Insurance Claims Resolutionand Self-Pay Recovery

Spend more time with patients,and less time worrying about receivables.

Transworld Systems Inc.

We’re in the business of profit recovery. We lead theindustry in providing medical practices with bettertools for recovering slow paying patient accounts andexpediting reimbursement from insurance companies.

� Last year, we recovered$650 Million for our clients

� Over 32 years of experiencerecovering slow-paying anddelinquent accounts

� Over 130 offices acrossthe United States

“Transworld gets credit for the highest recoveryrate in the industry.”

— Barron’s

Time is not on your side

� 80% of all revenue for most hospitals and medicalpractices comes from insurance claims filedelectronically or manually

� Delays in payment causefrustration and restrictcash-flow

� GreenFlagSM InsuranceResolution Recovery is arevolutionary new tool toassist in the rapid recoveryand resolution of theseclaims

Delays in claim resolution?

Possible Causes:

� Incorrect information

� Missing codes, signature, etc.

� Money applied to deductible

� Insurance checks released to patients

� Insurance companies simply holding on to your money as long as possible

� “Claims never received”

� Claims held in “Review”

Internal issues...

� Rising internal recovery costs and FTE expenses

� Continued depreciation of old claims

� Coordination of benefits with primary orsecondary provider

� Billing staff tendency towards concentration oncurrent claims after numerous attempts to recoverolder claims have failed

� Continued restriction of cash-flow

Phase OneTypical In House Procedures

Internal Cost $20 – $27/claim

Day 1–30 31–60 61–90 91–120 121–150 151–180 181–210

HCFA Telephone Telephone Telephone Telephone Telephone Telephone1500 or Calls or Calls or Calls or Calls or Calls or Calls or

UB92 Send Send Send Send Send SendSent Tracers Tracers Tracers Tracers Tracers Tracers

$0.50 $2.75 $2.75 $2.75 $2.75 $2.75 $2.75

$1.25 $1.25 $1.25 $1.25 $1.25 $1.25

Two-Phase Approach

Day 1–30 31–60 60 81 95 109 123

HCFA Telephone TSI’s TSI’s TSI’s TSI’s TSI’s1500 or Calls First Second Third National Final

Demand Demand Demand Claims DemandManager

UB92 Refiling (30 day (StateSent dispute statute

Send clause) reference)Tracers

in-house in-house HIGHEST POSSIBLE RESOLUTION

1–3 4–6 LOWEST INTERNAL COST

Why GreenFlagSM

Profit Recovery?

� Insurance carrier by-laws and internal policiestypically require immediate response to our licensedthird party contracts.

� Our third party demand moves the responsibility forthe claim from a clerk to a supervisor, who settles theclaim more quickly.

� Our average fixed fee of less than $10.00 per claimallows you to utilize this unique service on claims asearly as 30–45 days past-due.

� Insurance carriers will call your staff — effectivelyreversing the line of communication.

Claims you can submit:

� Commercial Insurance

� Managed Care Plans

� HMO’s

� PPO’s

� Medicare

� Worker’sCompensation

Remember:

� It is not a matter of if insurance will pay, but wheninsurance will pay.

� GreenFlagSM Profit Recovery reduces your internalcosts and lowersresponse time, which works toreduce the age ofyour receivables.

The results speak for themselves

� A surgical hospitalsubmitted 265 claimstotaling $622,000to TSI. In 60 days we recovered over$400,000 at a totalcost of $2,120.

� A large non-profit hospital assigned 120+ dayold claims to TSI totaling $584,000 resolved andrecovered over $385,000 in 75 days.

Your practice will benefit

� Using GreenFlagSM Profit Recovery at 30–45 daysallows your staff to focus their attention and effortson claims in the 0–30 day window. This reducesthe number of claims reaching 60 days.

� Quicker resolution of claimsmeans patients get billedfaster for their share of the balance, reducing thenumber of outstandingself-pay issues.

� Reduced internal costs.

� Happier staff.

In Summary:

� Improved Cash Flow

� Higher Recovery onInsurance Claims

� Early Identification of Patient Obligations

� Automated ProgramReduces Costs

� Effective National Presence