GoTelecare Corporate Overview and Service Offerings
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Transcript of GoTelecare Corporate Overview and Service Offerings
1
Corporate Overview & Service Offerings
GoTelecare 41 Madison Avenue, 25th Floor, New York, NY 10010
CONTACT: RONNIE HASTINGS (646) 661-7853 EXT. 304
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 27001:2013 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
CALL: (646) 661-7853 EXT. 304
3© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Service Offerings
CALL: (646) 661-7853 EXT. 304
Provider Support
Member Support
Member Retention Program
Clinical Help Desk
Contact Center
Utilization ManagementMedication Therapy ManagementHospital Re-admission ManagementTherapeutic InterchangeFormulary Management
Clinical Services
Enrollment Processing & MemberFulfillment
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 provide services to
Prosthetics & Orthotics and DME companies in Revenue Cycle Management
Physicians and Hospitals in Revenue Cycle Management
Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
4© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Advantages & Benefits
CALL: (646) 661-7853 EXT. 304
Significant decrease in operational expenses• With over 5 years of successful O&P revenue cycle management experience, GoTelecare provides
professional consulting to best allocate resources to increase profit margins
• Significant operational savings that are effective immediately
Increased Accounts Receivable collection• 30% of O&P Rx are incomplete when first received. We excel in completing the Rx claim quickly
Cyclical Data Reporting• Data reporting interval can be customized to meet the needs of the customer
Demonstrated experience in handling O&P claims• Medicare, Medicaid and Commercial Plans Fee for Service and Capitated Plans
GoTelecare is currently servicing one of the largest O&P companies for their Revenue Cycle Management in the state of Illinois and they have
achieved significant savings and increased A/R collection in year one.
5© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Orthotics & Prosthetics Basics
CALL: (646) 661-7853 EXT. 304
Prosthetists provide artificial limbs (prostheses) to people who have all or part of a natural limb missing.
Orthotists provide supportive braces and splints (orthoses) to people with various conditions of the limbs or spine.
Prosthetists and orthotists work with people of all ages and with different requirements.
Prosthetics Artificial limb Artificial hand Exo-skeletal Prosthetic knees
Splints & braces Shoes & laces Collars TLSO
(Thoracolumbosacral orthosis)
Orthotics
E X A M P L E S
6© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Coverage & Billing
CALL: (646) 661-7853 EXT. 304
Prosthetics & Orthotics coverage may be subject to a copay or coinsurance. Authorization is required for various devices and this varies from payer to payer. This is considered a part of the member’s benefits provisions.
For Prosthetic & Orthotics devices to be covered, the general billing requirements are: A prescription from the ordering physician dated prior to delivery date Consideration of limitations based on time period within which the item can be covered if supplied earlier, e.g. a
pair of orthotic shoes are covered per calendar year by Medicare Appropriate modifiers must be billed, e.g. KX, LT / RT, NU etc. Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR Form for
prosthetic devices, Diabetic Verification Form for diabetic patients etc. Coverage for such equipment is subject to medical review by the payer
Coverage of devices also subject to qualifying diagnosis, e.g. orthotic shoes are not covered unless diagnosis states diabetic
Repair, replacement and supplies may be eligible for separate reimbursement
7© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Billing Cycle Overview
CALL: (646) 661-7853 EXT. 304
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
8© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Orthotics & Prosthetics Billing Cycle Details
CALL: (646) 661-7853 EXT. 304
Order entry based on the Rx received from the physician Patient demographics & insurance entry Provider information entry Product code, Rx & Dx entry If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry process
Eligibility verification and authorization requirement enquiry Patient’s appointment with Practitioner for Practitioner to assign codes Collection of detailed Rx from the ordering Physician’s office Collection of documents required by Payer for authorization approval, e.g. Diabetic Verification Form, initial
evaluation, medical notes to support K level, PPR Form Calculation of service estimates (Patient and Payer responsibility) Determination that Payer criteria are met before delivery of device (if criteria are not met, the Patient needs to
be contacted and informed of the additional financial liabilities) Generation of delivery ticket (based on which delivery is made to the Patient) Creation of claim after receipt of confirmation of delivery Submission of EDI/paper claim to Payers Cash posting Rejection & Denial Management A/R follow-up
9© 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
CALL: (646) 661-7853 EXT. 304
10© 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
CALL: (646) 661-7853 EXT. 304
11© 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 efficiencyProcess 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
CALL: (646) 661-7853 EXT. 304
12© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Sample Reports
CALL: (646) 661-7853 EXT. 304
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/20150
20
40
60
80
100
120
140
96
83
94
98 96
29
11
6
31 32
125
94
100
129
128
41
32
26
30 28
ELIGIBILITY VERIFICATION
Number of New Patient Patient Brought ForwardPrimary Checked Secondary Checked (if applicable)
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/20150
5
10
15
20
25
30
35
40
45
5045
25
38
4446
20
15
26
22 21
25
1012
2225
AUTHORIZATION
Auth Required Auth Obtained Auth Pending
13© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Denial Management
CALL: (646) 661-7853 EXT. 304
Auth Related14%
Coding Error5%
OON Issue8%
COB Issues10%Patient info missing
6%
Exceeds Timely Filing8%
Duplicate Claim5%
Service Not Covered6%
Primary Paid Max7%
Pre-Existing Con-dition
5%
Others26%
Distribution of Denied Claims
14© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Telemedicine Capabilities
CALL: (646) 661-7853 EXT. 304
Customizable telemedicine platform connects patients, healthcare providers and ancillary staff members to complete face-to-face consultationso Reduces healthcare costso Decreases patient wait times for patient appointmentso Increases patient satisfactiono Simple, easy to use user interface
Diabetic Verification Formo Expedites the process to receive the returned, signed Diabetic Verification Form from the
primary care physician Prescription Refills
o For rental devices; decreases the time associated with obtaining a prescription refill
15© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
REASONS TO CHOOSE US
CALL: (646) 661-7853 EXT. 304
16© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Our Billing Service Highlights
Above 95% Collection Rate Claims Submission TAT 24 – 48 hours max. Error-free Patient Entry 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
CALL: (646) 661-7853 EXT. 304
17© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Advantage GOTELECARE
1Over 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
2Consistent
Performance in Delivering 97% Collection Rate
to Clients
Already
Recovered over millions in
Account Receivables
and counting…
3The Only
Medical Billing Company with Its Own State-
of-the-Art Telemedicine
Platform
4The Best
References in Every
Segment of US
Healthcare Knowledge &
Business Process
Outsourcing
5The Lowest
Prices* in the Market!
* Only $10 / hour for a billing expert
working exclusively on the
client accountOR
just 4% of total collections realized
CALL: (646) 661-7853 EXT. 304
18© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
A Simple Answer
But really, why us?
Because we do Six Sigma quality work, validated by excellent client references, at the lowest prices in the market!
CALL: (646) 661-7853 EXT. 304
19© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Our 4 Pillars of Strength
Highest Quality
Excellent References
Unique Profile
Cheapest Rates
Consistently delivering the best quality, with the highest levels of accuracy, efficiency & expertise
Glowing testimonials from every client and not a single customer churn in our 8 years of operation
Huge experience in working for both Payers and Providers and
the only billing company with its own Telemedicine platform
The lowest rates in the market, with custom pricing options to
delight clients of all sizes
CALL: (646) 661-7853 EXT. 304
20© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Summary of Benefits
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 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection
CALL: (646) 661-7853 EXT. 304
21© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Testimonials
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 major US healthcare company
My firm has evaluated an outsourcing transaction with GoTelecare. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry
Chairman & CEO of a leading US healthcare company
CALL: (646) 661-7853 EXT. 304
22© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
The Next Step
41 Madison Avenue, Suite 2511, 25th Floor, New York, NY 10010, USA
(646) 661-7853 EXT. [email protected]
Ronnie Hastings
CALL: (646) 661-7853 EXT. 304