E4e Healthcare Services © e4e – Confidential and Proprietary Comprehensive Solutions for the...

e4e Healthcare Services

© e4e – Confidential and Proprietary

Comprehensive Solutions for the Healthcare Ecosystem

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2© e4e – Confidential and Proprietary

e4e Healthcare Business


IT Enabled Services & BPO

Offices in

3 Countries

2500

+ Employees

Globally

Work with over 6000 Physicians & 191

Hospitals

• Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines.

• With over 19 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP.

• A cross-border Healthcare Company with proprietary Software Platformsfor Revenue Cycle Management, Claims Processing, Audit and Process Automation.

• Technology agnostic solutions – experience in working with over30 Provider and multiple Payer Platforms.

• Expertise in System and Platform Integration – System Interface,Electronic Data Inter-change and Workflow Efficiency.

•We process over 135 million transactions annually and code/ auditover 30 million charts.

• HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified & SSAE 16 Type II Compliant Company.


SERVICE

LANDSCAPE

Revenue Cycle Management

Payer Services

Value Added Services

Technology Solutions

End to End Solutions for the Healthcare Payment Continuum

e4e Healthcare Service Landscape

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Revenue Cycle Management

•Patient Access Management

•Charge Capture including clinical documentation improvement

•Claims, Remittance & Denial Management

•Hospital, Physician & Remote Coding

•HEDIS & DRG Coding

•Revenue Recovery & A/R Services

•Charge Integrity & Compliance Solutions

•Successful EMR driven billing service

Payor Services

•Front End Claims Processing and Management

•Claims Adjudication and Error Suspense Resolution

•HCC Coding Services

•Enrollment Membership and Billing Services

•Customer Service•Mailroom Service•Grievance, Appeal & Refund Posting

•Reports Management


•Customer Support centers

•Business Rules Configuration

•Fraud , Waste & Audit Solutions

•RAC Response Management Solution for Providers

•Process Improvement Consulting for Physicians

•Ancillary Services for Payers

•Business consulting

Technology Solutions

•Claims Administration Platform

•Scheduler•Workflow Solutions including OCR

•ICD 10 Transition Support

•Document Management System

•Client Service Portal•Member Portal•Managed Services -Network & Desktop management

e4e Healthcare Services


Geographic Presence

Towson MD, USA

Chennai India

NoidaIndia

Bangalore India

Baldwinsville NY, USA

Manila, Philippines

Patient Access

ManagementBilling Medical

CodingDenial

ManagementA/R Follow

up

Hospital Service Offerings


• Scheduling & Registration

• Eligibility & Benefit Verification

• Data Entry• Cash Posting• Credit Balance Report

• Outpatient Visits• Clinic Visits• Emergency

Department• Same Day Surgery• Inpatient

• Weekly review to check on denials

• Account Receivables Service

• Insurance Follow Up

Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service

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Provider Service Offerings

© e4e – Confidential and Proprietary 7

• Scheduling & Registration• Patient Data Entry• Eligibility & Benef it

Verif ication• Point of Service

Collection

• Seamless integration with Provider Accounting Systems

• Electronic Claim Generation and Transmission

• Payment Posting • Denial Management • Reconciliation • Refunds • Provider Data Updates • Patient Billing

• Charge Capture• Charge Audits for accurate

& compliant billing• Identify missed charges on

retrospective claims• Improvements in Clinical

documentation through education session

• Remote Coding• Coding Staf f Augmentation

• Account Receivables Service• Calculate projected A/R

collections for outstanding accounts

• Monitor, identify and prevent future payment abuses f rom payers

• Underpayment Recovery Services

• Coding Audit• Charge Master Management• Billing and Coding Research to

plug areas of ‘Revenue Leak’

Charge Capture

Patient Access Management

Claims Remittance

& DenialManagement

ChargeIntegrity & Compliance Solutions Remote

Coding

Revenue Recovery & A/R Services

Payor Service Offerings


Mail Room Services &

Claims Management

Reports Management

& Compliance

Solutions

Member Enrollment

Customer Service

Grievance Handling &

Refund Posting

• Member Enrollment/ Disenrollment

• Member Maintenance

• Member Inbound Calls• Provider Service• Online Claim Status

Query

• Member/ Provider• Provider/Hospital Directories-

Report generation• UM , Statutory, Canned Reports• High Dollar Value Audits• Recovery Audit Contract (RAC)

Audits• Durable Medical Equipment (DME)

Audits

• Receipt and Records of Appeals• Analysis of Appeals• Amount Payable for favorable

cases• Process for payment / generate

check• Generate provider letter if

original denial is upheld• Refund Posting

• Scanning and Batching• Optical Character Recognition

Conversion• Data Capture• Claim Information Capture• Claim Data Audit• Member Validation• Benef it Validation• Fee Schedule Validation• EOB Generation• Front End Rules Application

and Data Verif ication

Configuration Support

• Benef it Loading• Provider Loading• Fee Schedule Loading


Technology Services

• Through Partner’s

• PriceFast - Medicare Quick Pricer

• OCRAS – Optical Character Recognition and Audit System

• Workf low Solutions

Practice Management

System

RCM Tools

Claims Management

Systems

Payer Processing

Tools

Electronic Medical

Records • CodED – Auto Coding Solutions

• ACES – Automated Coverage Check

• HITS – Hospital Interconnectivity Tools

• I DOS – Document Management Solutions

• Workf low Solutions

• Velocity PBS• Velocity CPS• HoCAS – DRG Coding

Audit System

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•Conducting focus assessments of HIM workflow challenges, staffing, and performance improvement needs.

• Improving revenue cycle, outcomes reporting, release of information, issues with working DRGs & ICD-9 codes.

HIM Operational Review Services

•Providing comprehensive suite of products and services to enable a smooth transition to ICD 10.

• ICD-10 Readiness Assessment, ICD-10 Impact Assessment Service supported by applications

ICD-10 Transition

• Improving the accuracy of clinical documentation and DRG coding through the coordinated efforts of caregivers, physicians and coding professionals, guided by experienced e4e consultants

DRG Assurance

•Sustaining the benefits of the DRG Assurance with leave-behind software that provides guidelines for concurrent chart review and identifying potential compliance risks, frequently missed concepts, and issues with working DRGs and ICD-9-CM codes

Clinical Documentation Improvement

•RAC risk assessments•Transition auditing, hospital-specific MS-DRG, hospital outpatient, and physician service accounts

•Support in deployment of RAC management programs

RAC Management

• Inpatient coding validation services provide comprehensive reviews to assess DRG code assignments, improve documentation, and quantify the impact of coding changes.

DRG Validation Services

•e4e has a suite of proprietary technology platforms primarily designed as an enabler to a more efficient and effective operating model.

•Velocity – RacER - CodED

Technology Services

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Technology & Platform Agnostic Solutions


• Epic

• Cerner Systems

• IDX

• Paragon

• McKesson

• Meditech

• Medicare DDE

• TMHP (Medicaid of Texas)

• Next Gen Hospital System

• HMS Hospital System

• MS4 Hospital System

• 3 M• Allscripts and Misys• Meditech• Cerner Systems• Siemens Signature• Image Flow/ Image Star• e ClinicalWorks• GE systems• Amicas• McKesson• QMS• Kareo• NextGen

• EZCap• Power MHS• Diamond• Health trio

Hospitals Providers

Payers & TPAs

Multi - Platform Multi - Specialty

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• Neurology• Gastroenterology• Rheumatology• Radiology • Neurosurgery • Emergency• Cardiology• Birthcare Healthcare• Radiology• Obstetrics• Oncology• Physical Therapy• Ophthalmology• Pain management• Rehab therapies• Acute Internal Medicines• Orthopedics

• Acute Care• Women’s Health• Dialysis Centers• Cardio Surgery• General Surgery• Emergency Department• Ambulatory Services• Pathology• Orthopedics• Anesthesiology• Nephrology• Hospitals• Radiology

• HMO Plans (include Medicare, Medicaid and self funded plans)

Hospitals Providers

Payers & TPAs

Delivery Strategy

Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings

Right-shoring

Onshore

OffshoreOnsite

US

USIndia

Philippines


The Numbers Speak


Process 2012 2013 2014

YTD - January

Coding 30,361,972 27,530,717 2,455,722

Accounts Receivables

3,301,539 3,091,395 266,200

Cash 10,854,505 13,934,574 1,277,912

Charge 7,358,441 7,397,076 838,549

Patient Demographics

4,762,631 3,664,214 414,779

Our Performance & Operational Scale

Metrics Target

Financial Claim Accuracy (for RCM) 99.1%

Administrative Claim Accuracy (for RCM)

99.7%

Coding Accuracy 97% plus

TAT for Claims

Norm is 24 hours, with exceptions delivered even

with in 8 hours


Delivering 100% on our Client SLAs & KPIs over several years

Process MeasuresOutcome Measures

Metrics Actual Targets

Collection as a % of Gross Charges 55%

Targeted Revenue Increase Y-O-Y 9%

AR days for Commercial & Blue Cross

42 days

180 days + AR as a component of total AR < 8.5%

Denials on patients with coverage and benefits information

< 0.25%

Denials & Transmission Rejects 3%

Specific Target for a customer for a location $ 1.275 m

AR Days for Medicare < 20

135Mn Transaction processed per annum

30Mn Charts coded & audited

5.79Mn Claims processed per annum

$1.61Bn Paid on claims per annum

Our Operational Scale

Foundation for Success


• Data Analytics• Optimal Staffing• Weekly, Monthly and Quarterly calls• Exclusive focus on TAT and revenue

collection• Tight quality assurance measures• HIPAA Compliance

Resource Capabilities

Transitions Business Excellence

Delivery Excellence

GovernanceInfrastructure & Automation

• Hiring the right people• Employee longevity• Product and Process Level understanding• Contextual Training• Periodic Refresher Training opportunities

• Project Scoping and opportunity identification

• Analysis on key drivers affecting the Process

• Cost effective solutions to improve the system

• Structured approach to execution and delivery

• Robust Infrastructure for uninterrupted business

• State of the art delivery solutions• In house application development

team to customize your solution• Powerful Knowledge Management

tools

• Fact based decision making approach• Provides transparency & build

controls on operations• Ensures highest level of Data

Integrity, Security & Compliance

• US relationship Management• Managing by Business Goals

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Why e4e ?


GrowthStrategic Initiatives

Profitability

• Reduced costs by up to 40 % by outsourcing to e4e.

• Consistent superior service delivery against client SLAs and KPIs. • We are flexible and nimble

and have a transitions methodology to quickly ramp our operations.

• Scalability & operational flexibility

• SW platforms and skilled staff to delivers significantly better economies of scale for you.

• Continuous Process Innovation leveraging Technology.

• Process Re-engineering with customized automation tools.

• Complementary Service Offerings

Our values and commitments of Adaptability, Community, Excellence and Integrity is what will drive the success of this engagement

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Contact Us

e4e Healthcare Business Services 502 Washington Avenue, Suite 200, Towson, MD 21204Tel: +1 (443) 275 1632

e4e Healthcare Business Services Fortune Towers152, Thoraipakkam Pallavaram, Radial RoadKovilambakkamChennai - 600 117Tel: +91 44 2268 1240 Fax: +91 44 2268 1244Toll Free: +1 (877) 559 8176

e4e Healthcare Business Services H33 Sector 63NOIDAUttar Pradesh – 201301Tel : +91120 6746666 Fax :+91120 6746688

e4e Healthcare Business Services Unit No.1303-1304, 13th FloorPrestige Meridian - II#30, M.G. RoadBangalore 560 001Tel: +91 80 3256 8763

e4e Global Services Philippines Inc.15th Floor,Fort Legend Building,Bonifacio Global City,Taguig City 1634

e4e Healthcare Business Services 60 Oswego Street Baldwinsville, NY 13027 Fax: (315) 638-6309

Thomas Renny GeorgeVice President - SalesMobile: +1 (813) 760 [email protected]

Mihir BhutaVice President - SalesMobile : +1 646 431 [email protected]

Paul Arvantides Vice President & Head US Coding Services Mobile : +1 315 254 [email protected]

Kathleen Maher Associate Vice President Sales Mobile : +1 617 512 2318 [email protected]

Teresa Crawford Associate Vice President SalesMobile: [email protected]

mailto:[email protected]





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