360 O REVENUE CYCLE MANAGEMENT SERVICES GoTelecare 41 Madison Avenue, 25 th Floor, New York, NY 10010 CONTACT: RONNIE HASTINGS (646) 661-7853 CONCISE VERSION
360O REVENUE CYCLE MANAGEMENT SERVICES
GoTelecare 41 Madison Avenue, 25th Floor, New York, NY 10010
CONTACT: RONNIE HASTINGS (646) 661-7853
CONCISEVERSION
2© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Company Overview
‘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 of Eastern India (facility inbuilt with all redundancies – power, infrastructure and others)
Sun Knowledge, our contracted company, is ISO 27001:2005 and ISO 9001:2008 certified
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
Awarded “Highest New Job Creator (IT/ITES)” by STPI (Software Technology Parks of India) on 3rd December 2015
Key Facts Awards, Affiliations & Certifications
3© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Our Service Offerings
Provider Support
Member Support
Member Retention Program
Clinical Help Desk
Contact Center
Utilization ManagementMedication Therapy ManagementHospital Re-admission ManagementTherapeutic InterchangeFormulary Management
Clinical Services
Enrollment Processing & MemberFulfillment
Claims Administration Coding & Medical Billing Credentialing Premium O&P Billing and Collections
Administrative Services
Analytics
Telemedicine Services
Application Development
Data Modeling & Data Warehousing
Technical Support
Technical Documentation
IT Services
Claims /Drug Utilization Analysis
PDE Analysis
RAF Analysis
Payment Reconciliation
We cater to
Prosthetics & Orthotics and DME companies in Revenue Cycle ManagementPhysicians and Hospital in Revenue Cycle Management
Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
4© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Revenue Cycle Management by GoTelecare
360° Revenue Cycle Management
Services
5© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Revenue Cycle Management – Service Portfolio
Inpatient/Outpatient Hospital Coding Physician Coding
Patient entry demographics & insurance information Fee Schedule / Charge Entry Scrubbing all entries for correctness and completeness with appropriate billing edits;
correction of identified errors Submission of claims to payers, e.g. EDI or paper Creation and mailing of patient statements Posting of payments received from patient and payer Reconciliation of charges, payments received and adjustments made
Denial Management (understanding denials and making corrections) Resubmission of claims AR calls as follow-up on outstanding issues Closure of a claim once the balance is zero
CODING
BILLING
A/R FOLLOW-UP
6© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
CLAIM VERIFICATION & AUTHORIZATION
7© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
HIGHLIGHTS Full Range of Verification Services
Fast 24-hour Turnaround Time
Above 99.9% Accuracy
Detailed Documentation
100% HIPAA Compliance
Diligent follow-up till resolution and closure
Uniform importance given to every claim - irrespective of its value
8© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
Because when claims need to be chased, we know whom to ask,when to askandhow to ask!
Why us?
9© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
ACCOUNTS RECEIVABLES (A/R) MANAGEMENT
10© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
Our A/R follow-up service is designed to increase the Revenue Collection for our clients.
The process begins after the Provider creates and sends Health Insurance Claims (Electronic/Paper claims or Manual HCFA forms) to various Insurance Companies.
Depending on the transmission type and length of time since submission, we begin our follow-ups.
11© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
A/R Analysis 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed
or written off by providers 50% of denied claims are never re-filed 50-70% of denied claims have higher chance of being recovered
Follow-up with payer Aggressive follow up with the insurance company's on all accounts at any
stage of the aging bucket plays an important part in A/R follow up activities.
Closure of claim
Reducing days in A/R, claims submission and improving collection ratio with an increase in the probability of payment through timely follow-up is the responsibility of the A/R team
12© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Billing & Coding
MEDICAL BILLING & CODING SERVICES
13© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Billing Cycle
Encounter (SOAP) notes review
Superbill generation and code review
Claims edit checking and correction
EDI claims submission through clearing house
Rejection managementERA/EOB posting and reconciliation
Automatic secondary payer billing
Denial Management
AR Follow-up
14© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Highlights
Above 95% Collection Rate Claims Submission TAT 24 – 48 hours max. Error-free Patient Entry ICD-10 Ready Over 99.9% Coding Accuracy Real-time Audits Proactive Follow-up on Rejections Denial Management Methodical and Proactive AR Follow-up 100% HIPAA Compliance Custom Reporting
15© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Areas of Operation
We provide turnkey billing services in the following areas:Hospitals Prosthetics & Orthotics DME (Durable Medical Equipment)
Pathology Critical Care Radiology
Internal Medicine EKG Urgent Care
Cardiology ENT Orthopedic Surgery
Anesthesia Family Practice Inpatient Hospitalization
Rehab Center Pharmacy Physicians, and more…
16© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Challenges and Our Approach
Assignment of adequate staff Completion of secondary verification Rigorous audit
Time consuming with limited staff Documentation collection requires
continuous follow-up Increased TAT
Time consuming with limited staff Secondary verification not carried out
Checking Authorization Requirement and Obtaining Authorization
Eligibility Verification
Patient Demographics / Insurance / Charge Entry
Transaction audit to minimize errors; reduces denial due to missing patient information
TASK DESCRIPTION CHALLENGES APPROACH
Missing information / Key-in errors Increased denial rate Increased TAT
Assignment of adequate staff Systematic and regular follow-up with
physicians’ offices & payers to collect documentation and obtain authorization
Proper tracking mechanism
17© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Challenges and Our Approach
Defining KPI for rejection management process and assigning responsibility
Claims reconciliation and exception report generation
Unapplied balance Accumulation of backlog Manual posting Denials not posted
Delayed correction and resubmission Possible loss of payment
Payment Posting
Rejection Management
Paper Claim Submission
Proper tracking of every submission of paper claims
Moving to EDI based submission whenever possible will reduce cost of manual work and faster payment cycle
TASK DESCRIPTION CHALLENGES APPROACH
Additional work for printing and faxing/mailing
Delayed filing leading to denials Lack of information about the actual
status
Defining guidelines
Review of patient payments
Define KPI – TAT & Accuracy
Denial posting and review
18© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Challenges and Our Approach
Proper documentation – process manual, guidelines & checklists
Defining proper tracking mechanism through various reports -Ageing, Status, Daily, Exception
Generate exception reports and regular audit of every process tasks
Defining KPIs and assigning responsibility
Lack of clarity of claims volume and current status affects management decision making process
Impact on overall billing process performance and improvement
Decreased productive efficiencyProcess Administration and Reporting
AR Follow-up & Denial Management
Regular analysis, follow-up and review
Transaction audit
TASK DESCRIPTION CHALLENGES APPROACH
Accumulation of backlog Denials not posted Claims reconciliation issue
19© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Why GoTelecare?
WHY US?
20© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Advantage GoTelecare
1Over 8 Years of Experience in Working as Vendors for
Major Health Insurance
Companies Across US
Deep Knowledge of both the Payer
and the Provider Side
of the US Healthcare Spectrum
2Consistent
Performance in Delivering 97% Collection Rate
to Clients
Already
Recovered over millions in
Account Receivables
and counting…
3The Only
Medical Billing Company with Its Own State-
of-the-Art Telemedicine
Platform
4The Best
References in Every
Segment of US
Healthcare Knowledge &
Business Process
Outsourcing
5The Lowest
Prices* in the Market!
* Only $10 per hour for a dedicated FTE
or just 4% of collections for A/R
services
Only .80 cents per claim for eligibility
verification & authorization
21© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Why Us?
Very Little Risk• Proven track record in providing healthcare BPO/KPO services• Highly experienced in providing services to both payers and providers• Experienced in working with various software platforms• Quick and efficient resource for special projects requiring technical and process expertise
Significant Upside Potential• Great understanding of the Healthcare 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 • Verification & authorization accuracy > 99.9%; TAT: 24 hours • High accuracy in Eligibility Data Maintenance (in sync with CMS)
Clear Communication and Quick Response at All Times ISO 27001:2005 & HIPAA Compliance for End-user Data Privacy and Protection
22© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
What are Our Clients Saying
"The professionalism I have experienced with GoTelecare’s employees has made them very easy to work with and has improved our operation processes. Any time I have a question, they are literally just a phone call or e-mail away. I love the accessibility!”
- CFO of a major US healthcare company
“I am starting to see an upswing with Medicare and United cash flow”
- CEO of a leading US healthcare organization
“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.
- Manager (Revenue Cycle) of a reputed US healthcare company
23© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Contact Us
41 Madison Avenue, 25th Floor, New York, NY 10010
(866) [email protected]
Ronnie Hastings