GoTelecare Medical Billing Company Services

Revenue Cycle Management ServicesPresented For:

Medical Billing Companies

41 Madison Ave. 25th Fl. New York, NY 10010Alex Marz Direct – 212-243-3237

2© GoTelecare 2015-16| All Rights Reserved Private & Confidential

‘Onshore /Offshore’ KPO & BPO Services

Serving US healthcare industry since 2007

Robust & scalable infrastructure

State-of-the-art technology and systems

Highly skilled and trained staff with good

communication skills and in-depth knowledge of process

Structured training, feedback and coaching

HIPAA-HITECH compliant

Offices located in US & India

• New York City, US – Situated in Manhattan (facility inbuilt with all redundancies – power, infrastructure

and others)

• Kolkata, India – Situated in the IT Hub(facility inbuilt with all redundancies – power, infrastructure and others)

Sun Knowledge, our contracted company, is ISO 27001:2005 and ISO 9001:2008 certified company.

CMMi-SVC implementation in progress under KPMGguidance

Member of NASSCOM, the Governing Industry body for IT/ITES in India

Awarded ‘Best Emerging BPO Company of the year 2010’ by The Economic Times, India

Recognized as one of the foremost 'Emerging companies in Eastern India' by NASSCOM in 2011

Awarded Asia-wide “Healthcare BPO Provider of the Year” at the Asia BPO Excellence Awards ceremony hosted by Asia BPO Summit on 14th February 2013 in Mumbai, India

Awarded the prestigious “Outsourcing Service Provider of the Year” award in the Asian Outsourcing Excellence Awards ceremony hosted by CMO Asia on 1st August 2013in Singapore

GOTELECARE OVERVIEW

Key Facts Awards, Affiliations & Certifications


CLIENT BENEFITS

Significant decrease in operational expenses

We charge a flat rate of $10 per hour per employee!

Our clients save on other associated costs for employees including:

Health Insurance Premiums, Payroll Costs, Medicare Tax, Human Resources, EmployeeAttrition, additional Real Estate, and Infrastructure Costs.

We guarantee > 50% operational savings effective immediately.

For Example: Our client reported to Sun Knowledge a $2.1 million operational savings in Y1*

Heightened collection and increased Account Receivables

30% of DME Rx are incomplete when first received. We excel in completing the Rx claim quickly.

Cyclical Data Reporting

Data reporting interval can be customized to meet the needs of the customer.

Productivity Efficiency Tracking allows for you to quantify your team workload.

Demonstrated experience handling DME claims

Medicare, Medicaid, and Commercial Plans Fee for Service and Capitated Plans

Very Little Risk

Proven track record in providing healthcare BPO/KPO services

Experienced in providing services to both payers and providers

Experienced working with various software platforms

Quick and efficient resource for special projects requiring technical and process expertise

Significant Upside Potential

Great understanding of the Health Care industry. Operation scale-up with a short notice.

Extremely competitive rates, greater productivity, improved quality, increased member and provider satisfaction

Proven process performance

Low denial rate increase in revenue collection

Claims Processing: Accuracy > 98%; TAT: 5 - 10 days

Contact Center: Abandonment Rate < 2%, as soon as within 30 Seconds for 90% of calls, High Client Satisfaction

High accuracy in Eligibility data maintenance – in sync with CMS

Clear Communication And Quick Response Time At All Times

End user data privacy and protection

CLIENT ADVANTAGES

4Private & Confidential© GoTelecare 2015-16| All Rights Reserved

REVENUE CYCLE MANAGEMENT EXPERIENCE

HOSPITAL

Accounts Receivables Follow - Up

Denial Management

Claims Resubmission

DME

Order Entry

Eligibility Verification/ Authorization

Follow up on Auth Approval

Delivery Scheduling

Submission of claim

Rejection Management

Payment Posting

A/R Follow-Up

Denial Management

CPAP Compliance Tracking

O&P

Rx Order Entry

Patient Demographics and Insurance Entry

Product Code entry/Rx & Dx Entry

Eligibility Verification/ Authorization

Collection of complete Rx

Collection of Documents for Auth Approval

Submission

Rejection/Denial Management

A/R Follow-Up

URGENT CARE

Order Entry –Patient Information, Ordering Physician, Rx & Diagnosis

Eligibility Verification

Medical Document Collection

Authorization Approval

Order Audit Confirmation

Submission of Claims


Payment Posting

A/R Follow-Up

Patient Entry: Demographics & Insurance

Eligibility Verification

Authorization Follow-Up

Charge Entry

Submission of Claims (EDI/Paper)


Payment Posting

A/R Follow-Up

Denial Management

PHYSICIAN

Patient Entry: Demographics & Insurance

Charge Entry

Submission of Claims (EDI/Paper)


Payment Posting

A/R Follow-Up

Denial Management

HOME HEALTH


Our clients depend on transparency. GoTelecare provides our clients with the ability to

maintain detailed tracking for productivity and efficiency. See below for sample

reporting:

PRODUCTIVITY EFFICIENCY TRACKING

Employee

Name

Note Count Days

Worked

Hours

Worked

Notes Per

Hour

Max Note

Time

Avg Note

Time

John Smith 977 23 203.55 4.8 1:29:52 0:07:15

Jane Doe 1025 23 214.97 4.77 0:55:14 0:04:56

Rick Williams 913 21 207.07 4.06 1:27:08 0:07:14

Robert Frost 870 21 187.35 4.64 0:42:54 0:04:05

Dan Chesser 910 23 216.47 4.2 3:50:55 0:06:18

Derek Malia 823 23 210.37 3.91 7:01:30 0:04:37


New Client Testimonial

Your productivity is very impressive for your first month. Almost everyone has an average of close to 40 accounts per day. We have gone over a few things with you and each time we talk, I am impressed with how quickly changes and improvements are put in place. I will continue to share feedback as I get it on additional improvements that can be made and appreciate your attentiveness and questions that you bring to our daily meetings.

Ashley Weidner, MBA, CRCR

Manager, Revenue Cycle | Ensemble Health Partners


CODING & BILLING


MEDICAL BILLING - INTRODUCTION

Medical billing is the process by which providers submit claims for the services rendered and receive payment from health insurance companies. It also involves resolving any disputes and

following up on claims that have been delayed or rejected.


MEDICAL CODING & BILLING SERVICES

Service Offerings

• Medical Coding

• Place of Service Based Coding – Inpatient, Outpatient Coding

• Provider Specialty Based Coding– DME, Orthotics & Prosthetics

• Medical Billing

• Provider EDI enrollment

• Patient Demographics entry

• Charge entry

• Claim submission – Electronic and Paper

• Payment entry

• Denial posting

• Payment reconciliation

We can handle medical coding & billing processes - promptly, perfectly and professionally using Emdeon or other billing systems preferred by the client.


BILLING SYSTEM

We use Kareo Billing system “Emdeon One” for coding and billing services that covers complete billing cycle:

SOAP notes review

Superbill generation and coding

Claims edit checking and correction

Claims submission through EDI clearing house at a scheduled time

Rejection management

ERA/EOB posting and reconciliation

Automatic secondary payer billing

Denial Management

Patient statement generation and mailing


MEDICAL CODING – KEY FACTS

• Our coders deliver error free charge sheets within agreed TAT provided by the client

• We monitor, analyze, and improve coding documentation to avoid denials and guarantee reimbursements

• We carefully determine the codes according to the clinical information provided by the Healthcare Provider/Professionals and reports back according to the information provided

• Our coders have undergone extensive medical coding training and are well aware of updated coding guidelines

Our Specialties

• Urgent Care • Inpatient Hospitalization • DME

• Radiology • Orthotics and Prosthetics • Home Healthcare

• Physician • Nursing Home • Emergency Department

• Compounding Pharmacy • Psychiatric Care • Hospice


MEDICAL BILLING – KEY FACTS

HIPAA compliance (Complete Data and Document Security)

Secure Information & Data Flow between Sunknowledge and our partners enabled with reliable networkingsoftware & hardware (includes secured Virtual Private Networks and FTP sites)

Claims are submitted through EDI clearing house

All low pay and no pays reports are sent to the client/AR team on a day-to-day basis

Work on re-processing of the denied claims starts immediately after receipt of ERA

ERAs are posted to the respective patients’ accounts

Quality check is conducted at all stages of process

Turn Around Time for this process is 24 - 48 hours


TECHNOLOGY, OPERATIONAL AND COMPLIANCE

FRAMEWORK

SOFTWARE DEVELOPMENT

Some of the applications which we have developed include,

GoTelecare - A full fledged Telehealth application for providers, hospitals and patients with integrated EMR, practice management system and video conferencing system

Integration of DICOM server, DCM4CHE with EMR software

mHealth – Remote patient monitoring and health data collection through medical devices and QUALCOMM cloud services

PDP Manager – To manage Medicare Part D processes

Medication Therapy Management (MTMpro) application


Our technology development team works with Java platform enterprise edition (JEE) and technology components include,

Web application technologies like servlets, JSP, JSTL, JSF, JSON, web sockets, applets

Open source frameworks like Struts, Spring, Hibernate

Enterprise technologies like dependency injection, messaging services, transaction management services, persistence management services, annotations, javamail, java enterprise beans, interceptors, connector architecture

Web service technologies like RESTful web services, enterprise web services, JAX -WS, JAX- RPC

Database servers like MS SQL server, Oracle, MySQL

IT INFRASTRUCTURE

High end workstations from HP and Lenovo providing reliable and powerful computing solutions

1Gbps local area network to access and share files and resources faster

Combined 24 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic failover configuration

Data protection and security provided by Fortigate 310B firewall combined with other physical and logical access controls

Data center with 13 IBM x3650 rack servers with rack mounted UPS

Polycom VSX 7000A video conference system for remote training and client communication

24/7/365 IT-Infrastructure support personnel for user support, using ticket management system

120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power generator


OPERATIONAL AND COMPLIANCE FRAMEWORK

TRANSITION

Project scoping & planning

Knowledge transfer – Process training and assessment

Process documentation

Solution customization

Infrastructure set up

Pilot/Transition period

Time: 4 Weeks

TRAINING

Training Need Identification

Customized training program as per client’s requirement

Pre-process & process training

Voice & accent and cultural training

Refresher training

Time: 2 Weeks

PRODUCTION

Project management approach

Exception handling and reporting

Effective coaching & monitoring practices

Periodic review and evaluation

Service level management and reporting

Time: 4 Weeks

QUALITY

Regular audit for process and deliverables

Identify and analyze errors to take corrective measures

Flowcharting and root cause analysis for process improvement measures

Management reporting of quality assurance activities

Capacity planning

Forecasting, staffing & scheduling

Real time reporting

Billing and revenue management

MIS / WFM

Ensure 100% adherence to federal / data protection laws

Governance & compliance audits

Organization preparedness for client & third party audits

HIPAA compliance

CONTROL &

COMPLIANCE

PROJECT MANAGEMENT & OVERSIGHT

IT INFRASTRUCTURE– TOOLS & TECHNOLOGY


CLIENT BILLING AFTER 60 DAYS AND PAYMENT AFTER 90 DAYS

GOVERNANCE MODEL

18Private & Confidential

Our

Governance Model

Steering Committee

Program Management Office

Project Delivery Team

Executive sponsorship

Management oversight

Ensure business goals and

engagement goals alignment

Ensure tangible results and

demonstrable value

Continuously educate &

report executive leadership

on the critical success factors

of engagement

Plan and implement change;

define, establish performance,

metrics aligned to goal

Review project scope, timeline

and budget and monitor project

progress

Communication, status

reporting & escalation to

steering committee

Manage cross team

dependencies

Identify, initiate &

institutionalize process

improvements

Oversee knowledge repository

building

Project Management

Scope Management

Knowledge

Management

Change Management

Ensure successful

engagement startup

Quality Management

Resource Management

Communication &

Status Reporting

Issue Management

Monitor & measure

knowledge transfer

process

Incorporate industry

best practices

© GoTelecare 2015-16| All Rights Reserved

Quality Control & Assurance processes help us meet our client’s expectations and SLA target. We use Quality Assurance program to set production and quality goals. Our daily quality audit activities ensure that we evaluate our agents’ work on all relevant criteria. We ensure quality by carrying out

rigorous quality assurance and control activities.

QUALITY ASSURANCE & CONTROL

Periodic process review

Process audit

Testing deliverables and root cause analysis

Process improvement / re-engineering

Incorporating customer feedback

N% internal quality audit of client deliverables & review reporting

Weekly/monthly monitoring of productivity reports


TRAINING METHODOLOGY

20Private & Confidential

• Process training and refreshers

• Availability of training documents in ‘Knowledge Net’ portal

• V&A, Soft skills training

• Post-training assessment

• Training feedback

• Review of training program

• Preparation of training Modules

• Preparation of training Plan in ‘Knowledge Net’ training module

• Regular process test and appraisals

• Work in-sync with Operations & QA

Training Need Identification

Training Program Planning

Conduct Training

Training Evaluation

© GoTelecare 2015-16| All Rights Reserved

We have defined and established a process and system to avoid compliance risks while carrying out operations and encourage employees to proactively report compliance issues to the higher

management.

COMPLIANCE – KEY FACTS

Well defined policies to cover compliance aspects

Written procedures covering compliance aspects

Proactive compliance reporting and issue escalation

Action list for changes in rules and regulations by regulatory authorities

Compliance evaluation framework

Periodical training on compliance issues and update

Periodic audit and review mechanism to address potential compliance risks

Implementation of data privacy and security standards

Incident reporting for data security violation

Compliance awareness among the employees and reward on compliance reporting

Compliance violation by employees leads to employee retraining and reassessment


COMPLIANCE - ESCALATION STRUCTURE

Service Delivery

Service Delivery Mgr

(Service Delivery POC)

Head of Operations

(1st Level Escalation POC)

Operations

CEO & MD

(Final Escalation POC)

Executive Board

Board of Directors

Compliance

Compliance Mgr

(Compliance Escalation POC)

Head of Compliance

Compliance

Team Lead

Process Team Lead

(Service Delivery POC)

Technology

Technology Mgr

Quality

Quality Mgr

HR/Training

HR/Training Mgr

Compliance Issue

Trigger Point

Process Team Leader will inform Service Delivery Manager and Compliance Manager immediately after occurrence of the event

Compliance Manager/ Service Delivery Manager will assign the severity of the compliance issue

Compliance Escalation Path

Severe Compliance Escalation Path


DATA SECURITY AND END USER PRIVACY

Information security management system is aligned with ISO 27001:2005 standard

Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations

Data replication between Sun Knowledge’s servers in NY and India via site-to-site IPsec VPN tunnels helps strong business continuity management

Daily off-site backup process to mitigate data loss risk in case of disaster

Implementation of physical access control system in office premises restricts access to sensitive areas housing application and database

Physical and logical segregation of internal network into VLAN segments to control and protect data storage and transmission between business/process units

Implementation of perimeter security devices, like firewall and segregation of sensitive information systems

Access to all information systems through two levels of authorization

Implementation of two levels of end point malware protection network and system level anti-malware systems

Use of secure e-mail system for e-mails with sensitive PHI information

Implementation of access restrictions to prevent unauthorized deletion or movement of data using external storage devices like optical discs, pen drives, etc.

Security incident monitoring, reporting and resolution system

Periodic employee awareness training on data privacy & protection and HIPAA regulations
