GoTelecare Revenue Cycle Management Services

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


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


Revenue Cycle Management by GoTelecare

360° Revenue Cycle Management

Services


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


Eligibility Verification & Authorization

CLAIM 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



Because when claims need to be chased, we know whom to ask,when to askandhow to ask!

Why us?


Accounts Receivables (A/R) Management

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.



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


Medical Billing & Coding

MEDICAL BILLING & CODING SERVICES


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


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


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…


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



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


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



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


Accumulation of backlog Denials not posted Claims reconciliation issue


Why GoTelecare?

WHY US?


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


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


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


Contact Us

41 Madison Avenue, 25th Floor, New York, NY 10010

(866) [email protected]

Ronnie Hastings

https://www.facebook.com/GoTelecare/

https://twitter.com/GoTelecare

https://www.linkedin.com/company/5239333

Documents

GoTelecare Revenue Cycle Management Services