Sun Knowledge provides Cost-Effective Solutions and Step by Step Account Receivable Management Services for Hospitals
Sun Knowledge is your next-gen partner for expert solutions in AR services. Our quality processes and dedicated resources have been delivering state-of-the-art solutions in claims adjudication to major health insurance payers & providers.
We provide our tailored solutions for AR services for hospitals and helping them gain more reimbursements with reduced TAT. Over the years, we have developed our specialization with an astute understanding of Payer processes helping you set the tone with better collections.
Our clients prefer us for:
~ Streamlined and improved workflow using effective tracking tools
~ Multiple follow-up calls for the same claim
~ Follow-up on all paper submissions
~ Payor-specific analysis
~ Detailed reporting with suggestions for actions to be taken
~ Improved cash flow
~ Reduction in turn-around time
~ 100% HIPAA compliant~
~ We charge only $8 per hour per dedicated FTE (Full Time Employee).
~ Our charges are only $5 per prior authorization. Lowest in the industry.
~ We also provide check posting services.
~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy
Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.
We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetic, Nursing home, physician office and many more billing industry.
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Practice management & Revenue Cycle Management Services for Home Healthcare
1. PRACTICE MANAGEMENT &
REVENUE CYCLE MANAGEMENT
FOR HOME HEALTHCARE
(WITH OASIS SERVICES)
Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
2. Private & Confidential 2Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SUNKNOWLEDGE OVERVIEW
Key Facts
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 office inbuilt with all redundancies –
power, infrastructure and others
Office at
41 Madison Avenue, 25th Floor,
New York, NY 10010
3. SUNKNOWLEDGE SERVICE PORTFOLIO
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
Medical Coding & Billing
Claims Administration
Enrollment Processing & Member
Fulfillment
Credentialing
Premium billing and collections
Administrative Services
Analytics
Telemedicine Services
Remote Patient Monitoring
Application Development & Support
Technical Support
Technical Documentation
IT Services
Claims /Drug Utilization
Analysis
PDE Analysis
RAF Analysis
Payment Reconciliation
We provide services to
Providers – Physicians, DME, P&O, Laboratories, Home Health Care, Physical Therapists and Pharmacies
Payers – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
Private & Confidential 3Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
4. SERVICE PORTFOLIO
PRACTICE
MANAGEMENT
Scheduling
Eligibility &
Authorization
Verification
Prior Authorization
Customer Care
BILLING &
COLLECTIONS
Coding
Charge Posting
Claims Submission
Payment Posting
Denial Management
Accounts Receivable
PAYER SERVICES
Claims
Adjudication
Credentialing
Utilization
Management
Customer Care
TELEMEDICINE
Telemedicine
Remote Patient
Monitoring
Tele-radiology
Private & Confidential 4Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
5. SERVICE AREAS
We provide our services in the following areas:
Nursing Homes Prosthetics & Orthotics Urgent Care
Durable Medical Equipment Home Healthcare Skilled Nursing Facilities
Wound Care Pain Management Pharmacies
Cardiology Specialty Clinics Surgery
Physical Therapy Family Practice Radiology
Rehab Centers Dermatology Diabetics
Anesthesia Healthcare Facilities and more…
Private & Confidential 5Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
6. SERVICE HIGHLIGHTS
Up to 97% in overall collection
Instant reduction of billing cost by 70%
FREE medical billing software, EMR & setup*
Real-time eligibility checks & quick authorization
100% HIPAA-HITECH compliance
Fast claim-status analysis using Rapid Automation Technology®
Proprietary tools that increase accuracy and reduce time
Turnaround time less than 48 hours max.
Low service fees with no hidden cost
Zero lockup service contract that can be cancelled anytime
Backed by excellent references from reputed clients across the US
Real-time audits and custom reporting
* Conditions apply
Private & Confidential 6Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
7. A UNIQUE EDGE
Since 2011, Sunknowledge has been adjudicating claims in Home Health Care
for major health insurance companies* in New York and California.
This has given us a unique edge over other medical billing companies, in better
understanding various Payer guidelines and how to submit clean claims that
meet with no denials and get paid quickly!
We are constantly tutored in the latest policy
updates and guidelines as set by the
Insurance companies from time to time
We are regularly exposed to Home Health
Care claims of many different kinds, leading
to full familiarity with such claims and how
to handle them efficiently
* Sunknowledge is proud to be associated with
Private & Confidential 7Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
8. OUR HIPAA COMPLIANCE SUMMARY
SL. COMPLIANCE ASPECT HIGHLIGHTS
1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review
2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years
3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording
4 Vendor Access
Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during
all times
5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility
6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility
7
Network &
Application Usage
Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass
storage devices, printers – controlled by Domain Group Policy | No wireless access points
8 Firewall
Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) |
Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic
9
VPN (Virtual
Private Network)
Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization
controlled by Active Directory's authentication service
10
Redundancy
Management
Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS
and 750 KVA generator | 22 KVA UPS backup for server and network systems
11
Virus & Malware
Protection
Central anti-malware system | Automatic updates | Extra protection by gateway firewall |
Centralized OS patch management system (using Microsoft's WSUS server)
12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills
Private & Confidential 8Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
9. REVENUE CYCLE
MANAGEMENT
Private & Confidential 9Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
10. REVENUE CYCLE MANAGEMENT – KEY PROCESSES
360°
Revenue Cycle
Management
Services
Eligibility &
Authorization
Verification
Patient
Information
Entry
Coding
Charge Entry
Claim
Submission
Payment
Posting
Accounts
Receivable
Denial
Management
Reporting
Private & Confidential 10Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
11. IMPORTANT TASKS
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, e.g. 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
Private & Confidential 11Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
12. A WORD ABOUT DME BILLING
Durable medical equipment (DME) is any equipment that provides therapeutic benefits to a
member because of certain medical conditions and/or illnesses that can withstand repeated
use, is primarily and customarily used to serve a medical purpose, and is appropriate for use in
the home.
Examples:
Ambulatory equipment: rollator, cane, crutch
Chairs: Geriatric chair, wedge cushions, Wheel chairs etc.
Breast pump
CPAP & BiPAP machines & supplies
Continuous Passive Motion machine
Perenteral & enteral feeding equipment & products
Hospital bed: Semi-electric, fully electric, side rails, gel overlay mattress etc.
Blood pressure, Glucose monitoring devices
Orthotics: Splint, brace , inserts etc.
Oxygen devices: Concentrator & supplies
Respiratory equipment: Nebulizer compressor, Suction machines etc.
Private & Confidential 12Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
13. GENERAL MEDICAL BILLING CYCLE
Rx Order Entry
Patient
Demographics
and Insurance
Entry
Product Code /
Rx & Dx Entry
Eligibility
Verification/
Authorization
Collection of
complete Rx
Collection of
documents for
Auth Approval
Submission
Rejection/Denial
Management
A/R Follow-up
Private & Confidential 13Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILLING
14. MEDICAL BILLING CYCLE
Order entry based on the Rx received from the Physician
• Patient demographics & insurance entry
• Provider information entry
• Product code entry
• Rx & Dx entry (with appropriate timeframe)
• If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry process
Eligibility verification and authorization requirement enquiry
Collection of documents required by payer for auth approval, e.g. face-to-face consultation notes, and obtaining
authorization from Payer
Determination that Payer criteria is met before delivery of equipment, e.g. some products have time/frequency/
annual cost limitations f (if criteria is not met, the Patient is contacted and informed of the financial
responsibility)
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
Private & Confidential 14Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILLING
15. MEDICAL BILLING SYSTEM
Sunknowledge handles medical coding - promptly, perfectly and professionally –
using Kareo® or any other billing system as preferred by the client.
Our billers and coders are proficient in using a wide range
of billing and practice management software suites that
cover the entire billing cycle.
BILLING
Private & Confidential 15
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
16. MEDICAL CODING OVERVIEW
Service Offerings
• Place of Service Based Coding – Inpatient, Outpatient Coding
• Provider Specialty Based Coding– Dentistry, E/M, Cardiology, Orthopedics, Physical
Medicine etc.
• Review medical notes and clinical documents
• Assign ICD-10 codes for the diagnosis identified by the physician and Procedure codes
(CDT/CPT/ ICD 10 PCS)
• Assign modifiers as applicable
• Code review and quality assurance
• Communication with Physician’s office for
additional medical documentation and clarification
Key Tasks
Private & Confidential 16Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILLING
17. MEDICAL CODING – PROCESS
Private & Confidential 17Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
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
BILLING
18. MEDICAL CODING – HIGHLIGHTS
• Our coders deliver error-free charge sheets within agreed TAT provided by the client
• We monitor, analyze and improve coding
documentation to avoid denials and guarantee
reimbursements
• We carefully determine the codes according to the
clinical information provided by the Healthcare
Provider/Professionals and report back accordingly
• Our coders have undergone extensive medical
coding training and are well aware of updated
coding guidelines
• All our coders are ICD-10 certified (CPC)
Private & Confidential 18Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILLING
19. MEDICAL CODING – QUALITY
Collecting patient documentation
Assigning accurate diagnosis codes
Collaborating with clinicians, physicians and/or
managers/administrators
Ensuring that all activities are done in a legal and ethical manner
that supports home health agency policy, regulatory and
professional guidelines
Our coders specializing in Home Healthcare coding are highly-skilled professionals,
with extensive knowledge in medical terminology, anatomy / physiology, disease
processes, pathophysiology, and pharmacology.
Typical tasks performed by them include:
Certified by
BILLING
Private & Confidential 19Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
20. ELIGIBILITY & AUTHORIZATION VERIFICATION
• Full range of verification services
• Fast 24-hour turnaround time
• 96 – 99.9% accuracy
• Detailed documentation
• 100% HIPAA compliance
• Experience with national and private carriers
VERIFICATION
• Diligent follow-up till resolution and closure
• Uniform importance given to every account irrespective of
size, age or claim value
• Fast completion of authorization process
• Periodic follow-ups to maintain authorization validity
ELIGIBILITY VERIFICATION
AUTHORIZATION VERIFICATION
Private & Confidential 20Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
22. PRIOR AUTHORIZATION
• Full Range Service (Authorization Request Follow-up Approval)
• 99.9% accuracy
• 100% HIPAA-HITECH Compliance
• Low prices with no hidden cost
• Highly streamlined, fast and accurate service
• Home Health Care
• DME
• Oxygen & Related Equipment
• Physical Therapy
• Diabetes
• Many other conditions…
We cater to
PRIOR
AUTHORIZATION
Private & Confidential 22Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
23. ACCOUNTS RECEIVABLE
ACCOUNTS
RECEIVABLE
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.
Private & Confidential 23Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
24. 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
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
Private & Confidential 24Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACCOUNTS
RECEIVABLE
25. DENIAL MANAGEMENT
ACCOUNTS
RECEIVABLE
Claim Correction and Resubmission
These are the claims which are corrected, modified, and resubmitted as a corrected
claim to Insurance companies.
For such claims, every effort is made to resolve the denial to avoid billing the patient.
Patients' Responsibility
These are claims which cannot be further worked upon and the final bill is sent to the
patient for payment collection.
The reasons for sending the patient a bill generally include In-Network deductibles and
non-covered benefits as per the insurance plan. Patients receive a statement with a
clear explanation for the balance due.
1
2
2 Categories of Denial Management
Private & Confidential 25Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
26. DISTRIBUTION OF DENIED CLAIMS
ACCOUNTS
RECEIVABLE
24%
11%
3%
35%
17%
10%
Distribution of Denied Claims
Auth Related
Coding Correction Required
OON Issue
Others
Patient info missing
Timely Filing
Private & Confidential 26Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
27. AR AGING REPORT SAMPLE
ACCOUNTS
RECEIVABLE
Sunknowledge WEEKLY AR AGING REPORT FOR Client X Inc. - 07/06/2015 through 07/12/2015
PAYER
>120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days
Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining
AARP HEALTH CARE
OPTIONS
26 23 3 17 16 1 44 41 3 37 32 5
AMERICAN TRANSIT
INSURANCE COMPANY
12 11 1 6 5 1 15 15 0 10 10 0
BCBS 28 24 4 16 13 3 41 37 4 32 30 2
MAGNACARE 13 12 1 9 9 0 23 22 1 11 10 1
HIP_PALLADIAN
HEALTH
6 6 0 12 9 3 12 10 2 15 15 0
MANAGED PHYSICAL
NETWORK
12 10 2 8 7 1 10 10 0 10 8 2
STATE FARM
INSURANCE
7 6 1 4 4 0 5 5 0 4 4 0
TOUCHSTONE HEALTH 5 5 0 8 6 2 6 4 2 16 12 4
UNITED HEALTHCARE 31 28 3 23 20 3 49 43 6 41 39 2
Private & Confidential 27Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
28. OASIS HANDLING
O A S I S
We take care of all OASIS
requirements and ensure that every
claim handled by us maintains full
compliance with the OASIS data tool.
We ensure that every Home Health Care claim meets
the CMS requirements with regard to:
• Effectiveness
• Efficiency
• Equity
• Patient Centeredness
• Safety
• Timeliness
The Outcome and ASsessment Information Set (OASIS) is a group of data elements that:
• Represent core items of a comprehensive assessment for an adult home care patient; and
• Form the basis for measuring patient outcomes for purposes of outcome-based quality
improvement (OBQI).
Source:
Private & Confidential 28Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
29. OASIS RELATED ASSISTANCE
O A S I S
We provide complete assistance for
successful OASIS transmissions to ensure
maximum reimbursement.
These include:
Accurately encoding for OASIS
Maintaining the correct data format
Timely transmission of OASIS data
Private & Confidential 29Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
30. OASIS TRANSMISSION
O A S I S
Complete adherence to CMS standards for accuracy, encoding & completeness, as
required for successful OASIS transmission
Fully conversant with both the OASIS-C1/ICD-9 and OASIS-C1/ICD-10 versions*
Full familiarity in working with transmission tools and interfaces such as jHAVEN
(Home Assessment Validation and Entry System)
Our OASIS coders are highly experienced and are
BCHH-C certified by the National Credentialing
Board of Home Health & Hospice
HIGHLIGHTS
We are also
OASIS-C2/ICD-10
ready!
Private & Confidential 30Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
31. Our telemedicine solution is highly customizable and can be tailored to a specific program –
hospitals, nursing homes, home healthcare and providers.
It brings unparalleled benefits – Improved Access, Highly Convenient, Availability on Demand
and Reduction in Supplementary Cost.
TELEMEDICINE SOLUTION
TELEMEDICINE
Our proprietary Telemedicine platform enables patients to have tele-consultation with physicians
at remote locations through secure video conference. A Home Health Agency can use our
vast network of specialist doctors for remote consultation with a patient in need.
Our Telemedicine solution supports end-to-end workflow for tele-consultation and is bundled with
our medical billing services.
Patient registration & Appointment scheduling
Patient’s health records
Alert/Reminder management through mail
Secured video conference
Electronic payment
Reporting services
Private & Confidential 31Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
32. THE Sunknowledge ADVANTAGE
Increased revenue – reduced collection time (up to 97% collection rate)
Reduction in accounts receivable by 30% within 1 month
Expert handling of accounts receivable by highly experienced staff with demonstrated expertise
Claim submission within 48 hours of receipt of billing input
Provider can focus more on core services
Adherence to CMS billing requirements
Proper records maintenance and visibility through reporting
Private & Confidential 32Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
33. CHALLENGES & RESPONSES
Private & Confidential 33Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
34. CHALLENGES & 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 & payors to collect
documentation and obtain authorization
Proper tracking mechanism
Private & Confidential 34Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
35. CHALLENGES & 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
Private & Confidential 35Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
36. CHALLENGES & 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
Private & Confidential 36Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
37. SUMMARY OF BENEFITS
Very Little Risk
• Proven track record in providing healthcare BPO/KPO services
• Experienced in providing services to both payers and providers
• Experienced 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 reduced collection time increase in revenue collection
• Billing & Coding Accuracy > 99.9%; TAT: 24 – 48 hours
• Adherence to CMS billing requirements
Clear Communication and Quick Response Time at All Times
ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection
Private & Confidential 37Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
38. TESTIMONIALS
Private & Confidential 38Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
39. CLIENTSPEAK
“We have had the pleasure of working with the Sunknowledge team throughout the
few months utilizing their services for patient data entry and eligibility verification.
They are a devoted and responsible team that is highly experience in what they do.
They are always concerned about the client’s needs and are always there to help.
I highly recommend the services offered by Sunknowledge.”
COO of a leading medical billing and credentialing company in New York
“Your team amazed me with the manual and the amount of info you provided with that
short training session.”
Practice Manager of a major Dermatology group in New York and New Jersey
Private & Confidential 39Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
40. CLIENTSPEAK
“My firm has evaluated an outsourcing transaction with Sunknowledge. 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, President and CEO of a major New York based Health Plan
“Our company is very pleased with the administrative, and business analytical
solutions which Sunknowledge delivers to our company from a quality & cost
perspective. They have been a true partner in bringing industry expertise, and
innovative solutions to the table. Their ability to grow with our evolving needs for
higher end services such as clinical services is a significant differentiator among
healthcare business process outsourcing firms.”
Executive Vice President of operations of a leading MSO
Private & Confidential 40Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
41. CLIENTSPEAK
“I was always against the idea of outsourcing our back end claims processing
work but I was wrong. Sunknowledge provided extraordinary deliverables on
a timely basis which led to cost cutting considerably for us.”
CEO of a leading MA-PD Plan
Private & Confidential 41Phone: (646) 930-4608 | E-mail: michael.smith@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
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For Additional Information, Please Contact…
Michael Smith
Phone: (646) 930-4608
Email: michael.smith@sunknowledge.com
Sunknowledge Services Inc.
41 Madison Ave., Suite 2503, 25th Floor
New York, NY 11001, USA