gotelecare corporate overview and service offerings

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Corporate Overview & Service Offerings

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

CONTACT: RONNIE HASTINGS (646) 661-7853 EXT. 304

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

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Service Offerings

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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 provide services to

Prosthetics & Orthotics and DME companies in Revenue Cycle Management

Physicians and Hospitals in Revenue Cycle Management

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


Advantages & Benefits

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Significant decrease in operational expenses• With over 5 years of successful O&P revenue cycle management experience, GoTelecare provides

professional consulting to best allocate resources to increase profit margins

• Significant operational savings that are effective immediately

Increased Accounts Receivable collection• 30% of O&P Rx are incomplete when first received. We excel in completing the Rx claim quickly

Cyclical Data Reporting• Data reporting interval can be customized to meet the needs of the customer

Demonstrated experience in handling O&P claims• Medicare, Medicaid and Commercial Plans Fee for Service and Capitated Plans

GoTelecare is currently servicing one of the largest O&P companies for their Revenue Cycle Management in the state of Illinois and they have

achieved significant savings and increased A/R collection in year one.


Orthotics & Prosthetics Basics

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Prosthetists provide artificial limbs (prostheses) to people who have all or part of a natural limb missing.

Orthotists provide supportive braces and splints (orthoses) to people with various conditions of the limbs or spine.

Prosthetists and orthotists work with people of all ages and with different requirements.

Prosthetics Artificial limb Artificial hand Exo-skeletal Prosthetic knees

Splints & braces Shoes & laces Collars TLSO

(Thoracolumbosacral orthosis)

Orthotics

E X A M P L E S


Coverage & Billing

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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 & Orthotics 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


Billing Cycle Overview

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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


Orthotics & Prosthetics Billing Cycle Details

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Order entry based on the Rx received from the physician Patient demographics & insurance entry Provider information entry Product code, Rx & Dx entry If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry process

Eligibility verification and authorization requirement enquiry Patient’s appointment with Practitioner for Practitioner to assign codes Collection of detailed Rx from the ordering Physician’s office Collection of documents required by Payer for authorization approval, e.g. Diabetic Verification Form, initial

evaluation, medical notes to support K level, PPR Form Calculation of service estimates (Patient and Payer responsibility) Determination that Payer criteria are met before delivery of device (if criteria are not met, the Patient needs to

be contacted and informed of the additional financial liabilities) 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


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

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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

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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

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Sample Reports

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4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/20150

20

40

60

80

100

120

140

96

83

94

98 96

29

11

6

31 32

125

94

100

129

128

41

32

26

30 28

ELIGIBILITY VERIFICATION

Number of New Patient Patient Brought ForwardPrimary Checked Secondary Checked (if applicable)

4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/20150

5

10

15

20

25

30

35

40

45

5045

25

38

4446

20

15

26

22 21

25

1012

2225

AUTHORIZATION

Auth Required Auth Obtained Auth Pending


Denial Management

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Auth Related14%

Coding Error5%

OON Issue8%

COB Issues10%Patient info missing

6%

Exceeds Timely Filing8%

Duplicate Claim5%

Service Not Covered6%

Primary Paid Max7%

Pre-Existing Con-dition

5%

Others26%

Distribution of Denied Claims


Telemedicine Capabilities

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Customizable telemedicine platform connects patients, healthcare providers and ancillary staff members to complete face-to-face consultationso Reduces healthcare costso Decreases patient wait times for patient appointmentso Increases patient satisfactiono Simple, easy to use user interface

Diabetic Verification Formo Expedites the process to receive the returned, signed Diabetic Verification Form from the

primary care physician Prescription Refills

o For rental devices; decreases the time associated with obtaining a prescription refill


REASONS TO CHOOSE US

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Our Billing Service Highlights

Above 95% Collection Rate Claims Submission TAT 24 – 48 hours max. Error-free Patient Entry 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

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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 / hour for a billing expert

working exclusively on the

client accountOR

just 4% of total collections realized

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A Simple Answer

But really, why us?

Because we do Six Sigma quality work, validated by excellent client references, at the lowest prices in the market!

CALL: (646) 661-7853 EXT. 304


Our 4 Pillars of Strength

Highest Quality

Excellent References

Unique Profile

Cheapest Rates

Consistently delivering the best quality, with the highest levels of accuracy, efficiency & expertise

Glowing testimonials from every client and not a single customer churn in our 8 years of operation

Huge experience in working for both Payers and Providers and

the only billing company with its own Telemedicine platform

The lowest rates in the market, with custom pricing options to

delight clients of all sizes

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Summary of Benefits

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

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Testimonials

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 major US healthcare company

My firm has evaluated an outsourcing transaction with GoTelecare. 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 & CEO of a leading US healthcare company

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The Next Step

41 Madison Avenue, Suite 2511, 25th Floor, New York, NY 10010, USA

(646) 661-7853 EXT. [email protected]

Ronnie Hastings

CALL: (646) 661-7853 EXT. 304

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

https://twitter.com/GoTelecare

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

gotelecare corporate overview and service offerings

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