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GoTelecare Revenue Cycle Management Services
- 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
Client Benefits
Significant decrease in operational expenses
We charge as low as $10 per hour per employee!
Our clients save on other associated costs for employees including Health Insurance Premiums, Payroll Costs,
Medicare Tax, Human Resources, Employee Attrition, additional Real Estate and Infrastructure Costs
We guarantee > 50% operational savings effective immediately; e.g. one of our clients reported a $2.1 million
operational savings in Y1 alone!
Heightened collection and increased Accounts Receivables
30% of DME Rx are incomplete when first received. We excel in completing the Rx claim quickly.
Cyclical Data Reporting
Data reporting interval customized to meet the needs of the customer
Productivity Efficiency Tracking allows for quantifying the team workload
Demonstrated experience handling DME claims
Medicare, Medicaid and Commercial Plans Fee for Service and Capitated Plans
- 6. 6© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Revenue Cycle Management Experience
HOSPITAL
Accounts
Receivables
Follow - Up
Denial
Management
Claims
Resubmission
DME
Order Entry
Eligibility
Verification/
Authorization
Follow up on Auth
Approval
Delivery
Scheduling
Submission of
claim
Rejection
Management
Payment Posting
A/R Follow-Up
Denial
Management
CPAP Compliance
Tracking
O&P
Rx Order Entry
Patient
Demographics
and Insurance
Entry
Product Code
entry/Rx & Dx
Entry
Eligibility
Verification/
Authorization
Collection of
complete Rx
Collection of
Documents for
Auth Approval
Submission
Rejection/Denial
Management
A/R Follow-Up
URGENT CARE
Order Entry –
Patient
Information,
Ordering
Physician, Rx &
Diagnosis
Eligibility
Verification
Medical
Document
Collection
Authorization
Approval
Order Audit
Confirmation
Submission of
Claims
Rejection
Management
Payment Posting
A/R Follow-Up
Patient Entry:
Demographics &
Insurance
Eligibility
Verification
Authorization
Follow-Up
Charge Entry
Submission of
Claims
(EDI/Paper)
Rejection
Management
Payment Posting
A/R Follow-Up
Denial
Management
PHYSICIAN
Patient Entry:
Demographics &
Insurance
Charge Entry
Submission of
Claims
(EDI/Paper)
Rejection
Management
Payment Posting
A/R Follow-Up
Denial
Management
HOME HEALTH
- 7. 7© 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
- 8. 8© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Productivity Efficiency Tracking
Employee
Name
Note Count Days Worked
Hours
Worked
Notes Per
Hour
Max Note
Time
Avg. Note
Time
John Smith 977 23 203.55 4.8 1:29:52 0:07:15
Jane Doe 1025 23 214.97 4.77 0:55:14 0:04:56
Rick Williams 913 21 207.07 4.06 1:27:08 0:07:14
Robert Frost 870 21 187.35 4.64 0:42:54 0:04:05
Dan Chesser 910 23 216.47 4.2 3:50:55 0:06:18
Derek Malia 823 23 210.37 3.91 7:01:30 0:04:37
Our clients depend on transparency.
We provide our clients with the ability to maintain detailed tracking for increased
productivity and efficiency.
Sample Report
- 9. 9© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
ELIGIBILITY VERIFICATION
& AUTHORIZATION
- 10. 10© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Eligibility Verification & Authorization Services
Eligibility check covers the following:
Policy active for date of service
DME coverage
Copay / Coinsurance / OOP
Rx & Dx entry (with appropriate timeframe)
Provider status (INN / OON)
CSI check
Authorization requirement
Obtaining authorization
Patient responsibility
- 11. 11© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Sample SOW (Statement of Work)
Each pre-authorization service consists of three transactions. Tasks involved in carrying out this
Pre Authorization service include the following steps:
a) Authorization Initiation transaction involves the following activities:
Calling up insurance to find the authorization filing procedure and turnaround time
Gathering pre-authorization form and relevant medical documents from the providers
Submission of the authorization request (fax/online) to the payer along with relevant
documentation
Tracking of Fax receipts
b) Authorization Follow up transaction will involve following up with the payer to check the
status of the authorization as per the TAT set for each payer.
c) Acknowledgement of Authorization approval transaction will involve updating approved
authorization in the clients billing system with the start and end date for the Authorization
approval. If required by the client, scanned image of the approval will be uploaded into the
clients system.
- 12. 12© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Sample Reports
0
20
40
60
80
100
120
140
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
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 Forward
Primary Checked Secondary Checked (if applicable)
0
5
10
15
20
25
30
35
40
45
50
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
45
25
38
44
46
20
15
26
22 21
25
10
12
22
25
AUTHORIZATION
Auth Required Auth Obtained Auth Pending
- 13. 13© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
ACCOUNTS RECEIVABLES
(AR) FOLLOW-UP
- 14. 14© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Reasons for AR Management
Authorization Issues
Referral Issues
Medical Necessity and Medical
Records requests
Non-Participation with Insurance
Network
Terminated Insurance
Coordination of Benefits
Wrong Diagnosis
Inclusive Procedures
Partial Payments
Out-of-network Claim Status and
Deductibles
EDI Rejections
No Status and No Claim on File
PIP cases
- 15. 15© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Steps in AR Follow-up
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
Reducing days in A/R, claims submission and improving collection ratio with an increase
the probability of payment through timely follow-up is the responsibility of the A/R team
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
- 16. 16© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Sample SOW of AR Follow-up
Go Telecare will make outbound calls to reach out to the Payers to gather information about the
status of claims as per the list provided by Customer. Key tasks involved in carrying out this work
are detailed below.
Planning to start calling Payers as per the list of claims based on the downloaded AR Reports
Research details of the claims in the AR list in the Clients system
Making outbound calls to the respective Payers for claims aged 31 days and more
Document finding of the calls
Preparation of claims reports with status information gathered during the call
Modifications, removal or adding tasks to this are agreed upon between client and Go Telecare
- 17. 17© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Sample SOW of AR Follow-up
No remark claims:
Any claims in which absolutely no status is known for the claim.
Last remark claims:
Any claims which remain unpaid for various reasons. These claims are routinely
followed up on a monthly basis.
2 types of claims follow-ups
- 18. 18© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Billing & Coding
MEDICAL BILLING &
CODING SERVICES
- 19. 19© 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
97% Collection Rate
99.9% Coding Accuracy
Claims Submission within 24 – 48 hours max.
100% HIPAA Compliance
Custom Reporting
Excellent References
Real Time Audits
- 20. 20© 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:
Urgent Care Prosthetics & Orthotics DME (Durable Medical Equipment)
Pathology Critical Care Radiology
Internal Medicine EKG Compounding Pharmacy
Cardiology ENT Orthopedic Surgery
Anesthesia Family Practice Inpatient Hospitalization
Rehab Center Pharmacy Physicians, and more…
- 21. 21© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Medical Coding – Overview
Downloading Allocation
CodingQuality Check
Uploading Feedbacks & Updates
Encrypted reports are
downloaded from SFTP site
Reports are allocated to
coders according to specialty
Quality checked for LCDs,
updates and client specs.
Analysis of reports, allocation
of ICD and Service codes
Analysis of reports, allocation
of ICD and CPT codes
Client reports back with
feedbacks and updates
Medical Coding Process Flow
- 22. 22© 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
- 23. 23© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Billing Cycle – Details
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 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 & 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
- 24. 24© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Coding & Billing System
We use Kareo for coding and billing services that covers the complete billing cycle:
SOAP notes review
Superbill generation and coding
Claims edit checking and correction
Claims submission through EDI clearing house at a scheduled time
Rejection management
ERA/EOB posting and reconciliation
Automatic secondary payer billing
Denial Management
Patient statement generation and mailing
- 25. 25© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Payment/Denial Posting Process
Payment posting is crucial to the billing process. Due to the sensitivity of this process,
accurate and efficient payment posting process is indispensable.
Our billers are known to be highly efficient and analytical in the payment posting process.
Payment Entry Process
Select Patient Account
Select EncounterSelect Encounter
If not found
Refer Client SpecifiesDenial
Denial Code
Hold Transfer BalanceTransfer BalanceWrite-off
Post Payment
Payment
- 26. 26© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Productivity Efficiency Tracking
Employee
Name
Note Count Days Worked
Hours
Worked
Notes Per
Hour
Max Note
Time
Avg. Note
Time
John Smith 977 23 203.55 4.8 1:29:52 0:07:15
Jane Doe 1025 23 214.97 4.77 0:55:14 0:04:56
Rick Williams 913 21 207.07 4.06 1:27:08 0:07:14
Robert Frost 870 21 187.35 4.64 0:42:54 0:04:05
Dan Chesser 910 23 216.47 4.2 3:50:55 0:06:18
Derek Malia 823 23 210.37 3.91 7:01:30 0:04:37
Our clients depend on transparency.
We provide our clients with the ability to maintain detailed tracking
for increased productivity and efficiency.
A Sample Report
- 27. 27© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Denial Management
Auth Related
14%
Coding Error
5%
OON Issue
8%
COB Issues
10%Patient info missing
6%
Exceeds Timely Filing
8%
Duplicate Claim
5%
Service Not Covered
6%
Primary Paid Max
7%
Pre-Existing Condition
5%
Others
26%
Distribution of Denied Claims
- 28. 28© 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
- 29. 29© 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
- 30. 30© 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
- 31. 31© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Technology, Operational & Compliance Framework
TECHNOLOGY, OPERATIONAL
& COMPLIANCE FRAMEWORK
- 32. 32© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Software Development
Some of the applications which we have developed include,
GoTelecare - A full fledged Telehealth application for providers, hospitals and patients with integrated EMR,
practice management system and video conferencing system
Integration of DICOM server, DCM4CHE with EMR software
mHealth – Remote patient monitoring and health data collection through medical devices and QUALCOMM
cloud services
PDP Manager – To manage Medicare Part D processes
Medication Therapy Management (MTMpro) application
Our technology development team works with Java (Enterprise Edition) and technology components include,
Web application technologies like servlets, JSP, JSTL, JSF, JSON, web sockets, applets
Open source frameworks like Struts, Spring, Hibernate
Enterprise technologies like dependency injection, messaging services, transaction management services,
persistence management services, annotations, javamail, java enterprise beans, interceptors, connector
architecture
Web service technologies like RESTful web services, enterprise web services, JAX -WS, JAX- RPC
Database servers like MS SQL server, Oracle, MySQL
- 33. 33© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
IT Infrastructure
Service continuity supported by BCP and disaster management mechanisms
100% redundancy in all IT assets, providing high-availability and reliability
12 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic
failover configuration
Data protection and security provided by Fortigate® 310B firewall combined with other physical
and logical access controls
Voice telephony infrastructure built using E1 lines provided by two IPLC
providers
Avaya PBX with IVR, ACD and CTI functionalities and 100% call recording
& reporting features
Data center with 13 IBM x3650 rack servers with rack mounted UPS
Polycom VSX 7000A video conference system for remote training
and client communication
24/7/365 IT-Infrastructure support personnel for user support, using ticket management system
120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power
generator
- 34. 34© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Operational Framework
TRANSITION
Project scoping
& planning
Knowledge
transfer –
Process training
and assessment
Process
documentation
Solution
customization
Infrastructure
set up
Pilot/Transition
period
TRAINING
Training Need
Identification
Customized
training program
as per client’s
requirement
Pre-process &
process training
Voice & accent
and cultural
training
Refresher
training
PRODUCTION
Project
management
approach
Exception
handling and
reporting
Effective
coaching &
monitoring
practices
Periodic review
and evaluation
Service level
management
and reporting
QUALITY
Regular audit for
process and
deliverables
Identify and
analyze errors
to take
corrective
measures
Flowcharting
and root cause
analysis for
process
improvement
measures
Management
reporting of
quality
assurance
activities
Capacity
planning
Forecasting,
staffing &
scheduling
Real time
reporting
Billing and
revenue
management
MIS / WFM
Ensure 100%
adherence to
federal / data
protection laws
Governance &
compliance
audits
Organization
preparedness
for client & third
party audits
HIPAA
compliance
CONTROL &
COMPLIANCE
PROJECT MANAGEMENT & OVERSIGHT
IT INFRASTRUCTURE– TOOLS & TECHNOLOGY
- 35. 35© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Governance Model
GoTelecare
Governance
Structure
Steering Committee
Program Management Office
Project Delivery Team
Executive sponsorship
Management oversight
Ensure business goals and
engagement goals alignment
Ensure tangible results and
demonstrable value
Continuously educate & report
executive leadership on the
critical success factors of
engagement
Plan and implement change;
define, establish performance,
metrics aligned to goal
Review project scope, timeline
and budget and monitor project
progress
Communication, status reporting
& escalation to steering committee
Manage cross team
dependencies
Identify, initiate & institutionalize
process improvements
Oversee knowledge repository
building
Project Management
Scope Management
Knowledge
Management
Change Management
Ensure successful
engagement startup
Quality Management
Resource Management
Communication &
Status Reporting
Issue Management
Monitor & measure
knowledge transfer
process
Incorporate industry
best practices
- 36. 36© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Quality Assurance & Control
Our Quality Control & Assurance processes help us meet our client’s expectations and SLA target. We
use Quality Assurance program to set production and quality goals. Our daily quality audit activities
ensure that we evaluate our agents’ work on all relevant criteria.
The highest quality is ensured by carrying out rigorous quality assurance and control activities such as,
Periodic process review
Process audit
Testing deliverables and root cause analysis
Process improvement / re-engineering
Incorporating customer feedback
Internal quality audit of client deliverables & review reporting
Weekly/monthly monitoring of productivity reports
- 37. 37© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Training Methodology
• Process training and
refreshers
• Availability of training
documents in
‘Knowledge Net’ portal
• V&A, Soft skills training
• Post-training assessment
• Training feedback
• Review of training
program
• Preparation of training
Modules
• Preparation of training
Plan in ‘Knowledge Net’
training module
• Regular process test and
appraisals
• Work in-sync with
Operations & QA
Training Need
Identification
Training
Program
Planning
Conduct
Training
Training
Evaluation
- 38. 38© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Compliance – Key Facts
Well defined policies to cover compliance aspects
Written procedures covering compliance aspects
Proactive compliance reporting and issue escalation
Action list for changes in rules and regulations by regulatory authorities
Compliance evaluation framework
Periodical training on compliance issues and update
Periodic audit and review mechanism to address potential compliance risks
Implementation of data privacy and security standards like HIPAA-HITECH and ISO 27001
Incident reporting for data security violation
Compliance awareness among the employees and reward on compliance reporting
Compliance violation by employees leads to employee retraining and reassessment
GoTelecare has defined and established a process and system to avoid compliance risks while carrying
out operations and encourage employees to proactively report compliance issues to the higher
management.
- 39. 39© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Compliance Escalation Structure
Service Delivery
Service Delivery Mgr
(Service Delivery POC)
Head of Operations
(1st Level Escalation
POC)
Operations
CEO & MD
(Final Escalation POC)
Executive Board
Board of Directors
Compliance
Compliance Mgr
(Compliance Escalation
POC)
Head of Compliance
Compliance
Team Lead
Process Team Lead
(Service Delivery POC)
Technology
Technology Mgr
Quality
Quality Mgr
HR/Training
HR/Training Mgr
Compliance
Issue
Trigger Point
Process Team Leader will inform
Service Delivery Manager and
Compliance Manager immediately
after occurrence of the event
Compliance Manager/ Service Delivery
Manager will assign the severity of the
compliance issue
Compliance Escalation Path
Severe Compliance Escalation Path
- 40. 40© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Data Security and End-User Privacy
Information security management system is aligned with ISO 27001:2013 standard
Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations
Data replication between Sun Knowledge’s servers in NY and India via site-to-site IPsec VPN tunnels helps strong
business continuity management
Daily off-site backup process to mitigate data loss risk in case of disaster
Implementation of physical access control system in office premises restricts access to sensitive areas housing
application and database
Physical and logical segregation of internal network into VLAN segments to control and protect data storage and
transmission between business/process units
Implementation of perimeter security devices, like firewall and segregation of sensitive information systems
Access to all information systems through two levels of authorization
Implementation of two levels of end point malware protection network and system level anti-malware systems
Use of secure e-mail system for e-mails with sensitive PHI information
Implementation of access restrictions to prevent unauthorized deletion or movement of data using external
storage devices like optical discs, pen drives, etc.
Security incident monitoring, reporting and resolution system
Periodic employee awareness training on data privacy & protection and HIPAA regulations
- 41. 41© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Why GoTelecare?
WHY US?
- 42. 42© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Advantage GoTelecare
1
Over 7 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 .85 cents /claim for
eligibility verification &
authorization.
Clients enjoy
Extra Savings with
FREE Billing Software
FREE EMR
FREE Implementation
No Hidden Cost !
- 43. 43© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
GoTelecare vs. Other Staffing Agencies
- 44. 44© 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 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection
- 45. 45© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
The Real Question
But really, why us?
Because we do Six Sigma quality work, validated
by excellent client references, at the lowest
prices in the market!
We are so confident of the quality of our
services that we challenge you to find
another company which can deliver
better quality services at a cheaper rate!
- 46. 46© 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 all clients
- 47. 47© 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
- 48. 48© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Contact
41 Madison Avenue, 25th Floor,
New York, NY 10010
(866) 636-6264
rh@GoTelecare.com
Ronnie Hastings