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GoTelecare Services-Overview
- 2. 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
State-of-the-art facility inbuilt with all redundancies –
power, infrastructure and others
Sun Knowledge, our contracted company, is
ISO 27001:2013 and ISO 9001:2008 certified
CMMi-SVC implementation in progress under KPMG
guidance
Member of NASSCOM
Awarded ‘Best Emerging BPO Company of the year 2010’
by The Economic Times
Recognized as one of the foremost ‘emerging companies'
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 on
3rd December 2015
Key Facts Awards, Affiliations & Certifications
- 3. 3© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Our Service Offerings
Provider Support
Member Support
Member Retention Program
Clinical Help Desk
Contact Center
Utilization Management
Medication Therapy Management
Hospital Re-admission Management
Therapeutic Interchange
Formulary Management
Clinical Services
Enrollment Processing & Member
Fulfillment
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 cater to
Prosthetics & Orthotics and DME companies in Revenue Cycle Management
Physicians and Hospital in Revenue Cycle Management
Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
- 4. 4© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Revenue Cycle Management by GoTelecare
360°
Revenue Cycle
Management
Services
Eligibility
Verification &
Authorization
Billing
Coding
Scheduling
Payment
Posting
Account
Receivables
- 5. 5© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Revenue Cycle Management – Service Portfolio
Inpatient/Outpatient Hospital Coding
Physician Coding
Patient entry demographics & insurance information
Fee Schedule / Charge Entry
Scrubbing all entries for correctness and completeness with appropriate billing edits;
correction of identified errors
Submission of claims to payers, e.g. EDI or paper
Creation and mailing of patient statements
Posting of payments received from patient and payer
Reconciliation of charges, payments received and adjustments made
Denial Management (understanding denials and making corrections)
Resubmission of claims
AR calls as follow-up on outstanding issues
Closure of a claim once the balance is zero
CODING
BILLING
A/R FOLLOW-UP
- 6. 6© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
CLAIM VERIFICATION &
AUTHORIZATION
- 7. 7© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
HIGHLIGHTS
Full Range of Verification Services
Fast 24-hour Turnaround Time
Above 99.9% Accuracy
Detailed Documentation
100% HIPAA Compliance
Diligent follow-up till resolution and closure
Uniform importance given to every claim - irrespective of its value
- 8. 8© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization
Because when claims need
to be chased, we know
whom to ask,
when to ask
and
how to ask!
Why us?
- 9. 9© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
ACCOUNTS RECEIVABLES
(A/R) MANAGEMENT
- 10. 10© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
Our A/R follow-up service is designed to increase the Revenue Collection for our
clients.
The process begins after the Provider creates and sends Health Insurance Claims
(Electronic/Paper claims or Manual HCFA forms) to various Insurance Companies.
Depending on the transmission type and length of time since submission, we
begin our follow-ups.
- 11. 11© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Accounts Receivables (A/R) Management
A/R Analysis
14% of all claims submitted to the payers are denied and have to be resubmitted, appealed
or written off by providers
50% of denied claims are never re-filed
50-70% of denied claims have higher chance of being recovered
Follow-up with payer
Aggressive follow up with the insurance company's on all accounts at any
stage of the aging bucket plays an important part in A/R follow up activities.
Closure of claim
Reducing days in A/R, claims submission and improving
collection ratio with an increase in the probability of payment
through timely follow-up is the responsibility of the A/R team
- 12. 12© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Billing & Coding
MEDICAL BILLING &
CODING SERVICES
- 13. 13© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Billing Cycle
Encounter
(SOAP)
notes
review
Superbill
generation
and code
review
Claims edit
checking
and
correction
EDI claims
submission
through
clearing
house
Rejection
management
ERA/EOB posting
and reconciliation
Automatic
secondary
payer billing
Denial
Management
AR
Follow-up
- 14. 14© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Highlights
FREE Billing Software
FREE EMR
FREE Implementation
No Hidden Cost
95% Collection Rate
99.9% Coding Accuracy
Claims Submission within 24 – 48 hours max.
100% HIPAA Compliance
Custom Reporting
Excellent References
Real Time Audits
- 15. 15© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Areas of Operation
We provide turnkey billing services in the following areas:
Hospitals Prosthetics & Orthotics DME (Durable Medical Equipment)
Pathology Critical Care Radiology
Internal Medicine EKG Urgent Care
Cardiology ENT Orthopedic Surgery
Anesthesia Family Practice Inpatient Hospitalization
Rehab Center Pharmacy Physicians, and more…
- 16. 16© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
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
- 17. 17© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Challenges and Our Approach
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
TASK DESCRIPTION CHALLENGES APPROACH
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
- 18. 18© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Challenges and Our Approach
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 efficiency
Process Administration
and Reporting
AR Follow-up &
Denial Management
Regular analysis, follow-up and review
Transaction audit
TASK DESCRIPTION CHALLENGES APPROACH
Accumulation of backlog
Denials not posted
Claims reconciliation issue
- 19. 19© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Why GoTelecare?
WHY US?
- 20. 20© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Advantage GoTelecare
1
Over 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
2
Consistent
Performance
in Delivering
97%
Collection
Rate to
Clients
Already
Recovered
over millions
in Account
Receivables
and
counting…
3
The Only
Medical Billing
Company with
Its Own State-
of-the-Art
Telemedicine
Platform
4
The Best
References
in Every
Segment
of US
Healthcare
Knowledge &
Business
Process
Outsourcing
5
The Lowest Prices*
in the Market!
* Only $10 /hr for a
full time biller | Just 4% of
collections for AR services |
Only .80 cents /claim for
eligibility verification &
authorization.
Clients enjoy
Extra Savings with
FREE Billing Software
FREE EMR
FREE Implementation
No Hidden Cost !
- 21. 21© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
GoTelecare vs. Other Staffing Agencies
- 22. 22© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Why Us?
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
- 23. 23© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
HIPAA Compliance
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
- 24. 24© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
What are Our Clients Saying
"The professionalism I have experienced with GoTelecare’s
employees has made them very easy to work with and has
improved our operation processes. Any time I have a
question, they are literally just a phone call or e-mail away.
I love the accessibility!”
- CFO of a major US healthcare company
“I am starting to see an upswing with Medicare and
United cash flow”
- CEO of a leading US healthcare organization
“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
reputed US healthcare company
- 25. 25© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Contact Us
41 Madison Avenue, 25th Floor,
New York, NY 10010
(646) 661-7853
ronnie.hastings@GoTelecare.com
Ronnie Hastings