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Healthcare Sherpa, LLC Revenue Cycle Management Solutions 1

Revenue Cycle Management Solutions - Healthcare Sherpa, LLC

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Healthcare Sherpa is a Revenue Cycle Management service provider, which serve end to end RCM services to all Healthcare Providers throughout United States. In Healthcare Sherpa, Revenue Cycle Management Services includes but not limited to Medical Coding Insurance Verification Patient Demographics and Charge Posting Claim Submission (or) Transmission Payment Posting Denial Management Accounts Receivable Management Printing and Mailing Patient Statements We offer all these services as a Healthcare Sherpa’s complete suite or as a standalone services such as only Charge Entry or only Accounts Receivable(etc)… as per our providers (or) clients comfort zone.

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Page 1: Revenue Cycle Management Solutions - Healthcare Sherpa, LLC

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Healthcare Sherpa, LLCRevenue Cycle Management Solutions

Page 2: Revenue Cycle Management Solutions - Healthcare Sherpa, LLC

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Healthcare Sherpa’s Revenue Cycle Improvement System

REVENUE CYCLE IMPROVEMENT SYSTEM

Identify actual/

potential problems in RCM cycle

PLANNING

Benchmark base

performance to

industry standards

IMPLEMENTATION

Develop Management Reports

Constant process

improvement to

eliminate problem

Implement Changes,

Set Productivity & Provide

feedback

Continually monitor

performance.

RESULT

Increased Practice / Provider

Revenue

Fewer Rejections & Denials

Fewer Write-off’sEnhanced Cash

Flow

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Sherpa’s Auto-regulating Process Flow to Increases Revenue, Enhances Cash Flow and Reduces Write-Off’s

Proper input of patient insurance info & codes into

the billing software

Delay in submitting claims at the year beginning (to reduce no. of deductibles

Timely follow-up & No resubmissions without

carrier calls

Involve patients in the process for faster payment

Cycle billing method for patient statement and

three statements scenario for collections

Verify address / insurance change at

every encounter

Insurance Eligibility & Verification

24 hrs TAT by submitting claims

on same day

Healthcare Sherpa

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Scheduling and Patient Registration

99% accuracy with process for gathering complete patient demographic information

reduces 20% of rework

Process-oriented Insurance and Eligibility verification leads to faster payment within 20

days

Process based verification of patient ‘s plan benefit, results in prompt 80% POS

collections

Sherpa’s Solution

Problems

• Inaccurate / Incomplete patient Demographic Information

• Inaccurate / Incomplete Insurance information

• No verification of financial information

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Charge Posting

Process based insurance verification keeps claim resubmissions ratio to 2%

Good knowledge of insurance id formats and an extra minute spent to recheck insurance keeps claim rejections below 2%

Separate process step reduces authorization and referral denials to 5%

Problems

• Duplicate Charges

• Un-posted Charges

• Wrong Insurance Selection

• Missing Authorizations & Referrals

• Neglecting Payer Contracts

Process step for generating charge reports and regular contract updates ensures correct contract details and keeps contract denials under 1%

Process based posting and submission of all services bring down TFL exceed denials by 99% and reduce revenue loss by 2-5%

20% additional effort in charge entry with random Q.C. reduces duplicate charges & time spent chasing wrong AR by 5%

Sherpa’s Solution

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Sherpa’s process for secondary re-submission by printing or uploading the primary EOB’s brings loss of revenue down from 10% to 2%

Ensure accurate analysis of EOB and bill correct patient balance to avoid compliance issue

Facilitate EDI agreements with insurance companies. Leverage electronic posting to track payments and to bring down AR Balance to 15%

Payment Posting

Problems

• Lack of reconciliation

• Patient statements with wrong patient balances

• Ignoring secondary payment submission

Sherpa’s Solution

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Ensure claims submission to insurance with auth/referral & Retro-auth appealing

Process-oriented COB verification

Denial analysis and prompt appealing

Denial Management

Problems

• Medical necessity

• Non-Covered Services

• Co-ordination of benefits

Sherpa’s Solution

• Prior-Authorization / Referral

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Process-oriented insurance correspondence with necessary actions (e.g., Medical Records, Primary EOB etc.,) eliminates payment delay

Improved claims appeal process prevents up to 20% loss in revenue

Prioritize work on Old AR and try to collect >7% of old claims

Improved workflow process and increased productivity using our proprietary AR tracking spreadsheet to prevent 30% loss in revenue.

Insurance Follow-up

Sherpa’s Solution

Problems

• Lack of proper follow-up

• Pending claims never worked

• Erroneous claims that are not resubmitted

• Ignoring claims appeal

• Ignoring insurance correspondence

• Ignoring Old AR

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Self-pay Follow-up

Problems

• Incorrect data collection at front desk

• Statement sent to wrong address

• Rendering Non-Covered services

• Inadequate patient contact

Leveraging experienced patient account representatives to lower Bad debt adjustments from 20% down to under 5%

Proper insurance eligibility verification along with benefit plan to eliminate non-covered service denials

Getting correct patient address from USPS & verifying with TP software (e.g., White pages) to avoid sending statement to incorrect address

Sherpa’s Solution

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Privacy Confidentiality & HIPAA Compliance

• Secured Premises- guarded 24*7 • All employees signed to a confidentiality agreement• Restricted and monitored internet access• No media drives• HIPAA compliant Secured Data transmission • HIPAA compliant products and procedures• Frequent training and trouble-shooting per HIPAA guidelines

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Any Questions…

Please Contact us:E-mail: [email protected]

Phone: (919) 665-6942

Further Details,Please visit our website: www.healthcare sherpa.com

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Thank You.