthcare physician staff of data entry, follow-up, payment posting and
other time-intensive tasks.
2.4.1.3 Empower healthcare physician with technology
MTBC’s web-based, real-time practice management system provides transparency
throughout the billing process and 24/7 accessibility from any Internet-enabled PC, Mac
—even a iPhone, BlackBerry or Windows Media Device
2.4.1.4 Reduce healthcare physician’s billing expenses
Our business model and commitment to value translates into unrivaled pricing when
compared to other outsourcing or in-house billing options.
2.4.2 Compatibility
9
Whether healthcare physician’s practice is “high-tech” or “low-tech”, MTBC can
perform healthcare physician’s billing effectively and enhance healthcare physician’s
practice management.
MTBC facilitates both paper and electronic transmission of healthcare physician’s
encounter data (patient information and procedure/diagnosis codes). It’s healthcare
physician’s choice.
2.4.2.1 No EMR (No problem!)
If healthcare physician do not use an EMR, nor plan to use one in the near future, then
healthcare physician are like the majority of MTBC’s clients. These practices securely
scan superbills—which we can customize for each provider—to MTBC.
2.4.2.2 MTBC’s Integrated Solution: Free EMR & Billing Platform
For maximum efficiency and functionality, practices use MTBC’s EMR in addition to
our billing service. Encounter data is transmitted via automated synchronization between
the EMR (which healthcare physician maintain on healthcare physician’s network) and
MTBC’s online platform, no superbills or clicking required!
2.4.2.3 Third-party EMR Interface
If healthcare physician’s practice prefers to continue using a third-party EMR (not
MTBC’s), with the support of healthcare physician’s EMR vendor, we will build the
requisite “bridge” or IT interface as long as healthcare physician’s EMR meets basic
industry standards. By clicking a button (ex. “Send to billing”) in healthcare physician’s
EMR, healthcare physician seamlessly export encounter data to MTBC’s billing
executives and online platform. Typically, just one click sends all un submitted claims to
MTBC.
10
2.5.1 Reasons to Choose MTBC
2.5.1.1 Bill smarter & get paid faster
Tired of submitting claims that will be rejected? MTBC's 4% medical billing service
offers next-day billing and follow-up with claims scrubbing technology that virtually
eliminates the submission of bad claims. With end-to-end solutions, MTBC provides
healthcare physician and healthcare physician’s office staff with the resources healthcare
physician need in order to submit clean claims every time. In addition, through such tools
as Electronic Remittance Advice, and Electronic Funds Transfer healthcare physician
will receive many payments in as little as 5 days.
2.5.1.2 Keep more of what healthcare physician earn
According to the AMA, it costs approximately 10% of an average medical practice's
income to process the medical billing in-house. In addition, a typical medical billing
service charges between 6-10% for primary care. MTBC has broken the cost barrier by
charging a flat rate of 5% of the collected amount with an all-inclusive service that
contains no hidden fees or charges.
2.5.1.3 Eliminate data entry with enhanced services & reporting
Save time and improve efficiency by eliminating data entry from healthcare physician’s
office. MTBC billing executives process all of healthcare physician’s data by entering all
charges, payments, and adjustments on a next-day basis. MTBC's all-inclusive service
allows healthcare physician to view detailed real-time reports on all of healthcare
physician’s billing information.
11
2.5.1.4 4¢ Medical Transcription
Physicians using MTBC’s 4¢ per line transcription service record their dictations into a
handheld digital voice recorder. These recordings are then sent to MTBC for dictation.
Using MTBC’s transcription, physicians no longer need to handwrite patient notes, or use
complicated voice recognition software. Rather, they transcribe their patient notes
directly into the digital voice recorder, allowing them to transcribe on-the-go without
being tied down by phone lines or computer based software.
2.5.1.5 Take efficiency to the next level
With end-to-end solutions, MTBC provides healthcare physician and healthcare
physician’s office staff with the resources healthcare physician need to run healthcare
physician’s practice efficiently. We offer healthcare physician all the tools healthcare
physician need in one convenient location, at no additional charge. With MTBC's web-
based system, healthcare physician will never have to install or train healthcare
physician’s office staff to use cumbersome software. The ability to access healthcare
physician’s information from any Internet-ready computer means that healthcare
physician’s practice information is only a click away. With real-time reporting, online
access to all of healthcare physician’s patient and financial information, healthcare
physician will always have healthcare physician’s finger on the financial pulse of
healthcare physician’s practice.
2.5.1.6 Minimize the impact of employee turnover
Minimize the impact of employee turnover by utilizing MTBC's 5% medical billing
solution. No longer will healthcare physician’s medical billing be disrupted because an
individual is unavailable. In addition, bringing on new employees is a breeze because no
12
substantial training is required. No longer will healthcare physician have to worry about
billing, employee training or turnover.
2.5.1.7 Improve collections
Healthcare physician’s practice will receive reimbursement faster. Electronic claims
filing eliminates the lengthy time of mailed submission, which often takes weeks to be
received and processed. By electronically submitting healthcare physician’s claims,
information regarding healthcare physician’s accounts is available the next day and
payments can be received within five days.
2.5.1.8 Monitor healthcare physician’s practice's financial success
Keep track of all aspects of healthcare physician’s practice by monitoring co-pays, self-
pays, and insurance payments. Our software allows healthcare physician to view the
details of healthcare physician’s accounts and claims in order to assure healthcare
physician that the appropriate parties have been billed. Healthcare physician can also
generate and sort reports to consolidate and analyze healthcare physician’s patient
records.
2.5.1.9 Implementation of an EMR
We save healthcare physician more than just time and money. We provide healthcare
physician with the latest in EMR software, and we support and train healthcare
physician’s staff on our system. A practice using an EMR will be able to export a file
with billing information at the end of each day. MTBC will then ensure that every patient
is billed and accounted for.
13
2.5.1.10 Paperless office
We have a vision to create for healthcare physician a virtually paperless office
environment by empowering healthcare physician with tools such as 4% Medical Billing,
free EMR software, 4¢ medical transcription, and billing services. Healthcare physician
can now create in fact paperless office environment with our software that secures patient
records, provides complete HIPAA compliancy, and a hassle free ease of use.
14
Chapter no. 3
Brief on Department Worked
3.1 Medical Billing Process
Doctor sends the patient’s information & bills to MTBC by uploading on FTP
MTBC downloads the data from FTP and place it in
download folder
Billing Executive enters the patient’s info & bills in MTBCSoft
Patient visits the doctor’s office
Direct to Insurance from MTBC
Through EMDEON indirectly-
Insurance processes the claims and
releases the
statement (EOB)
Insurance sends paid EOB to Dr. & Pt
Doctor sends the paid EOB to MTBC
B.E enters the payment in MTBCSoft
Medical Claim Submission
Insurance sends unpaid EOB to Dr. & Pt
Dr. sends the unpaid EOB to MTBC
B.E will
follow-up on
unpaid claimsIf there is any error, it is corrected and resubmitted to
Ins. ERA sent to MTBC
An appropriate action is taken on paid, denied and unmatched ERA accordingly
If the mandatory information is missing then it will be entered
in PTL (for required info)
15
Let’s explain this diagram 3.1 in detail.
1st of all patient visit to the insurance company in order to get the policy from the
insurance, Insurance company offers the wide range of plans in order to cover the
medical cost of the patients. On the same time insurance allot a PCP i.e. Primary care
physician to the patient. Patient has to visit on primarily basis to that specific doctor.
When patient visit to Provider office, he has to give all the required information to
Provider which includes
Registration form
Medical History Form
Family Information Form
When he\she fulfilled basic requirements, then Provider is supposed to check the patient.
After checking, Provider has to sent all the information to Medical Billing Company
which includes
Patient Demographic form (Also known as Registration form)
Insurance Information
Super bills
3.2 Healthcare Insurances
3.2.1 What is it?
It’s a method of funding medical treatment. This funding is provided by a medical
insurance company under a health plan, which is simply a contract between an insurance
company and a subscriber.
16
3.2.2 When is it used?
When a patient receives costly medical treatment, which is too expensive to be
paid from pocket.
When a medical provider wants to bill for the medical services provided to the
patient.
3.2.3 What are the benefits of Medical Insurance?
Peace of mind that one will receive proper medical attention when a need arises.
Peace of mind that one is covered from the impact of large medical bills.
Peace of mind that the insurance company will make all administrative
arrangement for medical treatment
3.3 What are Super bills?
Super bill is an itemized list or statement of services and their fees or charges, as
determined by a provider. A Super bill is also known as an encounter form or a charge
slip.
3.3.1 How super bills are received at MTBC?
Scanned document
Amazing Chart text file
Through EMR
3.3 Types of super bill
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Following are the commonly used types of super bills.
Office super bill
Hospital super bill
Nursing home super bill
3.3.1 Office Super bill
3.3.1.1 What is it?
It’s a form that is generated at a doctor’s office for each patient visit. It serves to
communicate information about the number and type of services provided by a medical
provider. The provider signature (when present) on this form makes it a legal document,
and attests to the fact that services were performed and may be billed for.
3.3.2 Hospital Super bill
3.3.2.1 What is it?
It’s a form that is generated by a provider’s office when hospital care is provided to a
patient. This form serves to communicate information about specific hospital services
provided by the medical provider.
3.3.2.2 When is it used?
When a medical provider wants to bill for services provided to a patient (new or existing)
in a hospital.
3.4 Provider Enrollment & Participation
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3.4.1 What is enrollment?
It’s a process by which a medical professional becomes a member with an insurance
company.
3.4.2 What is a participating provider?
An enrolled provider who agrees to accept insurance’s assignment of charges for covered
services is a participating provider.
3.4.3 Highlights:
Fast claim processing
Direct payment to the provider
Claims directly forwarded to Medigap (for Medicare only)
Publicity in insurance’s participating providers directory
3.4.4 What is a non-participating provider?
An enrolled provider who reserves the right to accept or reject insurance’s assignment of
covered services is a non-participating provider.
3.4.5 Highlights:
Providers set their own fee
They do not have to accept the insurance’s allowed amount (but cannot exceed
the limiting charge).
Patients pay the difference between the insurance’s approved charge and the
provider’s total fee.
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Providers collect their money
3.4.6 Limiting charge:
It’s the highest amount that a non-participating provider can charge for a covered service.
3.5 EOB (Explanation of Benefits)
3.5.1 What is it?
EOB stands for Explanation of Benefits. It is the statement that is received after a patient
or a medical provider has filed a medical claim with an insurance company. This
statement is the summary of actions taken on the claim—how much was paid and how
much remains to be paid by the patient.
3.5.2 How is it received?
Mailed to providers
Providers then scan and send to MTBC
EOB is never sent directly to MTBC
3.5.3 ERA (Electronic Remittance Advice)
An Electronic Remittance Advice is an electronic version of a payment explanation
which provides details about providers' claims payment, and if the claims are denied, it
would then contain the required explanations. ERAs are provided by plans to Billing
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Companies. A notice of payment due as a notice of an electronic data interchanges
financial transaction.
3.6 Summary
Summary is this that we are sending Bills to the insurance company, insurance company
pays the agreed amount to provider which is also in the knowledge of patient. Insurance
pays the major portion of medical cost of care received by the patient from healthcare
provider after that patient is responsible for rest of the amount which is defined by
healthcare insurance. MTBC is getting 4% and 5%of overall collection of the Providers
of that specific month.
Chapter no. 4
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Company’s Analysis
4.1 Operational Analysis
4.1.1 Business Areas & Departments
Allied to the services provided by the MTBC is result of the combine endeavor &
fulfillment of the unachievable challenges by the assistance of the following departments
& brief description on their responsibilities:
1. IT Department
2. Operations Department
3. HR Department
4. Finance Department
5. New Account Setup Department
6. CSS Department
All winning teams are goal-oriented. Teams like these win consistently because everyone
connected with them concentrates on specific objectives. They go about their business
with blinders on; nothing will distract them from achieving their aims.
4.1.2 IT Department
Using smart technology to deliver quality in-house software for the medical billing
process. Basically, they are improving & maintaining software’s including other
technologies. Due to the company’s imaginative thinking & these no. of employees are
spread in the different sections related to IT department. Being in the IT industry and
taking edge over the competitors through new innovations, IT is the most expensive
department of the company. MTBC spend a lot on the IT research and development.
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Future plan of MTBC include 75% of total employee should be in the IT department.
They are looking for automation of processes to reduce the human involvement in all the
processes. Teams inside the IT department include
Web Team
Database Team
Soft Team
MIS Team
QA team
Network Team
IT department is headed by Mr. Humair Noor and Mr. Ikram Afzal. Both of them have
exceptional software development and planning skills. Most recent achievement of IT
department include converting all the products in new technology i.e. .Net
4.1.3 Operations Department
It plays a vital role towards the establishment & maintenance of the company. All this
process is conducted under the experienced and friendly people. All, which is, assemble
in three shifts as it is operated 24 hours. Their main objective is to satisfy customer’s
need by prior accuracy & precision in billing process. Therefore, their belief is that such
accuracy can be achieved through teamwork, for continual improvement of the
organization's overall performance. All the revenue generated by the originations is
through 4% of the total collections done by the clients in a month. Operations works as
real back bone of the organization.
Operation is controlled directly by GM through a senior Manager Operations, three
Manger Operations and two Manager Special projects. Operation is divided into three
shifts with an assigned manger operation. Function of Manager Operations is deal with
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the HR issues within the three shifts. MSPs provide then assistance in dealing with the
clients and to resolve the complex billing issues.
4.1.4 Human Resource Departments
Human Resources is a service-oriented team, responsible for providing a comprehensive
and co-ordinate personnel service. It supports line management in the departments and
performs centralized service tasks.
Main areas of responsibility include manpower planning, organizational development,
employment and association conditions, recruitment, job classification and salary
administration, performance appraisal, advancement, internal mobility, training and
development, social services, social security, working conditions, settlement of disputes
and relations with the personnel. As we already discussed that MTBC don’t get the ready
made stuff from the market so they to train all the staff for operation department. HR
department has a very effective and organized Training department. Medical billing
process training is a 20 days comprehensive training. MTBC training team is capable of
training 70 trainees in one session.
MTBC HR department upcoming project which they are caring out with the IT team is to
automate the payroll process. Employee record has already been put into MIS and
Employee attendance being automated through thumb Impression detector machine.
Every employee has access to its data through intranet website.
4.1.5 Finance Department
Serve as the company’s chief fiscal policy advisor. Promote responsible resource
allocation through the MTBC’s annual financial plan. Ensure the financial integrity of the
company by having competent staff & a probability of enhancement in such group by
looking towards the company’s forecasted policies i.e. expertise in fiscal matters of the
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company to promote the continuous improvement of: The structures, systems, processes,
programs, and performance of the company; our expertise; and our capability to initiate
and manage changes. Teams inside the Finance department include
FCU Team (Financial Control Unit)
Financial Analysts Team
Operations Analysis Team
4.1.6 CSS Department
“Voice of MTBC”, CSS really speaks MTBC voice. Connected to our NJ clients and
insurances through VOIP phones they serve as the face of MTBC. Client Services
Section executes & receives calls from our clients. It includes a very proficient staff.
Their accountability is towards satisfying their customers through timely handing.
4.1.7 New Account Setup Department
MTBC is a growing organization with a two new clients signing up daily. NASD’s
responsibility to setup a client with the insurances carriers create setup for all the new
clients so that claims can be submitted electronically and improve the payment cycle of
claims. NASD get practices setup and then hand it over to Operations for further
processing.
4.1.8 Transcription Department
4.2 Marketing Analysis
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4.2.1 Price:
MTBC competes on its price, no medical billing company with operations in USA can
provide billing services at 4%. MTBC having its operations in Pakistan compete in
international market on its 4% collection rate.
4.2.2 Place:
Being an IT company, having a separate optic fiber internet link and connected to the
USA office through its VOIP phones, place never been an issue for MTBC. From the
Human Resource point of view if MTBC keep on growing at the current rate current
building is enough for next 10 years. Located beside Murree road they are easily
accessible through public transport.
4.2.3 Promotion:
MTBC major clients are word of mouth referrals. They are referred by already existing
clients. Second major source of marketing is the post card which they send to all the
doctors in the targeted state.
4.3 Human Resource Analysis
4.3.1 Recruitment Process
MTBC advertise through following ways
Internal email to all the Employees with the details of vacant position
Advertisement in THE NEWS and Jang
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90% of employees in MTBC are from reference of already existing employees. Reason
behind that once there is an opportunity available and internal email is sent to all the
employees then they refer so many friends and colleagues that there is no need to get CV
from outside sources.
4.3.2 Selection Process
Internal Interview by HR and then a second interview by the respective department head
leads an employee go through the next step.
Every department has its own process because some departments like operations &
transcription require initial training so a test of capabilities is done before they are
selected for initial training session. Billing Department selects only those candidates who
have good communication skills along with good computing skills. IT department
selection is done through interview with no test.
4.3.3 Orientation
Initial orientation is done by the HR Manager Mr. Zaheer and then Employee is handed
over to department heads. Department head take the employee to the whole company and
get him introduced with all the stake holders. In case of Operations department this
responsibility is taken by Training team.
As the seating arrangement in the organization and other process as so much relax that
one can’t identify the differences between seniors and juniors. Starting from seating
arrangement to dining there is no difference on the basis of position in the hieratical level.
This concept of corporate culture was introduced in 2004 by the CEO following the
examples set by southwest air lines and other multinational organizations but the current
culture of MTBC is setting its own standard.
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4.3.4 Socialization Process
Being the followers of corporate culture usually employees don’t take much time in
getting used to the environment of MTBC. MTBC quarterly functions and trips are events
which are just arranged so that new employees can merge with the old employees.
4.3.5 Promotions /Job Rotations
Only parameter for Job promotion is performance. For each department there are monthly
appraisals and on the basis of those appraisals best employees get “Employee of the
month” and “Team of the month “awards. Employees are also rotated to other
departments in the same capacity so that they can learn the best skills to improve their
performance. MTBC has never encouraged termination of employees on the basis of
performance. Concept behind is the investment that we have done on the employee in
hiring should not be wasted and usually when such employees are moved to other
departments they start performing better.
4.3.6 Training and Development
Along with the initial training conducted by the training team under the supervision of
HR department, on job training remains the most of important activity. All the new
innovations coming in industry are communicated to the employees through emails from
the training team followed by lectures and quizzes awarding cash prized to encourage
employees to learn more. Training team has been awarding plaque to the most
knowledgeable employees on the basis of quizzes conducted.
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4.3.7 Carrier Development
MTBC’s corporate office visit and getting an opportunity to meet all the clients there
gives a lot of confidence to the employees who are given this opportunity by the
organizations. Exposure to the most competitive environment not only gives confidence
but also prepare employees to compete at any level.
4.3.8 Compensation
MTBC compensation packages are competitive to the market but there are lot of areas
which need improvement. Operations department has a low retention rate just because of
low salaries but IT department offers high salaries to attract skilled employees. This is a
department which needs a lot of improvement. Increments are ad-hock and so company
unable to retain skilled employees.
Problem statement in the report is also on the same topic “retention rate of employees”.
4.4 S.W.O.T Analysis
4.4.1 Strengths:
Operating in NJ since 2002 and has gained a lot of reputation, proof to that is 80%
clients are just referred by existing clients.
There is a friendly environment among the employees and everyone is given an
opportunity to prove his/her qualities.
Decentralized decision making process involving the participation to contribute.
Online banking is another strong point for the bank’s employees and its
customers.
Healthcare physicianng staff is hired which proves to be the most important asset
for the organization and plays a vital role in the company’s overall success.
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Strong R&D and provider enrollment unit.
In-house built software’s with no external dependences
Full support from the government for internet connection and also MTBC has its
own radio internet connection.
Operational backup office in Bagh-AJK which can be used in unfavorable
conditions.
Internal training team with no external dependences, they hire the raw material
and mold them to their needs.
Totally internal IT unit which is not dependable on any external source, starting
from web hosting to the software development.
Having very good relations with the USA embassy and there are occasional visits
from the ambassadors.
4.4.2 Weakness
Low retention rate and there is always a fear that we me get short of experience
and trained employees.
Marketing team doesn’t have many options available, and working in the very
competitive market they need a big budget to grab big clients.
Having no incentive plan is very de-motivating factor for employees.
No defined increment policy and ad-hock increments always create a doubt in the
employee’s minds.
Exceptional English communication skills are required by the CSS dept which is
not available at low cost in the local market.
4.4.3 Opportunities
Lack of quality competitors in the local market keeps them on step ahead of
getting the quality human resource.
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Cheap Labor in a developing country like Pakistan always gives an edge to
company to pass over this advantage to the client.
EMR is very famous product among the doctors in USA. MTBC’s futuristic
approach helps them develop EMR 3 years back. Now MTBC can provide fee
EMR to all its clients for free.
Friendly environments help the employees in gaining confidence and perform
openly, without any hesitation and help in improving the quality of the bank’s
services and products being offered to its customers.
A variety of products improve the level of customer satisfaction by providing
them greater options, which further enhances the image of the organization.
Hiring of healthcare physicianng and energetic people greatly enhances the value
of the organization’s services. When healthcare physicianng people are hired they
are energetic and accept changes. They opt to work under open and friendly
environment and barriers of communication are removed from the organizational
setup.
Getting MTBC website on the Google top ranking opening another horizon for
the company.
4.4.4 Threats
Out sourcing has always a threat from the USA government. Every time election
campaign for presidency starts one of the candidate has an opinion against out
sourcing .The day USA government take a decision to take the business in-house
then MTBC business will be over.
In case of any political mishandling in the country like happened recently
“Benazir Murder” MTBC operations are effected which is not acceptable to the
clients in USA.
Medical billing business is so volatile the patient and client any Sue the company
any moment. Billing companies are closed on even small mistakes.
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4.5 Competitor Analysis
MTBC is very lucky not to have strong competitors in the local market. There are three
major competitors of MTBC in Pakistan:
Ovex Technologies
DBS
CureMD
Ovex Technologies
They have a small billing unit but they pay very high so employee who just looks
for a good salary at current time they usually tend to go towards Ovex
technologies.
They don’t have any competition with MTBC from client’s point of view. MTBC
has a separate market to work on.
Cure MD
Cure MD operates in Lahore and don’t have any Clients competition with MTBC
but they defiantly are attracting those employees who are willing work away from
their home land.
DPS
DPS don’t have a significant Billing unit but they do attach the MTBC Employees
for there call center.
DPS has their HR department working in the same locality where MTBC is doing
business these days.
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4.6 P.E.S.T Analysis
4.6.1 Political Analysis
MTBC has a strong support from the Government of Pakistan; MTBC got the grade of
software Technology Park in 2007. Since then they have government sponsored
internees, government sponsored optical fiber internet .MTBC is regularly visited by the
US officials, especially the economic advisers to Pakistan and thus MTBC is getting a
very special treatment from the government. Only treat to MTBC is from the upcoming
US government. It has been regularly announced that USA should not outsource its
technology through private companies.
“The off shoring of high wage jobs from the United States to lower cost overseas
locations is currently contributing to unprecedented levels of unemployment among
American electrical, electronics and computer engineers. Off shoring also poses a very
serious, long term challenge to the nation's leadership in technology and innovation, its
economic prosperity, and its military and homeland security. Forrester Research has
projected that as many as 3.3 million white-collar jobs of all kinds and over $136 billion
in wages will be moved from the United States to lower cost, offshore locations by 2015.
Although the initial emphasis has been on routine service and technical support positions,
the trend is expanding to include more complex engineering and design services. It is
abundantly clear that many of the jobs being sent offshore were formerly held by U.S.
engineers, computer scientists and other information technology professionals.
(URL: http://www.ieeeusa.org/policy/POSITIONS/offshoring.html)”.
Political instability in Pakistan is always been a concern for the client in USA. Whenever
there is news about Pakistan MTBC finds it very difficult to keep the clients that their
business is in safe hands.
“But up to one quarter of lost wages translate to lost tax revenues, by conventional
accounting methods. So if 3.3 million white- collar jobs and $136 billion in wages move
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overseas by 2015 as Forrester Research predicts, that means federal, state and local tax
receipts could decline as much as $34 billion. Here's the big reason why tax revenues are
declining: all these jobs are leaving the country," said John McGowan, professor of
accounting at Saint Louis University. "We need to start talking about this problem and
not just blithely saying, 'Free trade is the solution' just because it boosts corporate profits
and Wall Street likes it. Cynthia Kroll, senior regional economist at the University of
California, Berkeley, said off shoring could jeopardize U.S. dominance in emerging
fields such as genetics and nanotechnology (URL:
http://findarticles.com/p/articles/mi_qn4176/is_20040408/ai_n14571549) “
4.6.2 Economical Analysis
MTBC is the only company in USA which can do billing at 4%, no company operating in
USA can ever think of providing billing service for less than 6% of total collections. As
all the revenue collected is in US dollars so whenever the price of dollar increase as
compare to Pakistan rupee MTBC has something to share with its employees.
These days value of rupee is decreasing very quickly so all such organizations which are
getting revenue in form of US dollar are paying its employee very high. High inflation
rate in the market compel the companies to give bounces to their employees. As
government is putting a lot of attention on foreign exchange reserves so companies like
MTBC is always treated like a hot cake. MTBC is not only bringing in foreign exchange
but also exposing the IT talent of Pakistan to the latest technology practiced in USA in
field of IT.
4.6.3 Social Analysis
As we discussed in the first chapter this project was initiated to provide highly skilled IT
jobs to such graduates who don’t have experience so MTBC serves as first step
organization for most of the employees. MTBC has never ignored its responsibility to
34
provide social life benefits to its employees. MTBC Haj Scheme provides a Haj ticket to
one of its employee allowing with his/her relative each year. Company sponsored
Quarterly trips to the employee designed destination is a regular activity for MTBC.
Providing regular donations in form of money and service to Rizwan shaheed foundation
is regular activity from MTBC management. Being part of PAFWA MTBC has
organized/participated in Mena bazaars and other functions. During the Azad Kashmir
earth quake MTBC arranged a full 3 weeks camp in Bagh Azad Kashmir and then
continued it over the next month to provide relief to the effectives.
In the wake of the devastating South Asian earthquake, a massive relief effort is currently
underway to speed life-saving relief to families affected by the region's most destructive
earthquake in nearly a century. The 7.6-magnitude earthquake has resulted in the death
of at least 30,000 people in Pakistan, with nearly 600 deaths in India. According to the
United Nations, more than 2.5 million people were left homeless after Saturday's disaster
and death tolls are expected to rise as rescue workers reach severely affected areas.
Immediate relief is needed for families who have lost homes and loved ones and
continued support will be required in the coming weeks to help restore power and
services as well as rebuild homes and shattered lives. MTBC's board of directors has
made a $10,000 contribution to the relief efforts. TBC has responded to this disaster by
rushing urgently needed relief to the victims. David Rosenblum, President of MTBC,
explained, "MTBC has prepared a convoy to travel to the affected areas with supplies of
food, tents, mattresses, and medicine, and we encourage anyone who can help to do
so."More help is needed as roads begin to open, enabling supplies to reach remote
villages. If healthcare physician would like to help in the relief effort, we invite
healthcare physician to direct healthcare physician’s browsers to www.unicef.org or
contact the organizations below (URL:http://www.mtbc.com/pressrelease13.aspx)
4.6.4 Technology Analysis
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MTBC’s in known in the market as a “Unique healthcare IT company”. Health
information technology (Health IT) allows comprehensive management of medical
information and its secure exchange between health care consumers and providers. Broad
use of health IT:
Improve health care quality;
Prevent medical errors;
Reduce health care costs;
Increase administrative efficiencies;
Decrease paperwork; and
Expand access to affordable care.
4.7 Software
MTBC has converted all its products to Microsoft .NET Framework, which enables them
to compete in the market of 21st century. MTBC website is a dynamic website which is
updated after every 5 minutes .So all the transaction which are made in system in
Islamabad office and replicated to clients in USA in 5 minutes. Biggest advantage to
MTBC is that they have all the technology is built in-house. Recently they became
Microsoft gold partners.
4.8 Hardware
Hardware sets the basis for a first-rated IT structure. MTBC’s has never compromised on
its hardware; hardware is all imported from USA directly. All the computers which are
used by employees are directly purchased from DELL and imported to Pakistan directly
by the company. All the servers, switches and firewalls are imported from USA. So
MTBC has exposure to the best technology available in the market. Servers used by
MTBC to run the website and the software are recently upgraded.
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4.9 Connectivity
MTBC has its own in-house call center, technical support and customer support team.
This team has VOIP phones which links them to the clients and other stake holders in
USA. MTBC has state of technology of connectivity, new office in Bagh also has the
same VOIP technology and therefore they have the best equipments and hardware
available in the market. They have provider 24/7 customer support to all the clients.
There are several toll free numbers which are provider to clients and their patients on
which they can call and get their issues resolved.
Chapter no. 5
Responsibilities Performed
Billing Executive
To carry out medical billing for off-shore medical providers.
37
To communicate with the clients over the internet and to assist them with their
day to day tasks of maintaining patient records.
To research/analyze and prepare appeals when claims are rejected by the
insurance Companies.
To Tele-converse with insurance companies for A/R follow up.
To keep the clients and the Team Leader informed about the changes and updates
in the process of Medical Insurances.
Reduced claim (A/R, deficit) and total aging (Receivable) for the assigned clients.
Chapter no. 6
Problems, Recommendations & Conclusion
6.1 Problems/ Weaknesses
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i. MTBC is charging 4% which is very low as compared to other billing companies’
rate.
ii. MTBC Days Account Receivables are high. Due to this factor payments received
late.
iii. We have access to limited info that’s why report consist the limited info.
iv. Company is not releasing financial statements and is kept quite confidential.
v. We cannot conduct grand survey because all employees are not available at the
same time.
vi. Minimum qualification is BA whereas a Master can do the better analysis and can
do efficiently.
vii. Employee job is not secure that’s employees’ retention rate is very poor.
viii. Follow up Teams are not separated from Billing Team. An individual has to do
the Billing and follow up on Account Receivables.
ix. Salary package is very low as compared to other medical billing companies.
x. No bonus given to the Billing Executives.
xi. Transportation facility is not provided to the employees that would increase their
motivation level.
xii. Night allowance is very low.
xiii. Heavy amount is utilized for curricular activities like trips, functions.
6.2 Conclusion
Overall MTBC is an organization where a graduate can improve his skill by providing his
services. His management skills will be improved as he has to deal with the insurance
companies that are in USA. Company is growing day by day and its revenue is increasing
day by day. MTBC has increased its clients by improving the quality of services. Audits
are conducted internal and external to maintain the level of performance. Company’s
weak area is employee retention. Company has to do something in the favor of
Employees so that they should retain and work in the progress of company. MTBC is an
organization who is growing day by day. Its clients are increasing. I have seen few
doctors are in pipeline to join MTBC.
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6.3 Recommendation
i. Job security should be provided to overcome the resignation and to promote
Employee retention.
ii. MTBC is providing services at 4%, It should be increased as now due to inflation
and world crises the rate should be increased to 5% or 6% to increase the revenue.
iii. Currently MTBC is not charging for Software’s. It should be provided on cost so
that MTBC should generate revenue.
iv. Its competitors are providing more salaries than MTBC. It should be revised and
employee should be paid handsome salaries.
v. If MTBC arrange more lines in operations for Billing Executives it will increase
the productivity, then there will be no need to hire separate client service
executive. It will decrease the MTBC monthly expense.
vi. MTBC should have to hire MBA. Higher Qualified people will work effectively
and will help in increasing the revenue of the company.
vii. MTBC has purchased LCD and replaced with monitors so it will improve the
work quality.
viii. DAR (Days Account Receivables) should be reduced by doing effecting follow
up.
ix. The software is in process that would be given to the Doctors so that Doctor
office would do billing by their self and MTBC will submit their claims. It will
reduce the daily turnaround time.
x. Billing Team should be separated and Follow up Team should be separated so
that by doing follow-up effectively account receivables are reduced.
xi. Bonuses should be given to the Billing Executives so that their productivity will
increase
xii. Transportation facility should be provided especially to employees of night shift.
xiii. Night allowance should be increased to motivate the employees to work in night
timings.
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xiv. A part of amount spend on curricular activities should be given to the employees
as a reward.
TERMS USED
AMA American Medical Association
CPT Current Procedural Terminology
CSS Customer Support Services
EOB Explanation of Benefits
ERA Electronic Remittances Advice
FCU Financial Control Unit
HEALTH INSURANCE
HEALTHCARE
HEALTHCARE PHYSCICIANS
ICD International Classification of Diagnoses
41
NASD
OPERATIONS DEPARTMENT
PAFWA Pakistan Air Force Welfare Association
PRACTICES Title of the healthcare client
SUPERBILLS Diagnose and applied procedure
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