GoTelecare Revenue Cycle Management Services

360O
REVENUE CYCLE
MANAGEMENT SERVICES
GoTelecare 41 Madison Avenue, 25th Floor, New York, NY 10010
CONTACT: RONNIE HASTINGS
(646) 661-7853
CONCISE
VERSION

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

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

Revenue Cycle Management by GoTelecare
360°
Revenue Cycle
Management
Services
Eligibility
Verification &
Authorization
Billing
Coding
Scheduling
Payment
Posting
Account
Receivables

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

Eligibility Verification & Authorization
CLAIM 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

Because when claims need
to be chased, we know
whom to ask,
when to ask
and
how to ask!
Why us?

Accounts Receivables (A/R) Management
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.

 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

Medical Billing & Coding
MEDICAL BILLING &
CODING SERVICES

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

Highlights
 Above 95% Collection Rate
 Claims Submission TAT 24 – 48 hours max.
 Error-free Patient Entry
 ICD-10 Ready
 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

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…

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

 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

 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
 Accumulation of backlog
 Denials not posted
 Claims reconciliation issue

Why GoTelecare?
WHY US?

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 per hour
for a dedicated FTE
or just 4% of
collections for A/R
services
Only .80 cents per
claim for eligibility
verification &
authorization

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

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

Contact Us
41 Madison Avenue, 25th Floor,
New York, NY 10010
(866) 636-6264
rh@GoTelecare.com
Ronnie Hastings

GoTelecare Revenue Cycle Management Services

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