Medical Coding
It is with great pride and excitement that we reflect on our journey in surgery coding at SCA Health India. We started operations back in 2013 with just a small team of 4-5 teammates, and we have come a long way since then. Today, we are a strong team of 100+ surgery coders and still growing, serving as the backbone of our organization. Surgery coding is a specialized process that requires a high level of expertise and accuracy. Our team has consistently demonstrated exceptional skills and knowledge in assigning appropriate Current Procedural Terminology (CPT) codes to surgical procedures performed by healthcare providers. We deal with a wide range of surgical specialties, covering the most complex portion of the CPT codes, and we have successfully navigated procedural, modifier, and diagnostic coding challenges with precision.
Our commitment to accuracy and attention to detail in surgery coding has had a significant impact on the revenue cycle management of our organization. Accurate coding is critical for proper reimbursement, and our team's expertise has played a crucial role in ensuring that our organization receives the revenue it deserves. Our success in surgery coding would not have been possible without the hard work, dedication, and expertise of each and every team member. Their tireless efforts, continuous learning, and unwavering commitment to excellence have contributed to the growth and success of our team. We are proud of the team we have built and the exceptional results we have achieved together.
As we look towards the future, we are confident that our team will continue to excel in surgery coding and drive our organization's success. We are committed to providing you with the necessary resources, training, and support to further enhance your skills and knowledge in this specialized field.
Support
Human Resource: The Human Resources Department at SCA Health India is responsible for handling the employee life cycle. The HRD is segregated to different teams to pay complete attention to different aspects like talent acquisition, training and development, employee relations and employer branding, compensation and benefits and legal compliance. The hiring rate per year has been increasing substantially and we are a team of 600+ teammates. We work on the new business transitions and establishing new business lanes. The HRD also follows an open-door policy and the general HR policies are very employee centric.
SCA Health India is continuously aiming towards increasing employee satisfaction and a knowledge sharing culture and creating a flat and egalitarian workspace.
Administration: The Administration Department at SCA Health India is responsible for general administration and facilities management. It oversees various aspects, such as transport management, vendor management, security, and infrastructure management.
The Administration Department ensures that the workplace is in excellent condition and does not impede the performance of any individual in the company.
IT: The “@SCA INDIA IT” at “SCA Health India” provides comprehensive IT services and ensures compliance with the quality standards to the Noida business unit and is wholly responsible for delivering timely and high-quality IT services to the SCA India teammates in collaboration with the US IT partners. The department oversees vendor management, asset management, research and procurement of IT assets and supplies, and server room management, with the related required IT assistance.
Revenue Cycle
The Revenue Cycle team in Noida CBO started in 2015 with a small team of 10-15 Full-Time Equivalents (FTEs) and a vision to transform and provide innovative solutions for healthcare providers to optimize revenue and improve financial performance. Over the years, the team consistently delivered exceptional service and tangible value to clients, leading to rapid growth and expansion. Several functions of revenue cycle management were added to the team's portfolio, including Insurance Verification, Patient Statements, Correspondence, AR, Cash Posting, and Refunds. The team outgrew their initial office space and moved to a larger facility to accommodate their growing team. They continued to attract top talent in the revenue cycle management field and invested in their team's professional development to empower them to excel in their roles.
The company's culture of innovation, collaboration, and continuous improvement became the driving force behind their success. Today, the team has grown to 209 strong heads, including experts in AR, Cash Posting, denial management, Insurance verification, Patient Statements, and Correspondence, making them a leading revenue cycle management team.
The team's story is a testament to their unwavering commitment to excellence, innovation, and customer satisfaction. Starting from humble beginnings with a small team, they have built a thriving company that is making a significant impact in the field of revenue cycle management. With their strong team and customer-centric approach, they are well-positioned for continued success in the years to
Insurance Verification
Insurance verification and benefits are critical processes in the healthcare industry that involve verifying a patient's insurance coverage and understanding the details of their insurance benefits. These processes help healthcare providers determine the patient's eligibility for services, estimate the patient's financial responsibility, and ensure that the healthcare services provided are covered by the patient's insurance plan. Our SCA team has expertise in insurance verification and benefits processes in healthcare for accurate billing and reimbursement. Effective communication, documentation, and follow-up are critical components of these processes to ensure smooth operations and financial viability for our Centers.
Correspondence
The correspondence process in medical billing involves communication between healthcare providers and various stakeholders, such as insurance companies, patients, and other relevant parties, to resolve billing-related issues, inquiries, or disputes. It is an important aspect of the medical billing workflow and helps ensure accurate and timely reimbursement for healthcare services. Our Correspondence team’s key responsibilities include receiving, reviewing, documenting, researching, responding, and resolving issues or inquiries related to billing and reimbursement. Patient Statements
Patient statements are typically generated after insurance claims have been processed and any patient responsibilities or adjustments have been applied towards the patient. In the spirit of our value ‘Service Excellence’ SCA ensures correct billing to our patients by validating the statements before generating and sending them to patients for the purpose of billing them for their portion of the healthcare services rendered. We are proud to have served our centers over these years with complete client satisfaction and look forward to this partnership with collective growth. Cash Posting/Payment Posting-
Payment posting/Cash Posting is a critical step in the RCO process, which involves recording and reconciling payments received from patients, insurance companies, and other third-party payers in the organization's financial system. It is an essential part of the overall financial management process and ensures accurate accounting of payments received for services provided by healthcare providers.
AR/Denial Management
AR & Denial management in the context of US healthcare refers to the process of identifying and resolving claims that have been denied by insurance payers. Denials can occur for various reasons, such as incorrect coding, missing documentation, billing errors, medical necessity issues, or eligibility concerns. Denial management is a critical aspect of revenue cycle management in healthcare organizations, as denied claims can result in delayed or lost revenue if not properly addressed and appealed in a timely manner.
Here are some key steps involved in denial management in US healthcare:
Denial Identification: Healthcare organizations need to have effective systems in place to identify denied claims. This typically involves regular monitoring and analysis of claims data, including claim rejections, denials, and explanation of benefits (EOB) reports from payers.
Root Cause Analysis: Once a denial is identified, the next step is to determine the root cause of the denial. This may involve reviewing the claim for coding errors, missing documentation, eligibility issues, or other billing errors. Identifying the root cause is essential to address the issue and prevent future denials.
Appeal and Resubmission: After identifying the root cause of the denial, the healthcare organization may need to appeal the denial with the payer or resubmit the claim with corrected information. This typically requires thorough documentation, supporting evidence, and adherence to payer-specific guidelines and timelines for appeals.
Follow-up and Tracking: It's important to closely monitor the status of appealed or resubmitted claims and track their progress. This may involve regular follow-up with payers to ensure that the claim is being reviewed and processed in a timely manner.
Patient Communication: In some cases, denials may be related to patient eligibility or insurance coverage issues. In such cases, effective patient communication is crucial. This may involve educating patients about their insurance coverage, resolving billing discrepancies, or assisting with insurance appeals.
Financial Shared Services
The formation of the Financial Shared Services department at SCA Health India was aimed at providing support in managing corporate Accounts Payable and Reconciliations, specifically Cash/Bank reconciliations. The department started as a pilot activity for Cash Accounting in 2018, and upon its successful management, it was officially established in 2019. Since then, the department has been making significant progress and has not looked back. The department initially started with a small team of 2 Full-Time Equivalents (FTEs) and focused on Cash Accounting and Accounts Payable activities. However, due to its growth and success, it has expanded its scope of activities and now manages multiple activities year-over-year (YoY). The department currently operates with a team of 39 FTEs and continues to grow.
One of the key indicators of the department's success is its high level of customer satisfaction, with an overall rate of 90%. The department has also achieved an impressive retention rate of around 95% in 2022, which speaks to the quality of its services and the satisfaction of its partners.
The Financial Shared Services department has been instrumental in maintaining and strengthening partnerships with different lanes within SCA Health. Its ability to manage multiple activities and achieve high customer satisfaction rates is a testament to the hard work, dedication, and expertise of its team members. The department's success reflects its commitment to excellence and continuous improvement, and it is poised for further growth and success in the future.
Enterprise Services Department
Enterprise Service Department is a shared-services division that was established in SCA India in January 2023 to support our onshore partners across various disciplines vis-à-vis US payroll, ITSM, Service Now, Data Analytics, Predictive modelling, Tableau development and dashboard publishing, Payer informatics, and various other lanes. This division has immense potential to grow and is anticipated to see diversity in the support spectrum.