Medical Coding, Auditing and Payment Integrity Specialists More than 150 certified medical professionals on staff Operating at 70 sites in over 40 states In business since 1998

1. Team HCRS
TEAM HCRS Value
Proposition
September
1, 2011

2. O
v
e  About our firms
r  Why us?
v  Our approach
i
 Questions and feedback
e
w
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3. A Major Provider of
Health Information Management
A Services
b
o  Medical Coding, Auditing and Payment Integrity
u Specialists
t  More than 150 certified medical professionals
on staff
H  Operating at 70 sites in over 40 states
C  In business since 1998
R  Woman- and Minority-owned business
S
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4. H
C
R
S
C
l
i
e
n
t
s
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5. Expert Payment Integrity Services
 Since 2000, providing comprehensive claims cost management
A services to diverse group of 70+ payer clients
b nationwide, including health plans, Managed Medicaid
Plans, Medicare Advantage Plans, TPA’s, and Taft Hartley Funds
o  Experienced team of multidisciplinary professional staff
u including:
 Special Investigators specializing in complex health care fraud
t investigations
 Managed care professionals experienced in both commercial and
government programs
T  Registered Nurses
 Certified coding professionals (RHIA, RHIT, CCS, CCSP, CPC, CPC-H)
C
 Able to manage large claim volume. Currently processing over
3 75 million claims annually with a claims value of over $55
billion through its fraud, waste, abuse and other payment
integrity programs
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6. Single Entry Point – High Impact Savings
Paid Claims
A
b
o Provider Match
Claim Diagnostics
u Claim Analytics
Clinical Code Editing
Discovery
t Duplicate Detection
Analysis of Automated Results
Complex/Medical Record
Reviews
T Validation
C
Letters to Providers
3 Recovery
Follow-up Calls to Providers
Client Portal
Customer Service Center
0.5%-3% Savings
6

7. O
v
e  About our firms
r  Why us?
v  Our approach
i
 Questions and feedback
e
w
7

8. Team HCRS Combined Capabilities
O
u  Current Medicaid audits, including Louisiana
r  High ROI audits
 Payment Integrity services to more than 70
payers
V  Over 65 successful contingency contracts
a  Leading-edge technology integrated with
l experienced staff
u  Assertive, professional recovery efforts
e  Prevention as well as recovery services
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9. Current Medicaid Audits
O  MIC audit subcontractor for nineteen states
and three territories (HCRS), including
u collaborative field audits with the State of
r Louisiana focusing on hospitals and long-term
care facilities
V  Special state-level inpatient audits for
a Maryland and Virginia (HCRS)
l  Subcontractor for Overpayment Identification
u for the State of New Jersey (TC³)
e  Focused audits related to transportation and
translator services for Managed Medicaid Plan
in MN (TC³)
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10. Louisiana Learning to Date
O % Audit Discrepancies By Provider Type
(n Samples >100)
u 100%
1400
r S 1200
a 1000
m 800
p
V l
600
85%
400 80% 68%
a e
s 200
100% # Samples
# Discrepant
l 0
u
e
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11. Louisiana Learning to Date
O Average Value of Overpayments by
Provider Type (n Samples >100)
u $3,000
$2,586
r $2,500
$2,000
$1,500
V $1,000
a $500 $214
$371
$84
$346 Average
Overpayment
l $0
u
e
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12. High ROI for Audits
O  HCRS MIC results have exceeded $8 in
u incorrect payments for every $1 spent
r on audit
– High-quality data analysis results in greater
return for the type of overpayments that are
V the focus of each audit
a – Highly-experienced auditors identify more
additional errors beyond the primary focus of
l the review
u  TC³ averages 5:1 ROI
e  TC³ achieves range of .5%-3% reduction
in paid medical claims cost
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13. Payment Integrity Services for
More Than 70 Payers- Tangible
Results
O
 Prevention – Cost avoidance through pre-payment
u integration
r  0.5-3% of paid medical cost reduction
 Feedback –
Identify and fix Monthly Savings
V root causes to 300
avoid future 250
a overpayments 200
 Recovery – Savings
l Customized ($Ks) 150
u pursuit of VALID 100
overpayments 50
e leads to 0
successful 11 13 25 28 30 45 48 60 62 80
# of Members (Ks)
recoveries and
few appeals
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14. Proven Results
“HCRS is a group of professionals who really know their business. They’re
reliable, easy to work with, and they deliver. We’ve been increasing the amount of
O work we do with them, and we see them as a long-time partner as we expand our
presence in Medicaid payment integrity.”
Vice-President, Business Development, OptumInsight (formerly known as
u Ingenix)
r “HCRS’ performance has not only been superior, but timely…At AETC we are
consistently asked what has generated such success, I can honestly say the
contract partnership with HCRS is at the center of our success.”
Chief, Medical Resource & Programming Branch, Headquarters, Air Education
V and Training Command, United States Air Force
a “We wanted to save money for our groups and members. All goals have been
surpassed on all levels with TC³. The company helped us streamline our internal
l processes and reduce administrative work by integrating with external data
sources. We are confident we’ve retained a highly-respected long term partner for
u more efficiently controlling costs.”
Client for 7+ years
e
“Our experience with TC3 has been excellent. Not only is their technology state of
the art, but their commitment to customer service is outstanding.”
Vice President-Operations, The Loomis Company
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15. Highly Experienced and Successful
Contingency Contractor
O
 Execution of successful contingency fee
u based relationships for over 8 years
r  Goals aligned – Accurate, sustainable
findings, recovery process that maintains
V positive provider relationships
a  Conservative approach - TC³ is sensitive to
the challenges faced by providers in today’s
l healthcare climate. The focus is not on
u penalizing providers.
e  Mature technology and processes in
place to support contingency fee
contracts
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16. Integrated Approach –
Technology and Experienced Staff
O
 Discovery – Technology to identify overpayments and
u suspect claims
r • Provider Match Program – Watch Lists
• Claim Analytics – Algorithm based technology
powered by DataProbe®
V • Claim Diagnostics - Rules-based technology powered
by TC³’s TruClaim engine
a • Code Edit Compliance and Duplicate Detection
l  Triage, Validation and Recovery
u • Post-payment review – Systematic validation of
automated reviews. Complex reviews performed by
e qualified staff
• Recovery process customized to client specifications
• Pre-payment option – Pay/Deny results within 24
hours. Complex reviews available.
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17. Findings - Examples
 Non-Emergency Transportation
 Identified 57,009 claims billed with a transportation code with no
corresponding medical claim (including dental/chiropractic encounter
claims and pharmacy/PBM claims) for the same member and same
date of service. The corresponding dollars paid for these
transportation claims was $3,025,502.86.
 Translator Services
 Review of the data indicated that there were 24,935 claims
submitted for interpreter services for dates on which no other
service was apparently provided. The dollars paid for these claims
was $1,315,676.43.
 Personal Care Attendant Services
 There were no medical claims found for many members receiving
daily PCA services. PCA services provided while the member was
inpatient totaled a paid claim amount of $24,668.97. The number of
units billed for single dates of service appears excessive. Daily
services were billed by a provider whose address is a 1-2 hour drive
from the home of the member (potential for services not rendered.)
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18. Assertive, Professional
Collections
O
 Customized process designed by the State of Louisiana
u (amount of time, number of letters, and phone effort)
 All payments can be directed back to any source that the
r State chooses.
 The State of Louisiana has access to all phases of effort
through a Client portal established in your name.
V  All phone conversations are recorded for quality
a assurance and are available for review by the State.
 Client has total control over any account in the system
l and can withdraw, suspend, or cancel our efforts at any
u time.
 Fully HIPAA compliant
e  All services are entirely based in the United States and
performed by personnel with specific skills in health care
related recovery
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19. An Option: Prevention
Capability and Experience
O
u  Pre-payment solution includes daily claim scrubbing
to identify potential overpayments
r  Utilizes same components and technology as post-
payment solution
V  Identify root causes that contribute to
overpayments and provide feedback to address
a these issues.
l  Why Pre-payment? Cost avoidance in real
u time, deterrent effect, individual claim denials more
acceptable than mass recoveries
e
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20. O
v
e  About our firms
r  Why us?
v  Our approach
i
 Questions and feedback
e
w
20

21. O Approach Overview
u
• Multilayered approach blends technology and
r Data
human expertise
Mining/ • Achieve and validate focus through traditional
Analysis edits, proprietary diagnostics/analytics + your input
A • Local call center and scanning staff – we train in
Record
p Request & customer service and provider relations
• We are experienced in f/u, scanning in Louisiana
Handling
p (Audit MIC subcontract)
r Record
• Initially, our experienced coding and pharmacy
auditors (later, local hires)
o Review • RN auditors for medical necessity review
• Medical necessity decision by physician
a
• Continuous consultation with state on individual
c Collections
cases
• Appeal process IAW law and regulations
h • Sensitive, prudent persistence
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22. O Process Overview
u
r
Data mining using
TruClaim (proprietary)
and Data Probe
A (Thomson Reuters)
Suspect provider data
bases
Synthesize
experience,
identify trends
MVA/PIS targets for study, and
p 100+ Proprietary and
traditional algorithms
update
screening
Code edit and duplicate MVA/PIS protocol
p detection technology
Validation studies
guidance
Continuing updates
r Run through
Validate,
report Collection or
o Claims
data file
customized
screening
protocol
potential
over/under-
payments to
Review? Yes
Collect /
refund?
Yes
refund IAW
Louisiana
law/regs
Feedback
to process
a
MVA/PIS
No
CORE/TruClaim Case Tracker
c
h
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23. O Implementation Plan
u
r
A
p
p
r
o
a
c
h
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24. O
v
e  About our firms
r  Why us?
v  Our approach
i
 Questions and feedback
e
w
24