Accounts Receivable Management for Hospitals | Accounts Receivable Services

ACCOUNTS RECEIVABLEMANAGEMENT SERVICES

FOR HOSPITALS

[email protected] [email protected]

SUN KNOWLEDGE OVERVIEW

Key Facts Awards, Affiliations & Certifications

2Sun Knowledge © 2015-16 Private & Confidential

‘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 office inbuilt with all redundancies –

power, infrastructure and others

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

41 Madison Avenue, 25th Floor, New York, NY 10010, USA

Office at 41 Madison Avenue, 25th Floor, New York, NY 10010


SERVICE PORTFOLIO

3Sun Knowledge © 2015-16 Private & Confidential41 Madison Avenue, 25th Floor, New York, NY 10010, USA

PRACTICE MANAGEMENT

Scheduling

Eligibility & Authorization Verification

Prior Authorization

Customer Care

We are currently providing only these 2 services for Hospitals.More services will be made available soon.


A UNIQUE EDGE


Sun Knowledge is the only Practice Management / Revenue Cycle Management company with a very own Telemedicine platform to be working for both major Payers like HealthCare Partners and Heritage Provider Network and Providers like Hospitals, Orthotics-Prosthetics & DME companies, Nursing Homes, Urgent Care Centers and more, across the US, with equal success!

We help our clients leverage this dual exposure and get a unique edge in making their business more successful in a much shorter time.

Serving since 2009!PAYERS SERVED BY US PROVIDERS SERVED BY US

Serving since 2007!

This is just a small selection from the list of hospitals and other healthcare organizations served by us currently


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


ACCOUNTS RECEIVABLE MANAGEMENT



ACCOUNTS RECEIVABLE IN THE REVENUE CYCLE


360° Revenue Cycle Management

Services


ACCOUNTS RECEIVABLE MGMT. PROCESS OVERVIEW


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.


ACCOUNTS RECEIVABLE FOLLOW-UP


No Remark Claims:

Any claim in which absolutely no status is known for the claim.

Last Remark Claims:

Claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis.

2 types of Claims Follow-ups

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2


COMPONENTS OF ACCOUNTS RECEIVABLE 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 Payor

• 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


APPROACHES IN ACCOUNTS RECEIVABLE FOLLOW-UP


Online Claims Follow-UpUsing various insurance company websites and Internet payer portals, we check on the status of outstanding claims.

Automated Claims Follow-Up (IVR)By calling insurance companies directly, an Interactive Voice Response (IVR) system will provide the status of unpaid claims.

Insurance Company RepresentativeIf necessary, calling a ‘live’ insurance company representative will give us a more detailed reason for claim denials when such information is not available by the first 2 methods.

1

2

3


DENIALMANAGEMENT



REASONS FOR DENIAL


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


STEPS IN DENIAL MANAGEMENT


Claim Correction and ResubmissionThese 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


DISTRIBUTION OF DENIED CLAIMS


24%

11%3%

35%

17%10%

Distribution of Denied Claims

Auth Related Coding Correction Required

OON Issue OthersPatient info missing Timely Filing

Claims denied as Others are due to the following reasons:

Claim denied as duplicate Claim previously paid Patient not eligible on DOS Payer didn’t receive EOB from primary payer Provider needs to verify if item billed is rental or purchase

Bill Primary Patient not covered due to pre-existing condition Plan doesn’t cover medical services such as DME Not covered by member’s plan Claim exceed maximum number times it can be billed


BENEFIT HIGHLIGHTS


Reduction in accounts receivable

by 30% within 1 month

Accounts Receivable recovery cost starts from

2.5% of collections

Expert handling of accounts receivable by highly experienced staff

Same attention to every cash amount regardless of

its size or source

Demonstrated expertise in working on difficult-to-recover aging A/R

Over 7 years’ experience in claim adjudication for

major US insurance plans



SAMPLEREPORTS



SAMPLE OF AGENT-WISE A/R REPORT


User ID Touched Accounts

Note Count Days Worked Hours

WorkedNotes Per

Hour Max Note Time AverageNote Time

XX12_GT 37 37 1 8.22 4.5 0:20:06 0:02:00

XX13_GT 50 51 1 8.83 5.77 0:35:44 0:05:45

XX14_GT 37 37 1 8.9 4.16 0:15:26 0:02:19

XX15_GT 41 41 1 8.65 4.74 0:38:47 0:09:48

XX16_GT 34 48 1 9.32 5.15 0:23:57 0:03:45

XX17_GT 83 83 1 9.63 8.62 0:42:35 0:02:37

XX18_GT 50 50 1 9.3 5.38 0:35:14 0:05:18

XX19_GT 45 46 1 9.65 4.77 0:24:11 0:05:05

XX20_GT 53 53 1 8.87 5.98 0:33:47 0:04:01

XX21_GT 14 14 1 9.93 1.41 0:37:20 0:08:23

Total Touched 444 460 Total time 91.30 5.04

Average Touched 44 46 Average time 9.13


SAMPLE OF A/R AGING REPORT


SUN KNOWLEDGE WEEKLY AR AGEING 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

MAGNACARE 7 7 0 11 9 2 5 5 0 8 3 5

OXFORD 12 9 3 17 12 5 23 22 1 22 16 6

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


SAMPLE SOW OF A/R FOLLOW-UP


Sun Knowledge 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 Sun Knowledge.

…


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



PRICING



Actual cost of services can only be determined only after a full understanding of the client’s specific requirements.

However, we have a very attractive pricing model that you’d like.

If you have already received a price offer from another vendor, tell us about it. We promise to meet or beat it!

TESTIMONIALS



CLIENTSPEAK


“We have had the pleasure of working with the Sun Knowledge 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 Sun Knowledge.”

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



CLIENTSPEAK


“My firm has evaluated an outsourcing transaction with Sun Knowledge. 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 Sun Knowledge 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



CLIENTSPEAK


“I was always against the idea of outsourcing our back end claims processing work but I was wrong. Sun Knowledge provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.”

CEO of a leading MA-PD Plan

Bruce BegleyEx-CEO at Methodist Hospital of Henderson, Kentucky Cell: (270) 860 5610Email: [email protected]

Ronnie Hastings, Executive Assistant to Bruce [email protected]

Sun Knowledge41 Madison Ave., Suite 2511, 25th Floor

New York, NY 11001, USA

For Additional Information, Please Contact…



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Date post:	13-Apr-2017
Category:	Healthcare
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