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© e4e – Confidential and Proprietary
e4e Healthcare Services
Comprehensive Solutions for the Healthcare
Ecosystem
Insert
Client
Logo
© e4e – Confidential and Proprietary 2
e4e Healthcare Business
• Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines.
• With over 19 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP.
• A cross-border Healthcare Company with proprietary Software Platformsfor Revenue Cycle Management, Claims Processing, Audit and Process Automation.
• Technology agnostic solutions – experience in working with over30 Provider and multiple Payer Platforms.
• Expertise in System and Platform Integration – System Interface,Electronic Data Inter-change and Workflow Efficiency.
•We process over 135 million transactions annually and code/ auditover 30 million charts.
• HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified & SSAE 16 Type II Compliant Company.
IT Enabled Services & BPO
Offices in
3 Countries
2500
+ Employees
Globally
Work with over 6000 Physicians & 191
Hospitals
© e4e – Confidential and Proprietary
e4e Service Landscape
3
Rev
enue
Cyc
le M
anag
emen
t •Patient Access Management
•Charge Capture including clinical documentation improvement
•Claims, Remittance & Denial Management
•Hospital, Physician & Remote Coding
• DRG Coding •Revenue Recovery & A/R Services
•Charge Integrity & Compliance Solutions
•Successful EMR driven billing service
Pay
or S
ervi
ces
•Front End Claims Processing and Management
•Claims Adjudication and Error Suspense Resolution
• HEDIS & HCC Coding Services
•Enrollment Membership and Billing Services
•Customer Service•Mailroom Service•Grievance, Appeal & Refund Posting
•Reports Management
Val
ue A
dded
Ser
vice
s •Customer Support centers
•Business Rules Configuration
•Fraud , Waste & Audit Solutions
•RAC Response Management Solution for Providers
•Process Improvement Consulting for Physicians
•Ancillary Services for Payers
•Business consulting
Tech
nolo
gy S
olut
ions
•Claims Administration Platform
•Scheduler•Workflow Solutions including OCR
•ICD 10 transition support
•Document Management System
•Client Service Portal•Member Portal•Managed Services -Network & Desktop management
© e4e – Confidential and Proprietary
Hospital RCM Services
4
Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service
Patient Access
ManagementBilling Medical
CodingDenial
ManagementA/R Follow
up
• Scheduling & Registration
• Eligibility & Benefit Verification
• Data Entry• Cash Posting• Credit Balance
Report
• Outpatient Visits• Clinic Visits• Emergency
Department• Same Day
Surgery• Inpatient (DRG)
• Weekly review tocheck on denials
• Account Receivables Service
• Insurance Follow Up
© e4e – Confidential and Proprietary
Provider RCM Services
5
• Scheduling & Registration• Patient Data Entry• Eligibility & Benef it
Verif ication• Point of Service
Collection
• Seamless integration with Provider Accounting Systems
• Electronic Claim Generation and Transmission
• Payment Posting • Denial Management • Reconciliation • Refunds • Provider Data Updates • Patient Billing
• Charge Capture• Charge Audits for accurate
& compliant billing• Identify missed charges on
retrospective claims• Improvements in Clinical
documentation through education session
• Physician and Remote Coding
• Coding Staf f Augmentation
• Account Receivables Service• Calculate projected A/R
collections for outstanding accounts
• Monitor, identify and prevent future payment abuses f rom payers
• Underpayment Recovery Services
• Coding Audit• Charge Master Management• Billing and Coding Research to
plug areas of ‘Revenue Leak’
Charge Capture
Patient Access Management
Claims Remittance
& DenialManagement
ChargeIntegrity & Compliance Solutions
Remote Coding
Revenue Recovery & A/R Services
© e4e – Confidential and Proprietary
Payor Services
6
Mail Room Services
ReportsManagement
Member Enrollment
Claim Processing & Adjudication
Customer Service
Grievance Handling & Refund Posting
• Data Capture• Claim Information Capture• Claim Data Audit• Member Validation• Benef it Validation• Fee Schedule Validation• EOB Generation• Front End Rules
Application and Data Verif ication
• HEDIS & HCC Coding
• Member Enrollment/ Disenrollment
• Provider Management• Benef it Management
• Member Inbound Calls• Provider Service• Online Claim Status Query
• Member• Provider• Provider/Hospital
Directories- Report generation
• UM Reports• Statutory Reports• Canned Reports
• Receipt and Records of Appeals
• Analysis of Appeals• Amount Payable for
favorable cases• Process for payment /
generate check• Generate provider
letter if original denial is upheld
• Refund Posting
• Scanning and Batching• Optical Character Recognition
Conversion
© e4e – Confidential and Proprietary
Value Added Services
7
• Both Provider & Patient Support Call Centers
•Medical Policy Edits •National Correct Coding Initiative
•Global Surgery•Procedure-Gender•Add On Codes•Diagnosis-Gender•Diagnosis-Age •Multiple Surgery/Multiple Endoscopy
•Plan Benef it Conf iguration•Provider Additions•Provider Contract Uploading•Fee Schedule Maintenance•Rule Upload & Validation
•Pre-Emptive AuditSolutions
•Front End Edits•CMS Audit Support•HEDIS , RAPS Chart Audit
•MRA Chart Review,DRG Validation
•RAC Response Management including Trackers
Customer Support Centers
RAC Response
Management for ProvidersProcess Improvement
Consulting for Physicians
Ancillary Services
for Payers
BusinessRules
Configuration
• Consulting Services for Front & Back Off ice Process Improvements
© e4e – Confidential and Proprietary 8
Delivery Strategy
Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings
Right-shoring
Onshore - Onsite
OffshoreOnshore -Remote
US
USIndia
Philippines
© e4e – Confidential and Proprietary
The Philippines – Why?
Single-country risk diversification for e4e
To take advantage of the resource pool – attuned to US culture, language etc
To leverage the talent availability in the Healthcare domain – 18,000
registered nurses and 200,000 science under-grads
The Philippines is known to have better US-English and accent skills, ideally
suited for Customer Service/ Support, Self Pay, Collections, AR Follow-up
and Coding domains
With ICD-10 conversion fast approaching, additionally tap into the Coding
talent, particularly for hospital and facility Coding
Some of our Clients also wanted parallel service delivery from the Philippines
9
© e4e – Confidential and Proprietary
Highly Educated Human Capital
American Cultural Affinity
Services Industry Orientation
The Philippines – Competitive Advantage
10
Strong Govt. Support
Robust IT & Infrastructure
© e4e – Confidential and Proprietary11
e4e LocationThomas Renny GeorgeVice President - SalesMobile: +1 (813) 760 [email protected]
Mihir BhutaVice President - SalesMobile : +1 646 431 [email protected]
Kathleen Maher Associate Vice President Sales Mobile : +1 617 512 2318 [email protected]
Teresa Crawford Associate Vice President SalesMobile: [email protected]
