Sun knowledge revenue cycle management services

Revenue Cycle Management Services Alex Marz

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

Presented For:

Medical Billing Companies

GOTELECARE OVERVIEW yFacts e K    

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‘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)

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c e C & n s,filto ard w A

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

CMMi-SVC implementation in progress under KPMG guidance 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 2013 in Singapore

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, Employee Attrition, 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

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CLIENT ADVANTAGES ●

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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 ●

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Very Little Risk

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

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REVENUE CYCLE MANAGEMENT EXPERIENCE HOSPITAL  Accounts Receivables Follow - Up  Denial Management  Claims Resubmission

DME

O&P

 Order Entry

 Rx Order Entry

 Eligibility Verification/ Authorization

 Patient Demographics and Insurance Entry

 Follow up on Auth Approval  Delivery Scheduling

 Product Code entry/Rx & Dx Entry

 Submission of claim

 Eligibility Verification/ Authorization

 Rejection Management

 Collection of complete Rx

 Payment Posting  A/R Follow-Up

 Collection of Documents for Auth Approval

 Denial Management

 Submission

 CPAP Compliance Tracking

 Rejection/Denial Management  A/R Follow-Up

HOME HEALTH  Order Entry – Patient Information, Ordering Physician, Rx & Diagnosis  Eligibility Verification

 Patient Entry: Demographics & Insurance

 Charge Entry

 Eligibility Verification

 Submission of Claims (EDI/Paper)  Rejection Management

 Authorization Approval

 A/R Follow-Up

 Order Audit Confirmation  Submission of Claims  Rejection Management  Payment Posting

PHYSICIAN

 Patient Entry: Demographics & Insurance

 Medical Document Collection

 A/R Follow-Up

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URGENT CARE

 Payment Posting

 Denial Management

 Authorization Follow-Up  Charge Entry  Submission of Claims (EDI/Paper)  Rejection Management  Payment Posting  A/R Follow-Up  Denial Management

PRODUCTIVITY EFFICIENCY TRACKING 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:

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

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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

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CODING & BILLING

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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.

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MEDICAL CODING & BILLING SERVICES gs fn rvicO Se • • • • • • • • • • •

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.

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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

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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

cialts e rSp u O •

Urgent Care

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Inpatient Hospitalization

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DME

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Radiology

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Orthotics and Prosthetics

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Home Healthcare

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Physician

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Nursing Home

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Emergency Department

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Compounding Pharmacy

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Psychiatric Care

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Hospice

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MEDICAL BILLING – KEY FACTS

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HIPAA compliance (Complete Data and Document Security)

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

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Claims are submitted through EDI clearing house

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

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

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ERAs are posted to the respective patients’ accounts

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Quality check is conducted at all stages of process

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Turn Around Time for this process is 24 - 48 hours

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TECHNOLOGY, Operational and compliance FRAMEWORK

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SOFTWARE DEVELOPMENT ● ●

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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

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IT INFRASTRUCTURE ● ● ●

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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

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OPERATIONAL AND COMPLIANCE FRAMEWORK TRANSITION

TRAINING

 Project scoping & planning

 Training Need Identification

 Knowledge transfer – Process training and assessment

 Customized training program as per client’s requirement

 Process documentation

 Pre-process & process training

 Solution customization

 Voice & accent and cultural training

 Infrastructure set up  Pilot/Transition period

PRODUCTION

 Project management approach  Exception handling and reporting  Effective coaching & monitoring practices  Periodic review and evaluation

 Refresher training

 Service level management and reporting

 Time: 2 Weeks

CONTROL & COMPLIANCE  Ensure 100% adherence to federal / data protection laws  Governance & compliance audits  Organization preparedness for client & third party audits  HIPAA compliance

 Time: 4 Weeks

 Time: 4 Weeks

QUALITY

MIS / WFM

 Regular audit for process and deliverables

 Capacity planning

 Identify and analyze errors to take corrective measures  Flowcharting and root cause analysis for process improvement measures  Management reporting of quality assurance activities

PROJECT MANAGEMENT & OVERSIGHT IT INFRASTRUCTURE– TOOLS & TECHNOLOGY CLIENT BILLING AFTER 60 DAYS AND PAYMENT AFTER 90 DAYS

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 Forecasting, staffing & scheduling  Real time reporting  Billing and revenue management

GOVERNANCE MODEL  Executive sponsorship  Management oversight  Ensure business goals and engagement goals alignment Sun Knowledge Governance Structure

 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

Steering Committee

 Review project scope, timeline and budget and monitor project progress  Communication, status reporting & escalation to steering committee

Program Management Office

 Manage cross team dependencies  Identify, initiate & institutionalize process improvements  Oversee knowledge repository building

Project Delivery Team

 Project Management  Scope Management  Knowledge Management  Change Management  Ensure successful engagement startup  Quality Management  Resource Management  Communication & Status Reporting  Issue Management

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 Monitor & measure knowledge transfer process  Incorporate industry best practices

QUALITY ASSURANCE & CONTROL 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.

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Periodic process review

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Process audit

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Testing deliverables and root cause analysis

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Process improvement / re-engineering

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Incorporating customer feedback

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N% internal quality audit of client deliverables & review reporting

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Weekly/monthly monitoring of productivity reports

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TRAINING METHODOLOGY

Training Need Identification

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Training Evaluation

• Post-training assessment • Training feedback • Review of training program

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

Training Program Planning

• Regular process test and appraisals • Work in-sync with Operations & QA

Conduct Training • Process training and refreshers • Availability of training documents in ‘Knowledge Net’ portal • V&A, Soft skills training

COMPLIANCE – KEY FACTS 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.

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Well defined policies to cover compliance aspects

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Written procedures covering compliance aspects

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Proactive compliance reporting and issue escalation

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Action list for changes in rules and regulations by regulatory authorities

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Compliance evaluation framework

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Periodical training on compliance issues and update

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Periodic audit and review mechanism to address potential compliance risks

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Implementation of data privacy and security standards

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Incident reporting for data security violation

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Compliance awareness among the employees and reward on compliance reporting

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Compliance violation by employees leads to employee retraining and reassessment

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COMPLIANCE - ESCALATION STRUCTURE Board of Directors

Executive Board CEO & MD (Final Escalation POC)

Compliance

Operations

Head of Compliance

Head of Operations

(Compliance Escalation POC)

(1st Level Escalation POC)

Compliance

Service Delivery

Compliance Mgr

Service Delivery Mgr (Service Delivery POC)

Quality

Technology

HR/Training

Quality Mgr

Technology Mgr

HR/Training Mgr

Compliance Issue Trigger Point

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Team Lead Process Team Lead (Service Delivery POC)

Severe Compliance Escalation Path Compliance Escalation Path

 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

DATA SECURITY AND END USER PRIVACY ● ● ●

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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

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