Revenue Cycle ManagementOverview

SAIcle One SolutionsOne Focus… Your Practice.

About Us

2010 NMSDC –REGIONAL SUPPLIER OF THE YEAR

2009 HONOREE

2010 50 FASTEST GROWING MBE

Recent Achievements

CT Tech Council –Top 40

• Established in 1986, in Shelton, CT• Privately Owned and Financially Debt free• Minority & Women Owned Business

Enterprise

Healthcare Focus• Supporting End to End

process for over 400 Clinicians• Provide partial services to

1000 provider group• 125+ staff focused on Care

Support Services• Over 12 unique EHR

implementations

Global Delivery Model

• 400+ employees• Access to

thousands of global consultants

• People centric HR policy, training, etc

Talent Base

Overview

2

ITSe

rvic

e

Application Maintenance Services

Quality Assurance

IT Consulting

Staff Augmentation

Application Development

Package/ERP Implementation

Revenue Cycle Management

Help Desk, Network Support, Transcription

Data Entry, Documentation MMC

BPO

Serv

ice

Cons

ultin

gSe

rvic

eSAI Service Offerings

3

intriCareTM

& intriCare-Oncology

Informatics & Analytics

HIPAA Security Assessments

& Audits

Health Information

Exchange

Revenue Cycle Management

Healthcare ProviderServices

4

Consider the SAIcle One Solutions team as an extension of your back office

• Efficiency, Capacity, Availability– Over 20 years experience managing medical revenue cycles with multiple

Practice Management and EHR Software– 24 x 7 Support to ensure timely submission and follow up with payers,

patients, and providers– 1 to 2 “billers” per each Full Time Provider– Account Management oversee SLA with Functional dedicated subgroups– Onsite Support (frequency based on complexity of practice)

• Robust Monthly Governance and reporting to ensure maximum effectiveness

• Add revenue to top line by capturing “lost collections”• Add to bottom line by providing cost effective rates• Customizable Provider friendly solutions designed for seamless

integration into current practice design• Achieving economies of scale

– Cross team reporting to “prevent things from falling through the cracks”– Continuous Improvement group

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6

SAIcle One RCM Offering

Detailed transition and cash flow management to mitigate risks and business interruption

• Onsite Transition Management (1 week to 1 month)

• Customized Transition checklist

• Weekly Transition Conference Calls

• Manage Expectations• Limited changes

– SAI application with Clearinghouses

– CMS 855 form 30 days post successful submission

– Remittance address

• Short term Receivable Advance

• Long term Advance Funds plan.– Receive Cash on submission

Transition Management

• Meet with existing billing organization

• Creation of Standard Operating Procedures (SOP)

• Document rules to share EOB and data

Cash Flow Management

Coordination

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Comprehensive process ensuring maximum productivity & reduction of person dependency

Patient

DenialPayment

Carrier Adjudication

Conversion / Submission

Clearinghouse

Claim Submission

Demographic Verification

Front Office

Provider

Charge Entry

A/R Follow-

up

Direct S

ubmission

Payment

(Coding)

ERAReports

$8

Receipt of Demographics and Super Bills

• Toll free E-fax number dedicated to the account

• SAI may login to client PM / EHR• EHR HL7 interface (option)• Electronic Mobile Charge

Capture• Scanned Images picked up from

Client’s server• Scanned Images picked up from

SAI SFTP• Paper sent to SAI Office• Paper picked up from PO box or

Lock box

• Double Key, Verify, Update mechanism

• 48 hours turn around for all data entry

• 24, 48, 96 hour claim verification (Received, Accept, Approved)

Charge Capture

Quality Control

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Back Office Processing• Verification at each

level to ensure accuracy of claim and data

• Communication with provider office for any supporting documentation

• *CPC Coding per SLA • Daily, Weekly

Transmission logs• Clearinghouse level

denial reporting per SLA

Conversion / Submission

Clearinghouse

Claim Submission

Demographic Verification

Charge Entry

Direct S

ubmission

(Coding)

10

Insurance AR Management• Electronic Remittance Advice to

post payments against patient charges

• Electronic Funds Transfer of all payments to provider account directly from payer

• Non EFT payers deposit only account

• Denied claims addressed with Payer and reprocessed

• Denials reviewed at monthly governance

• Specialized A/R follow up teams address payer specific relationships– Aged / Current managed separately

DenialPayment

Carrier Adjudication

A/R Follow-

up

ERA

Provider

Reports

$

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Additional AR Management• Secondary's filed

immediately along with EOBs

• Follow up calls to secondary payers made

• Patient statements for patient portion of bill sent

• *Additional patient soft collection calls made upon agreement with office

Patient

Front Office

Provider

Soft Collection

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• Aging Reports– By Date of Service– By Posting DateAging Reports will be run in summary by payor (no detail by patient-the report should show the total owed and aged by payor and self pay balances)

• Credit balance report

• Financial summary report that includes:– Adjustments Summary by type

of adjustment (e.g Medicare adjustment, insurance adjustment, bad debt adjustment)

– Charges Summary– Payments Summary

• Payments by payor• Adjustments by payor

– Productivity report which includes the CPT code and Units of Service (number of times the CPT code was used)

• Unbilled or accounts on hold

With an sizeable technology team, SAI can provide customized Reporting per your needs

All reports will be run following the close for the month before any new charges, adjustments or payments are entered for the next month. Reports (excluding aging reports) will be run for the month and year-to-date.

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Our service offering is comprehensive, robust and configurable

• Dedicated Single Point of Contact• Provider Reenrollment• Customized Super Bill• SAI-Port (Mobile Charge Capture)• Patient Demographic Entry• Coding by AAPC certified coders• Charge Entry• Claim Scrubbing / Validation• Charge Transmissions• Manual Payment Posting (or)• Electronic Remittance Posting• Electronic or Paper Patient

Statements• Claims Appeal / Actions on

Rejection

• Monitor Billing and collections• A/R Follow Up

– Payer (non and low pay)– Patient (Soft reminder calls)

• Monitor super bill completion & coding

• Manage Patient and Provider Inquiries

• Practice Management Software• Training• Maintain database of patient and

payer information• Maintain managed care allowable• Maintain Provider Numbers• Maintain referring physician

database

RCM Service Offerings

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Broader range of services provide a single partner to the practice

• Old Aged AR collections and analysis reports

• Provider Enrollment with EDI– Submitter ID applications– ERA / EFT enrollment

• Provider credentialing– Application / documentation

submission• Eligibility/Insurance

Verification• Quality and Compliance

Audits

• Temporary Front Office Staff Augmentation

• Monthly Advance on Reimbursements

• Technology Support and implementation

• Consultative Practice Analysis

Optional Add on Services Value Add Services

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Software / Tools Supported• eClinicalWorks• Medical Manager• Medisoft• Kareo/Practice Fusion• GE Centricity IDX• AthenaNet• SSIMed / Origins EMRge• Visionary Healthware

• PracticeMate• drchrono• OpenEMR• Charter by SAI

(proprietary product)• Multiple other products

and Web based solutions

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SAIcle One Qualifications

Specialties and practice sizes show breadth and depth of SAI Qualifications

• Internal Medicine• Family Practice• Urology• Psychiatry / Behavioral Health• Ophthalmology• Physical Therapy• Urgent Care• Pain Management• Surgery• Gastroenterology• Disease Management• Infectious Diseases• Pediatrics

• Internal Medicine in Franklin County, NY

• GI Practice in Franklin County, NY

• Family Practice in upstate NY

• 40 Provider practice in CT• 15 Provider practice in IL• 25 Provider Psych Practice

in NY• Large Multispecialty group

in TX

Areas of practice Customers

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Practices that transition to SAI’s RCM Solution collections improve by a minimum of 25%

ClientsBefore SAI After SAI

# of Proc

Billed Amount Collections % of

Collections# of Proc

Billed Amount Collections % of

Collections

CT Group 2,416 $301,380 $149,247 49.52% 6,739 $765,748 $476,656 62.25%

IL Group 389 $32,094 $11,172 34.81% 912 $89,219 $60,650 67.98%

NY Group 1,005 $351,394 $115,599 32.90% 1,159 $390,938 $187,424 47.94%

NY Provider 31 $8,075 $4,350 53.87% 338 $76,105 $61,925 81.37%

Collection Improvement Performance

CT Group IL Group NY Group NY Provider0.0%

20.0%

40.0%

60.0%

80.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

25.7%

95.3%

45.7%

51.0% Before SAIAfter SAIImprovement

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Manager RCM

• Location: Shelton, CT

• Senior Manager at SAI

• First point of escalation

• Location: Shelton, CT or Onsite at Practice or North Country

• Regular day-to-day interface with client

• Oversight of daily operation

• Key Point of contact

• Location : Offsite

• Primary responsibility: Drawing up

and managing the delivery

• Managing (hands-on) of operations

teams and subteams

Single Point of Contact supported by deep management bench

Account Representatives Functional Team Leads

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Industry experience is broad and results in better ROI for clients

All clients are welcome to speak to any / all members of the team.

Role Average Years of Experience

Account Representatives 12 YearsCharge / Claim Entry 2 Years

Coding Team 5 YearsTeam Leads 8 Years

QA/Verification Continuous Improvement

5 Years

A/R Follow Up / Denials 8 yearsEOB / Cash Posting Team 3 Years

Years of Experience

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Multiple ways to communicate with the team and regular scheduled checkpoints

Governance • Monthly meeting to provide account analysis• Designed for topline view of account• Identified trends and recommendations

Communication Methods• eFax (secure)• Client email account• Patient local number

Communication • Assigned account liaison from client will have daily communication with

SAI account team.• Daily, weekly, and monthly report• Account manager available for rapid response

Escalation Responsibilities Position ResponsibilityVP Resolves major Severity 1 issues such as more than

30 days of no receiptsManager, RCM

Resolves conflicts on process, effectiveness, and productivity of operations

Account Manager

Resolves issues related to daily operations or specific claims.

Escalation

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Comprehensive RCM Offering positioning SAI as a true partner to the practice

• Increase Top Line Collected– Manage Fee Schedule in line with

Industry and Insurance Companies

– Frequent follow-ups with 2nd, 3rd, & 4th level payers

• Adding to the Bottom Line– Lower fees than competitive

outsourcers or in-house– New Top Line Revenue added to

bottom line• Full Service Company

– RCM Services (Full Cycle)– Technology (Equipment + PM +

EHR ++)– Temporary Staff Augmentation

• Advance Funds– Paid when Charge Posted

• Up to 100% Paperless as much as your process will allow

• HIPAA Compliant – Secure Systems and Facilities

– Available for audit• Customer Service

– 24 x 7 availability– Onsite Transition– Monthly Practice Performance

Reviews– Account Meetings (Onsite)

• Quality and Efficiency– SLAs including Charge Posting,

Payment Receipt, etc.– High Ratio of “billers” to

providers to maximize collections– Documented Standard Operating

Procedures

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Summary

Financial

• Financially strong• Rapidly growing: double digit revenue and customer growth• Consistent competitive cost of service

Experience

• 25+ years of IT Experience• 20+ years of RCM Experience• Successful performance single provider medical practices and

Fortune500 companies

• Continuous Improvement Team• Industry certifications and credits – 96% customer retention• Mature processes and utilization of tools to achieve efficiencies• Dedicated customer focus and Metrics Reporting

Quality

People

• Global Delivery Model (North America, Europe, Asia)• Domain, Technical, and Management experts• Low attrition rate• Proactive and lean team deployment• Training and growing multi lingual capabilities

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For more information, kindly visit us

Disclaimer: All trademarks, logos, and copyright illustrated in this presentation are acknowledged as belonging to their respective owners.

Thank You

www.saisystems.com

Cathy Fortin

Manager, Revenue

Cycle Management

(203) 567-5267 or (203) 479 2874

cfortin@saisystems.com

Contact Information :

William Oravecz

Practice Lead, Healthcare

Provider and Life Sciences

(209) 567 5265 or (203) 788 4292

woravecz@saisystems.com

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Disclaimer & CirculationThis document has been drafted by SAI Systems International, Inc. (SAI). This document is for viewing by SAI and SAI authorized personnel only. Copying, reproduction and reuse of information provided in this document for any purpose other than what it is intended for by any third party organization, assigns or individuals is prohibited.

All trademarks and ownership of products, logos, images, photos and processes if cited in this document are acknowledged as belonging to their respective owners.

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RCM Process Flowchart• Over 25 years experience managing

medical revenue cycles • Increase Top Line Collected

– Manage Fee Schedule in line with Industry and Insurance Companies

– Frequent followup with 2nd, 3rd, & 4th level payers

• Adding to the Bottom Line– Lower fees than competitive

outsourcers or in-house– New Top Line Revenue added to bottom line

• Full Service Company– RCM Services (Full Cycle)– Technology (Equipment + PM + EHR ++)

• Customer Service– 24 by 7 availability – Monthly Governance Performance Reviews

• Upto 100% Paperless as much as your process will allow

• Specialization for Providers “on the road”– With CMS (Medicare/ Medicaid) expertise

• Quality and Efficiency– Service Level Agreements– Advance Response Technology - 30K

lookups/24hrs

• HIPAA Compliant – Secure Systems and Facilities

Informatics and Analytics

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Sample Clinical Measures of Performance• Performance Management• Benchmark Reports

– Patient Safety– Patient Satisfaction

• Outcome Monitor• DRG Utilization• Meaningful Metrics Calculation

– Appropriate medication utilization• Satisfaction surveys

Products and technology

intriCare Overview

1. A Care Management Platform drives clinician’s workflow, monitors the patient's health status, and directs appropriate care planning;

2. Substantial reporting on clinical and financial outcomes; and

3. A targeted community based clinical approach.

Features include:• Enhances Physician Resources for patient

centered care management by:– Making tools available for physician office to use– providing data collection for physician office

• Patient Navigation, Care Coordination and Patient Assessment Tools Fill Missing Gaps in Physician Software Solutions;

• Re-establishes treating physician as the focus for patient coordination rather than disparate care managers and specialty pharmacy patient oncology managers;

• Puts full care coordination data (even for care outside office) in the hands of treating physician• Deploy within the Plan, Provider office, Offsite, in the Home, any location

intriCare is a scalable technology solution that reduces the cost and increases the wellness of the Medicare Advantage and Medicaid Populations. Components are:

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Technology Integration

Mobile Environment Central Data Store Environment Visionary PM @ SAI

Billing side

Import/Export Service

Billing Software DB

OUT Location

Patient.out

Bill.out

IN Location

Patient.in

Bill.in

Server DataBase

Device DB

Export Service

Import Service

Device DB

Biller Offline App

Access DB

Access DB

EHR Environment

SQL DB SQL DB

SAIPort

SAIPort• Mobile Charge Capture / Electronic

Superbill Worklflow System• Patient Registration• Charge Entry with most used

Procedure Codes• ICD9 Precise List• Offline Capability• Synchronization with Practice

Management Database• Charge Review Reports• Encrypted Database