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Ncpo ppt for docs 0912



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  • 1. Revenue Cycle Management Overview SAIcle One Solutions One Focus… Your Practice.
  • 2. About Us Overview Healthcare Focus• Established in 1986, in Shelton, CT • Supporting End to End process• Privately Owned and Financially Debt free for over 400 Clinicians• Minority & Women Owned Business • Provide partial services to 1000Enterprise provider group Talent Base • 125+ staff focused on Care• 400+ employees Support Services• Access to thousands • Over 12 unique EHRof global consultants implementations• People centric HRpolicy, training, etc Recent AchievementsGlobal Delivery Model 2010 NMSDC – 2010 50 FASTEST 2009 REGIONAL GROWING MBE HONOREE SUPPLIER OF THE CT Tech Council YEAR –Top 40 2
  • 3. SAI Service Offerings IT ConsultingConsulting Service Quality Assurance Package/ERP Implementation Application Maintenance ServicesService IT Application Development Staff Augmentation Revenue Cycle ManagementService BPO Help Desk, Network Support, Transcription Data Entry, Documentation MMC 3
  • 4. intriCareTM & intriCare- OncologyRevenue Cycle InformaticsManagement & Analytics Healthcare Provider Services Health HIPAA Security Information Assessments Exchange & Audits 4
  • 5. Consider the SAIcle One Solutions team as an extension of your back office• Efficiency, Capacity, Availability – Over 20 years experience managing medical revenue cycles with multiple Practice Management and EHR Software – 24 x 7 Support to ensure timely submission and follow up with payers, patients, and providers – 1 to 2 “billers” per each Full Time Provider – Account Management oversee SLA with Functional dedicated subgroups – Onsite Support (frequency based on complexity of practice)• Robust Monthly Governance and reporting to ensure maximum effectiveness• Add revenue to top line by capturing “lost collections”• Add to bottom line by providing cost effective rates• Customizable Provider friendly solutions designed for seamless integration into current practice design• Achieving economies of scale – Cross team reporting to “prevent things from falling through the cracks” – Continuous Improvement group 5
  • 6. SAIcle One RCM Offering 6
  • 7. Detailed transition and cash flow management to mitigate risks and business interruption Transition Management Cash Flow Management• Onsite Transition • Short term Receivable Management (1 week to 1 Advance month) • Long term Advance Funds• Customized Transition plan. checklist – Receive Cash on submission• Weekly Transition Conference Calls Coordination• Manage Expectations• Limited changes • Meet with existing billing – SAI application with organization Clearinghouses • Creation of Standard – CMS 855 form 30 days post Operating Procedures (SOP) successful submission – Remittance address • Document rules to share EOB and data 7
  • 8. Comprehensive process ensuring maximum productivity & reduction of person dependency Patient Demographic VerificationFront Office Charge Entry (Coding) Reports Provider Claim Submission A/R Payment Denial Follow- up Clearinghouse Carrier Conversion / Adjudication Submission 8
  • 9. Receipt of Demographics and Super Bills Charge Capture• Toll free E-fax number dedicated to the account• SAI may login to client PM / EHR• EHR HL7 interface (option)• Electronic Mobile Charge Quality Control Capture• Scanned Images picked up from • Double Key, Verify, Update Client’s server mechanism• Scanned Images picked up from • 48 hours turn around for SAI SFTP all data entry• Paper sent to SAI Office • 24, 48, 96 hour claim• Paper picked up from PO box or verification Lock box (Received, Accept, Approv ed) 9
  • 10. Back Office Processing• Verification at each Demographic level to ensure Verification accuracy of claim and data Charge Entry• Communication with provider office for any (Coding) supporting Claim documentation Submission• *CPC Coding per SLA• Daily, Weekly Transmission logs Clearinghouse• Clearinghouse level denial reporting per SLA Conversion / Submission 10
  • 11. Insurance AR Management• Electronic Remittance Advice to post payments against patient charges• Electronic Funds Transfer of Provider Reports all payments to provider account directly from payer• Non EFT payers deposit only A/R account Payment Denial Follow-• Denied claims addressed with up Payer and reprocessed• Denials reviewed at monthly governance Carrier• Specialized A/R follow up teams Adjudication address payer specific relationships – Aged / Current managed separately 11
  • 12. Additional AR Management• Secondarys filed immediately along Soft Collection with EOBs• Follow up calls to Patient secondary payers made• Patient statements Front Office for patient portion of bill sent• *Additional patient Provider soft collection calls made upon agreement with office 12
  • 13. With an sizeable technology team, SAI can provide customized Reporting per your needs • Aging Reports • Financial summary report – By Date of Service that includes: – By Posting Date – Adjustments Summary by type Aging Reports will be run in of adjustment (e.g Medicare summary by payor (no detail by adjustment, insurance patient-the report should show the adjustment, bad debt total owed and aged by payor and adjustment) self pay balances) – Charges Summary • Credit balance report – Payments SummaryAll reports will be run following the • Payments by payorclose for the month before any new • Adjustments by payorcharges, adjustments or payments – Productivity report whichare entered for the next month. includes the CPT code and UnitsReports (excluding aging reports) will of Service (number of times thebe run for the month and year-to- CPT code was used)date. • Unbilled or accounts on hold 13
  • 14. Our service offering is comprehensive, robust and configurable RCM Service Offerings• Dedicated Single Point of Contact • Monitor Billing and collections• Provider Reenrollment • A/R Follow Up• Customized Super Bill – Payer (non and low pay)• SAI-Port (Mobile Charge Capture) – Patient (Soft reminder calls)• Patient Demographic Entry • Monitor super bill completion & coding• Coding by AAPC certified coders • Manage Patient and Provider• Charge Entry Inquiries• Claim Scrubbing / Validation • Practice Management Software• Charge Transmissions • Training• Manual Payment Posting (or) • Maintain database of patient and• Electronic Remittance Posting payer information• Electronic or Paper Patient • Maintain managed care allowable Statements • Maintain Provider Numbers• Claims Appeal / Actions on • Maintain referring physician Rejection database 14
  • 15. Broader range of services provide a single partner to the practiceOptional Add on Services Value Add Services• Old Aged AR collections and • Temporary Front Office analysis reports Staff Augmentation• Provider Enrollment with EDI • Monthly Advance on – Submitter ID applications Reimbursements – ERA / EFT enrollment • Technology Support and• Provider credentialing implementation – Application / documentation submission • Consultative Practice• Eligibility/Insurance Analysis Verification• Quality and Compliance Audits 15
  • 16. Software / Tools Supported• eClinicalWorks • PracticeMate• Medical Manager • drchrono• Medisoft • OpenEMR• Kareo/Practice Fusion • Charter by SAI• GE Centricity IDX (proprietary product)• AthenaNet • Multiple other products• SSIMed / Origins EMRge and Web based solutions• Visionary Healthware 16
  • 17. SAIcle One Qualifications 17
  • 18. Specialties and practice sizes show breadth and depth of SAI Qualifications Areas of practice Customers• Internal Medicine • Internal Medicine in• Family Practice Franklin County, NY• Urology • GI Practice in Franklin• Psychiatry / Behavioral Health County, NY• Ophthalmology • Family Practice in upstate• Physical Therapy NY• Urgent Care • 40 Provider practice in CT• Pain Management • 15 Provider practice in IL• Surgery • 25 Provider Psych Practice in NY• Gastroenterology • Large Multispecialty group• Disease Management in TX• Infectious Diseases• Pediatrics 18
  • 19. Practices that transition to SAI’s RCM Solution collections improve by a minimum of 25% Collection Improvement Performance100.0% 100.0% 80.0% 95.3% 80.0% 25.7% 51.0% 60.0% 60.0% Before SAI 40.0% 45.7% 40.0% After SAI 20.0% 20.0% Improvement 0.0% 0.0% CT Group IL Group NY Group NY Provider Before SAI After SAI Clients # of Billed % of # of Billed % of Collections Collections Proc Amount Collections Proc Amount Collections CT 2,416 $301,380 $149,247 49.52% 6,739 $765,748 $476,656 62.25% Group IL Group 389 $32,094 $11,172 34.81% 912 $89,219 $60,650 67.98% NY 1,005 $351,394 $115,599 32.90% 1,159 $390,938 $187,424 47.94% Group NY 31 $8,075 $4,350 53.87% 338 $76,105 $61,925 81.37% Provider 19
  • 20. Single Point of Contact supported by deep management bench Manager RCM • Location: Shelton, CT • Senior Manager at SAI • First point of escalation Account Representatives Functional Team Leads• Location: Shelton, CT or Onsite at • Location : OffsitePractice or North Country • Primary responsibility: Drawing up• Regular day-to-day interface with and managing the delivery client • Managing (hands-on) of operations• Oversight of daily operation teams and subteams• Key Point of contact 20
  • 21. Industry experience is broad and results in better ROI for clients Years of Experience Role Average Years of Experience Account Representatives 12 Years Charge / Claim Entry 2 Years Coding Team 5 Years Team Leads 8 Years QA/Verification 5 Years Continuous Improvement A/R Follow Up / Denials 8 years EOB / Cash Posting Team 3 YearsAll clients are welcome to speak to any / all members of the team. 21
  • 22. Multiple ways to communicate with the team and regular scheduled checkpointsGovernance Communication• Monthly meeting to provide • Assigned account liaison from account analysis client will have daily• Designed for topline view of communication with SAI account account team.• Identified trends and • Daily, weekly, and monthly report recommendations • Account manager available for rapid responseCommunication Methods Escalation• eFax (secure) Escalation Responsibilities Position Responsibility• Client email account VP Resolves major Severity 1 issues such as more than• Patient local number 30 days of no receipts Manager, Resolves conflicts on process, effectiveness, and RCM productivity of operations Account Resolves issues related to daily operations or specific Manager claims. 22
  • 23. Comprehensive RCM Offering positioning SAI as a true partner to the practice• Increase Top Line Collected • Up to 100% Paperless as much as – Manage Fee Schedule in line your process will allow with Industry and Insurance • HIPAA Compliant – Secure Companies Systems and Facilities – Frequent follow-ups with – Available for audit 2nd, 3rd, & 4th level payers • Customer Service• Adding to the Bottom Line – 24 x 7 availability – Lower fees than competitive – Onsite Transition outsourcers or in-house – Monthly Practice Performance – New Top Line Revenue added to Reviews bottom line – Account Meetings (Onsite)• Full Service Company – RCM Services (Full Cycle) • Quality and Efficiency – SLAs including Charge – Technology (Equipment + PM + Posting, Payment Receipt, etc. EHR ++) – High Ratio of “billers” to – Temporary Staff Augmentation providers to maximize collections• Advance Funds – Documented Standard Operating – Paid when Charge Posted Procedures 23
  • 24. Summary • Financially strong • Rapidly growing: double digit revenue and customer growth • Consistent competitive cost of serviceFinancial • 25+ years of IT Experience • 20+ years of RCM Experience • Successful performance single provider medical practices andExperience Fortune500 companies • Continuous Improvement Team • Industry certifications and credits – 96% customer retention • Mature processes and utilization of tools to achieve efficiencies • Dedicated customer focus and Metrics Reporting Quality • Global Delivery Model (North America, Europe, Asia) • Domain, Technical, and Management experts • Low attrition rate • Proactive and lean team deployment • Training and growing multi lingual capabilities People 24
  • 25. Thank You For more information, kindly visit us www.saisystems.com Contact Information : Cathy Fortin William Oravecz Manager, Revenue Practice Lead, Healthcare Cycle Management Provider and Life Sciences(203) 567-5267 or (203) 479 2874 (209) 567 5265 or (203) 788 4292 cfortin@saisystems.com woravecz@saisystems.com Disclaimer: All trademarks, logos, and copyright illustrated in this presentation are acknowledged as belonging to their respective owners.
  • 26. Disclaimer & CirculationThis document has been drafted by SAI SystemsInternational, Inc. (SAI). This document is for viewing by SAIand SAI authorized personnel only. Copying, reproduction andreuse of information provided in this document for anypurpose other than what it is intended for by any third partyorganization, assigns or individuals is prohibited.All trademarks and ownership ofproducts, logos, images, photos and processes if cited in thisdocument are acknowledged as belonging to their respectiveowners. -26-
  • 27. RCM Process Flowchart• Over 25 years experience managing medical revenue cycles• Increase Top Line Collected – Manage Fee Schedule in line with Industry and Insurance Companies – Frequent followup with 2nd, 3rd, & 4th level payers• Adding to the Bottom Line – Lower fees than competitive outsourcers or in-house – New Top Line Revenue added to bottom line• Full Service Company – RCM Services (Full Cycle) – Technology (Equipment + PM + EHR ++)• Customer Service – 24 by 7 availability – Monthly Governance Performance Reviews • Quality and Efficiency• Upto 100% Paperless as much as your – Service Level Agreements process will allow – Advance Response Technology - 30K lookups/24hrs• Specialization for Providers “on the road” – With CMS (Medicare/ Medicaid) expertise • HIPAA Compliant – Secure Systems and Facilities 27
  • 28. Informatics and AnalyticsProducts and technology Sample Clinical Measures of Performance • Performance Management • Benchmark Reports – Patient Safety – Patient Satisfaction • Outcome Monitor • DRG Utilization • Meaningful Metrics Calculation – Appropriate medication utilization • Satisfaction surveys 28
  • 29. intriCare OverviewintriCare is a scalable technology solution that reduces the costand increases the wellness of the Medicare Advantage andMedicaid Populations. Components are:1. A Care Management Platform drives clinician’s workflow, monitors the patients health status, and directs appropriate care planning;2. Substantial reporting on clinical and financial outcomes; and3. A targeted community based clinical approach.Features include:• Enhances Physician Resources for patient centered care management by: – Making tools available for physician office to use – providing data collection for physician office• Patient Navigation, Care Coordination and Patient Assessment Tools Fill Missing Gaps in Physician Software Solutions;• Re-establishes treating physician as the focus for patient coordination rather than disparate care managers and specialty pharmacy patient oncology managers;• Puts full care coordination data (even for care outside office) in the hands of treating physician• Deploy within the Plan, Provider office, Offsite, in the Home, any location 29
  • 30. Technology IntegrationMobile Environment Central Data Store Environment Visionary PM @ SAI IN Location Device DB Patient.in Billing Export side Billing Service Import/ Software DB Export Device DB Bill.in Service ServerBiller Offline App OUT Location DataBase EHR Environment Access Import DB Service Patient.out SQL DB SQL DB Bill.out Access DB
  • 31. SAIPortSAIPort• Mobile Charge Capture / Electronic Superbill Worklflow System• Patient Registration• Charge Entry with most used Procedure Codes• ICD9 Precise List• Offline Capability• Synchronization with Practice Management Database• Charge Review Reports• Encrypted Database