Sun Knowledge Revenue Cycle Management Services

Revenue Cycle
Management Services
Presented For:
Medical Billing Companies
Alex Marz
Direct – 212-243-3237
41 Madison Ave. 25th Fl. New York, NY 10010

 ‘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
(facility inbuilt with all redundancies – power,
infrastructure and others)
 Sun Knowledge, our contracted company, is ISO
27001:2005 and ISO 9001:2008 certified company.
 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
GOTELECARE OVERVIEW
Key Facts Awards, Affiliations & Certifications
© Sun Knowledge 2015-16| All Rights Reserved

CLIENT BENEFITS
 Significant decrease in operational expenses
 We charge a flat rate of $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.
 For Example: Our client reported to Sun Knowledge a $2.1 million operational savings in Y1*
 Heightened collection and increased Account Receivables
 30% of DME 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.
 Productivity Efficiency Tracking allows for you to quantify your team workload.
 Demonstrated experience handling DME claims
 Medicare, Medicaid, and Commercial Plans  Fee for Service and Capitated Plans

 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 Health Care 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
 Claims Processing: Accuracy > 98%; TAT: 5 - 10 days
 Contact Center: Abandonment Rate < 2%, as soon as within 30 Seconds for 90% of calls, High Client
Satisfaction
 High accuracy in Eligibility data maintenance – in sync with CMS
 Clear Communication And Quick Response Time At All Times
 End user data privacy and protection
CLIENT ADVANTAGES

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

Our clients depend on transparency. GoTelecare provides our clients with the ability to
maintain detailed tracking for productivity and efficiency. See below for sample
reporting:
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

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.
Ashley Weidner, MBA, CRCR
Manager, Revenue Cycle | Ensemble Health Partners
NEW CLIENT TESTIMONIAL

CODING & BILLING

MEDICAL BILLING - INTRODUCTION
Medical billing is the process by which providers submit claims for the services rendered and
receive payment from health insurance companies. It also involves resolving any disputes and
following up on claims that have been delayed or rejected.

MEDICAL CODING & BILLING SERVICES
Service Offerings
• Medical Coding
• Place of Service Based Coding – Inpatient, Outpatient Coding
• Provider Specialty Based Coding– DME, Orthotics & Prosthetics
• Medical Billing
• Provider EDI enrollment
• Patient Demographics entry
• Charge entry
• Claim submission – Electronic and Paper
• Payment entry
• Denial posting
• Payment reconciliation
We can handle medical coding & billing processes - promptly, perfectly and professionally using
Emdeon or other billing systems preferred by the client.

BILLING SYSTEM
We use Kareo Billing system “Emdeon One” for coding and billing services that covers 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

MEDICAL CODING – KEY FACTS
• 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 reports back according to the information provided
• Our coders have undergone extensive medical coding training and are well aware of updated coding guidelines
Our Specialties
• Urgent Care • Inpatient Hospitalization • DME
• Radiology • Orthotics and Prosthetics • Home Healthcare
• Physician • Nursing Home • Emergency Department
• Compounding Pharmacy • Psychiatric Care • Hospice

MEDICAL BILLING – KEY FACTS
 HIPAA compliance (Complete Data and Document Security)
 Secure Information & Data Flow between Sunknowledge and our partners enabled with reliable networking
software & hardware (includes secured Virtual Private Networks and FTP sites)
 Claims are submitted through EDI clearing house
 All low pay and no pays reports are sent to the client/AR team on a day-to-day basis
 Work on re-processing of the denied claims starts immediately after receipt of ERA
 ERAs are posted to the respective patients’ accounts
 Quality check is conducted at all stages of process
 Turn Around Time for this process is 24 - 48 hours

TECHNOLOGY, OPERATIONAL
AND COMPLIANCE
FRAMEWORK

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 platform enterprise edition (JEE) 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

IT INFRASTRUCTURE
 High end workstations from HP and Lenovo providing reliable and powerful computing solutions
 1Gbps local area network to access and share files and resources faster
 Combined 24 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
 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

OPERATIONAL AND COMPLIANCE FRAMEWORK
TRANSITION
 Project scoping &
planning
 Knowledge
transfer – Process
training and
assessment
 Process
documentation
 Solution
customization
 Infrastructure set
up
 Pilot/Transition
period
 Time: 4 Weeks
TRAINING
 Training Need
Identification
 Customized
training program
as per client’s
requirement
 Pre-process &
process training
 Voice & accent
and cultural
training
 Refresher training
 Time: 2 Weeks
PRODUCTION
 Project
management
approach
 Exception
handling and
reporting
 Effective coaching
& monitoring
practices
 Periodic review
and evaluation
 Service level
management and
reporting
 Time: 4 Weeks
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
CLIENT BILLING AFTER 60 DAYS AND PAYMENT AFTER 90 DAYS

GOVERNANCE MODEL
Sun Knowledge
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

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. We ensure quality by carrying out
rigorous quality assurance and control activities.
QUALITY ASSURANCE & CONTROL
 Periodic process review
 Process audit
 Testing deliverables and root cause analysis
 Process improvement / re-engineering
 Incorporating customer feedback
 N% internal quality audit of client deliverables & review reporting
 Weekly/monthly monitoring of productivity reports

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

We have 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.
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
 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

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

DATA SECURITY AND END USER PRIVACY
 Information security management system is aligned with ISO 27001:2005 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
23

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