Revenue cycle management for orthotics & prosthetics by sun knowledge

Revenue Cycle Management in Orthotics & Prosthetics

SUN KNOWLEDGE OVERVIEW

Key Facts Awards, Affiliations & Certifications

2Sun Knowledge © 2015-16 Private & Confidential

‘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 State-of-the-art office inbuilt with all redundancies –

power, infrastructure and others

ISO 27001:2013 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

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

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

SERVICE PORTFOLIO

Provider SupportMember SupportMember Retention ProgramClinical Help Desk

Contact Center

Utilization ManagementMedication Therapy ManagementHospital Re-admission

ManagementTherapeutic InterchangeFormulary Management

Clinical Services

Medical Coding & BillingClaims AdministrationEnrollment Processing &

MemberFulfillmentCredentialing Premium Billing and Collections

Administrative Services

Analytics

Telemedicine ServicesRemote Patient MonitoringApplication Development & SupportTechnical SupportTechnical Documentation

IT Services

Claims /Drug Utilization AnalysisPDE AnalysisRAF AnalysisPayment Reconciliation

3Sun Knowledge © 2015-16 Private & Confidential41 Madison Avenue, 25th Floor, New York, NY 10010, USA

We provide services toPROVIDERS – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies

PAYERS – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs


SERVICES AT A GLANCE

PRACTICE MANAGEMENT

Scheduling

Eligibility & Authorization Verification

Prior Authorization

Customer Care


REVENUE CYCLE MANAGEMENT BY SUN KNOWLEDGE

360° Revenue Cycle Management

Services


SERVICE AREAS

We provide revenue cycle management services in the following areas:

Durable Medical Equipment Prosthetics & Orthotics Urgent Care

Pathology Critical Care Radiology

Internal Medicine EKG Pharmacies

Cardiology ENT Orthopedic Surgery

Anesthesia Family Practice Specialty Clinics

Rehab Centers Dermatology Physicians

Mental Health Substance Abuse Healthcare Facilities

and more…


SERVICE HIGHLIGHTS

Up to 97% collection rate in accounts receivable

FREE medical billing software, EMR & setup

Real-time eligibility checks

100% HIPAA-HITECH compliance

Rapid claim status review in denial management

Turnaround time less than 48 hours (max.)

Low service fees with no hidden cost

Zero lockup service contract that can be cancelled anytime

Excellent references from reputed clients across the US

Real-time audits and custom reporting

REVENUE CYCLE MANAGEMENTFOR ORTHOTICS & PROSTHETICS



INTRODUCTION

• Splints, Bands & Braces• Shoes & Insoles• Collars, Corsets & Supports• Bandages & Callipers• AFO (ankle-foot-orthosis)

• KAFO (knee-ankle-foot orthosis)

• TLSO (thoracolumbosacral orthosis)

• Spinal Orthoses• Artificial Limb• Artificial Arm• Exo-skeletal• Prosthetic Knees

We provide billing services for a wide range of Orthotic & Prosthetic devices, including:


ORTHOTICS & PROSTHETICS COVERAGE & BILLING

Prosthetics & Orthotics coverage may be subject to a copay or coinsurance. Authorization is required for various devices and this varies from payer to payer. This is considered a part of the member’s benefits provisions.

For prosthetic and orthotic devices to be covered, the general billing requirements are: A prescription from the ordering physician dated prior to delivery date

Consideration of limitations based on time period within which the item can be covered if supplied earlier, e.g. a pair of orthotic shoes are covered per calendar year by Medicare

Appropriate modifiers must be billed, e.g. KX, LT / RT, NU etc.

Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR Form for prosthetic devices, Diabetic Verification Form for diabetic patients etc. Coverage for such equipment is subject to medical review by the payer

Coverage of devices also subject to qualifying diagnosis, e.g. orthotic shoes are not covered unless diagnosis states diabetic

Repair, replacement and supplies may be eligible for separate reimbursement


O&P MEDICAL BILLING – KEY STEPS

Rx Order Entry

Patient Demographics and Insurance Entry

Product Code /Rx & Dx Entry

Eligibility Verification/ Authorization

Collection of complete Rx

Collection of documents for Auth

Approval

Submission

Rejection/Denial Management

A/R Follow-up


MEDICAL BILLING – KEY STEPS EXPLAINED

Order entry based on the Rx received from the Physician• Patient demographics & insurance entry• Provider information entry• Product code entry• Rx & Dx entry (with appropriate timeframe)• If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry process

Eligibility verification and authorization requirement enquiry Collection of documents required by payer for auth approval, e.g. face-to-face consultation notes, and obtaining

authorization from Payer Determination that Payer criteria is met before delivery of equipment, e.g. some products have time/frequency/

annual cost limitations f (if criteria is not met, the Patient is contacted and informed of the financial responsibility)

Generation of delivery ticket (based on which delivery is made to the patient) Creation of claim after receipt of confirmation of delivery Submission of EDI / paper claim to payers Cash posting Rejection & Denial Management A/R follow-up


SUN KNOWLEDGE – BENEFITS

Increased revenue – reduced collection time (95% + collection rate)

Claim submission within 48 hours of receipt of billing input

Provider can focus more on core services

Adherence to CMS billing requirements

Proper records maintenance and visibility through reporting


MEDICAL BILLING SYSTEM

We use Kareo for coding and billing services that covers the complete billing cycle:

SOAP notes review

Superbill generation and coding

Claims edit checking and correction

Claims submission through EDI clearing house at a scheduled time

Rejection management

ERA/EOB posting and reconciliation

Automatic secondary payor billing

Denial Management

Patient statement generation and mailing

Sun Knowledge handles medical billing - promptly, perfectly and professionally – using Kareo® or other billing systems as preferred by the client.


MEDICAL CODING HIGHLIGHTS

• Our coders deliver error-free charge sheets within agreed TAT provided by the client

• We monitor, analyze and improve coding documentation to avoid denials and guarantee reimbursements

• We carefully determine the codes according to the clinical information provided by the Healthcare Provider/Professionals and report back accordingly

• Our coders have undergone extensive medical coding training and are well aware of updated coding guidelines

• All our coders are ICD-10 certified (CPC)

SAMPLEREPORTS



ORDER ENTRY

ORDER ENTRY SUMMARY REPORT FOR ABC – 05/09/2016

Device Category Orders Received Pending brought forward Total Orders Orders Entered Unable to Enter Pending

Diabetic Shoes and Inserts 50 10 60 51 2 7

AFO’S 25 0 25 25 0 0

Orthotics ( Foot, Hand, Shoulder) 28 8 36 27 1 8LSO 17 1 17 15 2 0Prosthetic Supplies 27 0 27 26 1 0

Total 147 19 165 144 6 15

DETAILED ORDER ENTRY REPORT FOR ABC (05/09/2016)

Date Received Batch Patient Name

Demo Entry Status

Order Entry Status Status

Client Intervention

RequiredComments Order Details

5/9/2016 Batch 1 Patient 1 Yes Yes Completed Yes Need Dx code Left DARCO surgical shoe w/peg assist

5/9/2016 Batch 2 Patient 2 Yes Yes Completed No Order entered on 4/17/2016 Soft Helmet

5/9/2016 Batch 3 Patient 3 Yes Yes Completed No - Right Cam Walker Boot

5/9/2016 Batch 4 Patient 4 Yes Yes Completed Yes Need Dx code Left AFO


ELIGIBILITY & AUTHORIZATION VERIFICATION

EIGIBILITY VERIFICATION & AUTHORIZATION SUMMARY REPORT FOR ABC – 05/09/2016

Device Category Number of New Patients

Patients Brought Forward Total Patients Primary Checked Secondary

Checked Auth Required Auth Obtained Fax sent Auth Pending

AFO 25 0 25 25 4 19 2 2 17

Diabetic Shoe 44 3 47 47 12 9 7 6 2

LSO 15 0 15 15 3 11 3 3 8

Orthotics (Foot/Hand/Shoulder) 50 12 62 61 18 23 5 21 18

Prosthetic Supplies 27 0 27 27 6 8 6 8 2

Total 161 15 176 175 43 70 23 40 47

DETAILED ELIGIBILITY VERIFICATION & AUTHORIZATION REPORT FOR ABC (05/09/2016)

Date Received

Patient ID

Patient Name Ins Name Eligibility

Status RX Date Branch Code Status

Auth Required Auth Status Codes Comments WIP

Update

5/9/2016 1234 Patient 1 Amerigroup Active 3/31/16 Branch 1 Assigned Yes Pending A5500, A5504, A5513 Auth raised Done

5/9/2016 2345 Patient 2 BCBS Active 3/18/16 Branch 2 Assigned Yes Pending L0456 Pre-Determination raised Done

5/9/2016 3456 Patient 3 BCBS Active 5/3/16 Branch 1 Assigned Yes Pending

L5301, L5629, L5940, L5910, L5637, L5671, L5673, L8440, L8470, L5972, L5986, L8420, L5683

Pre-Determination raised Done


DOCTORS’ OFFICE FOLLOW-UP

Received Date Branch Patie

nt IDPatient Name INS Name Doctor's

Name RX Date Reason for Follow-up

Next Follow up Date Comments

5/2/2016 Branch 1 1234 Patient 1 IlliniCare Health Dr. A 4/11/16 Detailed

Written OrderNot Required

4/13/2016 - Called Dr. A's office s/w Cathy, she informed that they have already received the request, physician will sign and fax us back within the next 48 hours. 4/18/2016 - Called Dr. A's office as we haven't received the signed DWO back, per Cathy doctor was out of office for the last two days but he is back today. Cathy will make sure that paper works are completed by today and once completed she will fax us back. 4/18/2016 - Received signed paper work from Dr. A's office, scanned in OPIE

5/2/2016 Branch 2 2345 Patient 2 Medicare Dr. B 4/8/16Diabetic Verification Form

5/9/2016

05/02/2016 - Called Dr. B's office and s/w Donna, she informed that till now they haven't received the Diabetic Verification Form. Verified fax number assigned in OPIE and found that we actually have wrong fax number added in OPIE. Took correct fax# 888-6352290 and re-faxed DVF. 05/07/2016 - called and was advised that they have received signed DVF and will send it to us within a few days

5/2/2016 Branch 1 3456 Patient 3Blue Cross Blue Shield Of Il

Dr. C 3/29/16 Detailed Written Order 5/9/2016

05/02/2016 - Called Dr. C's office and s/w Paula, she took fax# 888-6350066 and advised that DWO would be faxed to us. 05/05/2016 - Contacted Jennifer and was advised that DWO will be faxed within a couple of days

5/2/2016 Branch 1 4567 Patient 4 Medicaid Dr. E 3/21/16 Questionnaire Not Required

05/02/2016 - Called Dr. E's office s/w Barbara, informed her that we had faxed questionnaire to their office yesterday for signature. She checked her system and found that she has already faxed it back to us yesterday. Enquired about the fax number and found that she actually faxed it to wrong fax number. Provided her the correct fax number for our branch and requested her to re-fax. She did the same.05/06/2016 - Received signed questionnaire and forwarded to Authorization team to work on auth.


ACCOUNTS RECEIVABLE FOLLOW-UP

Payer>120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days

Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining

AARP HEALTH CARE OPTIONS 26 23 3 17 16 1 44 41 3 37 32 5

AMERICAN TRANSIT INSURANCE COMPANY

12 11 1 6 5 1 15 15 0 10 10 0

BCBCS 28 24 4 16 13 3 41 37 4 32 30 2MAGNACARE 13 12 1 9 9 0 23 22 1 11 10 1HIP_PALLADIAN HEALTH 6 6 0 12 9 3 12 10 2 15 15 0MANAGED PHYSICAL NETWORK 12 10 2 8 7 1 10 10 0 10 8 2MAGNACARE 7 7 0 2 11 -9 5 5 0 8 3 5OXFORD 12 9 3 17 12 5 23 22 1 22 16 6STATE FARM INSURANCE 7 6 1 4 4 0 5 5 0 4 4 0TOUCHSTONE HEALTH 5 5 0 8 6 2 6 4 2 16 12 4UNITED HEALTHCARE 31 28 3 23 20 3 49 43 6 41 39 2

S No. Date Payer Patient Name DOB DOS Claim No. Charge

Amount Status Comments Ref #

1 7/21/2015 Healthfirst Patient 1 8/29/1974 4/26/2015 1234 $195.00 Paid

Called Healthfirst spoke with Jane D Rep stated that claim received on 06/30/15 and processed on 07/17/15. Per rep ins paid $173.47 on check# 3023659 having bulk amount $11909.23. Check was issued on 07/17/15 and is not cashed yet.

A12

2 7/21/2015 Healthfirst Patient 2 5/3/1983 6/16/2015 2345 $195.00 Paid

Called Healthfirst spoke with Jane D Rep stated that claim received on 06/19/15 and processed on 07/10/15. Per rep ins paid $173.47 on check# 3019387 having bulk amount $25091.99. Check was issued on 07/10/15 and is not cashed yet.

B34

3 7/24/2015 Magna Care (Oscar) Patient 3 8/11/1942 5/26/2015 3456 $3,800.00 Paid

Per John D rep stated that claim received on 06/05/15 and ins applied $292.60 towards pt as coins and paid 2633.40 by ck# 69783. Check issued on 07/10/15 and not yet cashed.

C56

4 7/24/2015 Magna Care (Oscar) Patient 4 8/10/1952 6/17/2015 4567 $252.11In ProcessPer John D Rep stated that claim received on 07/06/15 and

still in process D78


PROCESS KPI

Sr. No. Task Description TAT Accuracy

1 Entry of patient’s demographics/insurance/Rx 12 hours from receipt 99%

2 Eligibility Verification & Auth initiation 24 hours from receipt 99%

3 Audit 24 hours from notification of delivery 99%

4 Claims Submission 24 hours from Audit

5 Payment Posting 24 hours from receipt of ERA / EOB 99%

MEETING CHALLENGES


CHALLENGES & 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

SUMMARY OF BENEFITS


Very Little Risk• Proven track record in providing healthcare BPO/KPO services

• Experienced in providing services to both payers and providers

• Experienced 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 reduced collection time increase in revenue collection

• High level of Billing & Coding accuracy; TAT: 24 – 48 hours

• Adherence to CMS billing requirements

Clear Communication and Quick Response Time at All Times ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection


TRANSITION, OPERATIONS AND COMPLIANCE

FRAMEWORK


TYPICAL TRANSITION SCHEDULE


The key resources of the customer are available during the transition phase.

All documents and process materials like P&Ps and SOPs are available to the Service Provider Transition team before the start of transition.

Any change in the Scope of Work will require re-planning.

All data files are made available for data migration work.

Any other assumptions made in the “Statement of Work” are applicable here.

A more accurate plan will be given at the time of transition

Transition plan tasks may vary depending on specific project

ASSUMPTIONSSr. No.

Phase / Task Description Start Week

End Week

Remarks

1. Project Initiation W + 0 W + 02. Transition Planning and Solution

IdentificationW + 1 W + 1 ABC to provide existing

SOPs/P&Ps/Flowcharts/Reports before this phase starts.

3. Knowledge transfer and detailed As-Is Process Mapping

W + 2 W + 3 Onshore activity at ABC

4. Validation of process mapping document / SOPs / training materials


5. Validation of solution customization requirements


6. Finalize SLA & reporting requirements


7. Staffing & Training W + 4 W + 78. Solution customization W + 4 W + 79. Solution testing and verify operation

ReadinessW + 7 W + 8 ABC to provide sample data

and participate in testing exercise.

10. Conduct Pilot W + 9 W + 911. Evaluate Pilot results and finalize

critical Quality parametersW + 9 W + 9

12. Handover to Operations & start “Go Live”

W + 10 Transition work ends and operations ramp-up

TRANSITION SUCCESS FACTORS


Executive buy-in

Foster win-win partnership relationship

Strong project leadership for both companies

Client’s involvement in approving key deliverables (i.e. project plan, process documents, etc.)

Maintain key current subject matter experts until knowledge is transferred and the key processes are stable

Availability of key client personnel for training

Accurate identification of desk procedures and processes is critical

Effective governance structure

Communicate, Communicate, Communicate

OPERATIONAL FRAMEWORK

TRANSITION

Project scoping & planning

Knowledge transfer – Process training and assessment

Process documentation

Solution customization

Infrastructure set up

Pilot/Transition period

TRAINING

Training Need Identification

Customized training program as per client’s requirement

Pre-process & process training

Voice & accent and cultural training

Refresher training

PRODUCTION

Project management approach

Exception handling and reporting

Effective coaching & monitoring practices

Periodic review and evaluation

Service level management and reporting

QUALITY

Regular audit for process and deliverables

Identify and analyze errors to take corrective measures

Flowcharting and root cause analysis for process improvement measures

Management reporting of quality assurance activities

Capacity planning

Forecasting, staffing & scheduling

Real time reporting

Billing and revenue management

MIS / WFM

Ensure 100% adherence to federal / data protection laws

Governance & compliance audits

Organization preparedness for client & third party audits

HIPAA compliance

CONTROL & COMPLIANCE

PROJECT MANAGEMENT & OVERSIGHT

IT INFRASTRUCTURE– TOOLS & TECHNOLOGY


GOVERNANCE MODEL


Sun Knowledge Governance

Structure

Steering Committee

Program Management Office

Project Delivery Team

Executive sponsorship

Management oversight

Ensure business goals and engagement goals alignment

Ensure tangible results and demonstrable value

Continuously educate & report executive leadership on the critical success factors of engagement

Plan and implement change; define, establish performance, metrics aligned to goal

Review project scope, timeline and budget and monitor project progress

Communication, status reporting & escalation to steering committee

Manage cross team

dependencies

Identify, initiate & institutionalize process improvements

Oversee knowledge repository building

Project Management

Scope Management

Knowledge Management

Change Management

Ensure successful engagement startup

Quality Management

Resource Management

Communication & Status Reporting

Issue Management

Monitor & measure knowledge transfer

process

Incorporate industry best practices

QUALITY ASSURANCE & CONTROL

Quality Control & Assurance processes at Sun Knowledge help us meet our client’s expectations and SLA target.

We use Quality Assurance program to set production and quality goals. Our daily quality audit activities ensure that we evaluate our agents’ work on all relevant criteria.

We ensure quality by carrying out rigorous quality assurance and control activities.

Periodic process review

Process audit

Testing deliverables and root cause analysis

Process improvement / re-engineering

Incorporating customer feedback

Internal quality audit of client deliverables & review reporting

Weekly/monthly monitoring of productivity reports


TRAINING METHODOLOGY


• Regular process test and appraisals

• Work in-sync with Operations & QA

• Preparation of training Modules

• Preparation of training Plan in ‘Knowledge Net’ training module

• Process training and refreshers

• Availability of training documents in ‘Knowledge Net’ portal

• V&A, Soft skills training

• Post-training assessment• Training feedback• Review of training program

Training Need Identification

Training Program Planning

Conduct Training

Training Evaluation

COMPLIANCE – KEY FACTS

Well-defined policies and written procedures covering compliance aspects

Proactive compliance reporting and issue escalation

Action list for changes in rules and regulations by regulatory authorities

Compliance evaluation framework

Periodical training on compliance issues and update

Periodic audit and review mechanism to address potential compliance risks

Implementation of data privacy and security standards like HIPAA-HITECH and ISO 27001

Incident reporting for data security violation

Compliance awareness among the employees and reward on compliance reporting

Compliance violation by employees leads to employee retraining and reassessment

Sun Knowledge has defined and established a process and system to avoid compliance risks while carrying out operations and encourages employees to proactively report compliance issues to the

higher management.


COMPLIANCE - ESCALATION STRUCTURE


Service DeliveryService Delivery Mgr

(Service Delivery POC)

Head of Operations

(1st Level Escalation POC)

Operations

CEO & MD

(Final Escalation POC)

Executive Board

Board of Directors

ComplianceCompliance Mgr

(Compliance Escalation POC)

Head of ComplianceCompliance

Team LeadProcess Team Lead

(Service Delivery POC)

TechnologyTechnology Mgr

QualityQuality Mgr

HR/TrainingHR/Training Mgr

Compliance Issue

Trigger Point

Process Team Leader will inform Service Delivery Manager and Compliance Manager immediately after occurrence of the event

Compliance Manager/ Service Delivery Manager will assign the severity of the compliance issue

Compliance Escalation Path

Severe Compliance Escalation Path

IT STRUCTURE


Service continuity supported by BCP and disaster management mechanisms

100% redundancy in all IT assets, providing high-availability and reliability

12 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic failover configuration

Data protection and security provided by industry leading firewall combined with other physical and logical access controls

Voice telephony infrastructure built using E1 lines provided by two IPLC providers

Avaya PBX with IVR, ACD and CTI functionalities and 100% call recording & reporting features

Data center with 13 IBM x3650 rack servers with rack mounted UPS

Polycom VSX 7000A video conference system for remote training and client communication

24/7/365 IT-Infrastructure support personnel for user support, using ticket management system

120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power generator

DATA SECURITY AND END USER PRIVACY


Information security management system is aligned with ISO 27001:2005 standard Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations Data replication between Sun Knowledge’s servers in NY and India via site-to-site IPsec VPN tunnels helps

strong business continuity management Daily off-site backup process to mitigate data loss risk in case of disaster Implementation of physical access control system in office premises restricts access to sensitive areas housing

application and database Physical and logical segregation of internal network into VLAN segments to control and protect data storage

and transmission between business/process units Implementation of perimeter security devices, like firewall and segregation of sensitive information systems Access to all information systems through two levels of authorization Implementation of two levels of end point malware protection network and system level anti-malware

systems Use of secure e-mail system for e-mails with sensitive PHI information Implementation of access restrictions to prevent unauthorized deletion or movement of data using external

storage devices like optical discs, pen drives, etc. Security incident monitoring, reporting and resolution system Periodic employee awareness training on data privacy & protection and HIPAA regulations

HIPAA COMPLIANCE SUMMARY


SL. COMPLIANCE ASPECT HIGHLIGHTS

1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review

2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years

3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording

4 Vendor Access Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during all times

5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility

6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility

7 Network & Application Usage

Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass storage devices, printers – controlled by Domain Group Policy | No wireless access points

8 Firewall Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) | Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic

9 VPN (Virtual Private Network)

Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization controlled by Active Directory's authentication service

10 Redundancy Management

Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS and 750 KVA generator | 22 KVA UPS backup for server and network systems

11 Virus & Malware Protection

Central anti-malware system | Automatic updates | Extra protection by gateway firewall | Centralized OS patch management system (using Microsoft's WSUS server)

12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills


TESTIMONIALS


CLIENTSPEAK


“We have had the pleasure of working with the Sun Knowledge team throughout the few months utilizing their services for patient data entry and eligibility verification. They are a devoted and responsible team that is highly experience in what they do. They are always concerned about the client’s needs and are always there to help. I highly recommend the services offered by Sun Knowledge.”

COO of a leading medical billing and credentialing company in New York

“Your team amazed me with the manual and the amount of info you provided with that short training session.”

Practice Manager of a major Dermatology group in New York and New Jersey


CLIENTSPEAK


“My firm has evaluated an outsourcing transaction with Sun Knowledge. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry.”

Chairman, President and CEO of a major New York based Health Plan

“Our company is very pleased with the administrative, and business analytical solutions which Sun Knowledge delivers to our company from a quality & cost perspective. They have been a true partner in bringing industry expertise, and innovative solutions to the table. Their ability to grow with our evolving needs for higher end services such as clinical services is a significant differentiator among healthcare business process outsourcing firms.”

Executive Vice President of Operations of a leading MSO


CLIENTSPEAK


“I was always against the idea of outsourcing our back end claims processing work but I was wrong. Sun Knowledge provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.”

CEO of a leading MA-PD Plan

Ronnie Hastings(646) 661-7853Email: [email protected]

Sun Knowledge41 Madison Ave., Suite 2511, 25th Floor

New York, NY 11001, USA

For Additional Information, Please Contact…


mailto:[email protected]