This document provides an overview of medical billing services. It discusses how medical billing can help doctors by handling insurance paperwork and administrative tasks, allowing them to spend more time with patients. The company claims to have 40 years of healthcare experience and can handle all aspects of the revenue cycle management process from credentialing to billing to collections. They work with multiple EHR systems and specialties. Key benefits include increasing net collections, reducing days in accounts receivable, and improving the billing process overall. Risks and mitigation strategies are also outlined, as well as the transition process and importance of quality assurance.

1. CORPORATE OVERIEW
&
SERVICES

2. Doctors spend more time filling insurance paperwork
and
doing administrative work than caring for patients
5 Billion Medical Claims are filed annually and growing out of
control
The real cost of filing your claims yourself is much more than you
think
MEDICAL BILLING – FACTS

3. Relax…….
we can handle
it!
More
Cash Flow
More
TIME
BETTER
PRACTICE
MANAGEMENT
Working at your practice!
We offer relief from all Medicare
and insurance carriers’ red tape
policies and overwhelming
procedures

4. Improve
Cash
Flow
Save
you
Money
Save
you Time
Better
Practice
Manageme
nt

5. Our HEALTHCARE OVERVIEW
Key Facts
40 years of cumulative experience in Healthcare
Management
On-Shore and off-shore capabilities
State-of-the art delivery center with maximum security
Multi-specialty billing and coding experience
Experience with multiple EHR/PMS
Certified coders
Highly experienced workforce
Statistics driven quality management
Best-in-class HR practices
HIPAA-HITECH Compliant

6. SERVICE
PORTFOLIO

7. Provider
Credentialing
Eligibility
&
Benefits
Authorization
Verification
Demo & Charge
Entry
Payment
Posting
Medical
Coding
Claims
Transmission
AR
Follow Up
Patient
Follow Up
Rejections
&
Denials
Clearinghouse
Set Up
Patient
Statement

8. Our HEALTHCARE SERVICE PORTFOLIO
We provide a comprehensive Revenue Cycle Management Services for the Clinics, Physician
groups and Hospitals. We manage your billing, collections with streamlined process, expert
resources and meaningful technology solutions so that you focus on the biggest part of your
practice…..Patient Care !!
Front-End Cycle
Mid-Cycle
Back-End Cycle
Demo & Charge Entry Credentialing Benefit Verification Pre-Auth Verification
Medical Coding Charge Entry Claims Transmission Scrubbing
Payment Posting AR Follow Up Denial Management Patient Follow Up
We provide medical transcription service as well

9. MULTI SPECIALTY EXPERTISE
Anesthesia Cardiology Chiropractic Dermatology
ER Medicine
Radiology
Family Medicine Gastroenterology Internal Medicine
Orthopedics Pediatrics Pathology

10. EXPERTISE IN MULTIPLE EHR/PMS

11. Delivery Process

12. Our HEALTHCARE - DELIVERY PROCESS
Service Delivery Process
Medical Coding
Charge Capture
• Client uploads transcribed charts on to a secure server or in the EHR system
• Files to be distributed/shared through EHR by Client to Our Healthcare for
coding
• Our CPC certified coders analyze each transcribed charts and code as per the
guidelines set by CMS and AMA
• Audited Super-bills are sent to the Charge Entry team to create claims in PMS
system
• Scanned patient’s demographics to be sent by Client to Our Healthcare Entry
team
• Each patient’s scanned record is analyzed and determined if it is a New
patient or an Established patient
• If it is a new patient, we create an account in Client’s PMS system. And
update the patient’s A/c if it is an Established patient

13. Our HEALTHCARE - DELIVERY PROCESS
Service Delivery Process
Cash Posting
AR Follow Up
• Scanned EOB’s to be downloaded from Client's office and distributed
among the
Payment posting team
• Analyzing each EOB and posting payments, adjustments or flag denials
in
Client’s PMS system as per the scanned EOB files
• Daily report of Cash deposited and Cash posted to be verified and
reported
• The AR team receives the work order from the Cash posting department
on all
the Unpaid/Part paid claims
• After analyzing the report, the Analyst identifies the claims that needs to
be
further researched and allocates the work order to our AR team
• Work orders are then distributed by the Analyst based on the Ageing /
Insurance Class / Filing / Appeal limits of outstanding claims
• AR team would also be responsible to work on rejections within a TAT of
48
hours

14. Our HEALTHCARE - DELIVERY PROCESS
Service Delivery Process
Self-pay Follow
up
• Self-pay team to follow up with patient after the statement is mailed out
• Capture any Insurance / demographic information on call and update in
PMS
• If patient wants to make payment, payment mode details could be
captured and shared with Client

15. BENEFITS PROPOSITION
Increase the Net collections to 95%
Reduce the Total Days in A/R to less than 90 days
Increase the collections cycle within 60 days
Reducing the Rejection to Less than 5%
Claim submission within 48 hours of receipt of billing input
Improve the overall RCM operations
Adherence to CMS billing requirements

16. Our HEALTHCARE - RISK MANAGEMENT
Risk
Delay in Project
Execution
Mitigating
Risk
• Proper documentation – process manual, guidelines & checklists
• Client to assign a Project Manager as a SPOC for project
guidance,
clarification, co-ordination (for meeting, training, etc.), setting
priorities & conflict resolution
Non-
availability of
work order
files, EOB’s,
patient’s
Demographics,
Medical
Records etc.
• Project Manager to identify the resource that is causing the
delay
and share the availability calendar for project planning &
execution
• Client to ensure the availability of the resource as per schedule
to
avoid missed deliveries. This will also help to have an effective
collaboration

17. Our HEALTHCARE - RISK MANAGEMENT
Risk
Delay in Client
feedback
Mitigating
Risk
• Client to make periodical quality feedback meetings in the initial
stages
of project execution to provide their key inputs for the Our
Healthcare’s team to improve on their delivery
Delay due to
lack of clarity or
changes in the
requirements
• Clear expectations about the scope of the project to be set for
Our
Healthcare
• Revisit the project timelines & cost based on the changes
requested and agreed upon
Missing
information /
Key-in errors,
Increased
denials
• Transaction audit to minimize errors; reduces denial due to
missing
patient information

18. Our HEALTHCARE - RISK MANAGEMENT
Risk
Secondary
Insurance
eligibility
verification not
carried out
Mitigating
Risk
• Rigorous audit
• Completion of secondary verification
Delayed correction
and resubmission
of rejections
• Clear defining of KPI for rejection management process and
assigning
responsibility
Payment posting
unapplied balance,
Backlog, Posting
errors
• Defining guidelines, KPI and TAT
• Rigorous audit

19. • Client to make periodical quality feedback meetings in the initial stages of
project execution to provide their key inputs for the Our Healthcare’s
team to improve on their delivery
Delay in Client feedback
• Clear expectations about the scope of the project to be set for Our
Healthcare
• Revisit the project timelines & cost based on the changes requested
and agreed upon
Delay due to lack of clarity or
changes in the requirements
• Transaction audit to minimize errors; reduces denial due to missing
patient information
Missing information / Key-in
errors, Increased denials
Risk
Mitigating
Risk
Our HEALTHCARE - RISK MANAGEMENT

20. Our HEALTHCARE - RCM TRANSITION STAGES
Day 1
Need to create logins
for EMR/PM
Need to create login
for clearinghouse
Face sheet to be updated by
the Physician to setup an
account
Day 3
Team Introduction
Introduction of team over
the call and going over
agreed SLA/SOW
Information Sharing
Protocols to be shared for all
Scope of Work, Insurance
Contract, Insurance logins and
Current Issues
Day 5
GO LIVE
The assigned team will start
working on the day to day
claims and payments
Q & A Session
Question and answer
session with client to clarify
any issue

21. • Strong project leadership for both
• Foster win-win partnership
• Client’s involvement in approving key deliverables like 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 if required
• Accurate identification of desk procedures and processes is critical
• Effective governance structure
• Seamless communication
RCM TRANSITION SUCCESS FACTORS

22. GOVERNANCE
Core Delivery Team
Steering
Committee
Director - Finance Account Manager
Front End Support
Staffs
Back Office Support
Staffs
Project Manager
Coders Callers
QA Specialist
Delivery Manager
Client Our Healthcare
The Project Governance framework will be setup between Our Healthcare and Client to cover all aspects
of the overall engagement that includes time, cost, quality, risk, scope, communication and compliance.
Our Healthcare will take ownership of resource deployment required for the project.
Cash Posters

23. QUALITY ASSURANCE AND CONTROL
Productivity without quality does not yield anything. Quality is an important aspect to sustain
growth and retain existing clients. Quality Control & Assurance processes helps us meet our
client’s expectations and Service Level Agreement (SLA) as well as deliver on time. Quality is
a race without a finish line. Our Healthcare has adopted an uncompromising approach
towards quality to meet and exceed client’s requirements. Our daily quality audit activities,
corrective and preventive actions ensure that we evaluate our agents’ work on all relevant
criteria and bring the quality level to meet client’s expectations.
• Daily audit to minimize error rates an denial risks
• Root cause analysis on errors
• Taking Corrective and Preventive actions
• Process improvement
• Feedback and Reporting
• Facilitating training
• Monitoring of weekly/monthly productivity reports

24. COMPLIANCE
As a Medical Billing and Coding company we work with lot of Protected Health Information.
Our Healthcare understands and takes compliance very seriously. We have well defined
process in place to avoid compliance risks while carrying out regular operations. All the staffs
are educated on compliance regulations and encouraged to proactively report any compliance
issues to the management team.
• Implementation of policies to cover compliance aspects
• Written policies for risk areas
• Proactive compliance reporting
• Integrity of Data Systems
• Action list for changes in rules and regulations by regulatory authorities
• Compliance evaluation framework
• Continuing Education on Compliance Issues
• Periodic audit and review mechanism to address potential compliance risks
• Incident reporting for data security violation
• Compliance awareness among the employees and reward on compliance
reporting

25. Delivery Structure
Our Core delivery team structure has been planned and structured to enforce
better governance and control during each phase of the project.

26. Thank you!