MDeverywhere 1

Physician-CentricRevenue Cycle Management Company

Presented By,Cathy Steadman

Director of Business

Development

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About MDeverywhere

MDeverywhere’s mission is simple – to increase your practice revenue

– Our product is a paid claim

Founded 1995, 500+ EmployeesCurrently Serving:

– 3,500 physicians nationwide– Over 60 different specialties– Solo practitioners, group practices, faculty

practices, hospitals

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Software & Workflow

Web Based Software – One integrated system for Practice Management and

Document Management

Workflow– Practice: Schedule & register patients and enter

charges via, Practice Management System, PDA, or integrated EMR

– MDeverywhere: Automate the eligibility process, transmit claims, enter payments, appeal denied & underpaid claims, work accounts receivable

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How We Increase Revenue:1. Eligibility Decreases Denials

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How We Increase Revenue:2. Rules Engine Reduces Denials 90%

PDA & web-based charge capture delivering rules at point-of-care– 15 Million pre-defined Payor Specific rules

including:

– Additional rules built based on your denials = System Gets Smarter

• Incorrect Diagnosis Code• Bundling/Unbundling• Missing Modifiers

• PQRI & E-Prescribe Measures• Invalid Referring Physician• Global Period Edits

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How We Increase Revenue:3. PQRI & E-Prescribing Rules = 4.0% Bonus

Physician Quality Reporting Initiative (PQRI)– Rules engine supports the 175 PQRI quality

measures

– If a patient is eligible our rules engine automatically enters PQRI procedure codes

– Result: 2.0% Medicare bonus

E-Prescribing rules will earn you the 2.0% Medicare bonus

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How We Increase Revenue:4. Payor Contract Compliance

Commercial payors underpay claims by 7%– We build a knowledge base with your payor

contracts and payment rules (multiple surgery reduction, etc.)

We know what you are supposed to be paid on every claim

– Appeal every claim where the payment is less than the contracted amount

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Payor Contract ComplianceIdentify Underpayments

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Payor Contract Compliance Appeal All Underpayments

Wisteria Insurance Company 100 Payor Lane, Suite 100 Big City, FL 77777 Regarding:

Patient Name: Jones, Pat Patient ID Number: 333-33-3333 Provider Name: SMITH, HENRY, M.D Date of Service: 01/04/2005 Payor Claim No.: 121123-12345

Dear Sir/Madam:

According to our agreement with Wisteria Insurance Company, the total allowable indicated on the Explanation of Benefits (EOB) for the above referenced claim is incorrect.

Total Expected Allowable: $97.21 Total Actual Allowable: $89.55 Remaining Allowable Due: $7.66

A Comparison of Allowable report is attached that provides additional detailed information regarding this claim, the services rendered and information regarding expected reimbursement by line item. Please review this information and process for appropriate disposition. If the information that I have provided regarding your obligations and reimbursement policies is in error, please provide applicable details to that effect. If it is not, please adjust the allowed amount and remit any additional monies owed. Your Prompt attention is greatly appreciated.

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How We Increase Revenue:5. Increase Patient Volume

Patient marketing and recall plan– Review current patient database and set

patients up on recall plans (Annual visits, preventative exams, etc.)

Reduce patient no show rate– Appointment reminder system calls patients to

remind them of upcoming appointments

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Our Web Based Practice Management Software offers Improved Visibility, Transparency and a Streamlined Workflow– Patient Ledgers

– Batch Status

– Patient Accounts Receivable

– Management Reports

Administrative Benefits: Visibility

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Administrative Benefits:Patient Ledger

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Administrative Benefits:Workflow Tracking

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Administrative Benefits:Patient Accounts Receivable

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Administrative Benefits:Management Reports

– Insurance Aging Summary– Insurance Aging Detail– Patient Aging Summary– Patient Aging Detail– Charge, Payment &

Adjustment Summary

– Procedure Analysis– Denial Summary– Denial Detail– Net Collection– Executive Summary– Payor Mix

Web based reports by doctor and department are available to different users based on their access level

MDeverywhere can also create custom reports for your practice

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Net Collection Report: Our Report Card

Charges by date of service

Payments tie back to date

of service

Money we are not allowed to

collect

Professional discount

Bad Debt

Net Collections % = (Payments) / (Charges – Contractual Write-offs – Discretionary Write-offs)

East Hills Medical

Month Orig Chgs Payments % Contract % Discretion % Uncollect % Total W/O % Net Bal % Net % ColNov-08 368,443 184,332 50% 176,554 48% 4,553 1% 2,788 1% 183,895 216 0% 98%Dec-08 370,443 183,887 50% 179,443 48% 2,544 1% 4,332 1% 186,319 237 0% 98%Jan-09 365,998 183,002 50% 175,449 48% 3,322 1% 3,322 1% 182,093 903 0% 98%Feb-09 366,598 181,224 49% 179,334 49% 2,988 1% 1,212 0% 183,534 1,840 1% 98%Mar-09 372,987 185,443 50% 181,229 49% 2331 1% 434 0% 183,994 3,550 1% 98%Apr-09 369,002 183,443 50% 178,443 48% 1239 0% 323 0% 180,005 5,554 2% 97%

May-09 345,098 172,334 50% 165,445 48% 455 0% 0 0% 165900 6,864 2% 96%Jun-09 359,012 171,334 48% 163,221 45% 124 0% 0 0% 163,345 24,333 7% 88%Jul-09 350,114 142,332 41% 153,222 44% 221 0% 0 0% 153443 54,339 16% 72%

Aug-09 344,229 130,445 38% 121,345 35% 0 0% 0 0% 121345 92,439 27% 59%Oct-09 372,998 97,894 26% 92,332 25% 0 0% 0 0% 92332 182,772 49% 35%Nov-09 361,873 11,239 3% 2,398 1% 0 0% 0 0% 2398 348,236 96% 3%

Write-Off

11/30/2009

Net Collection Report

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Denial Summary Report

East Hills Medical

Category / Reason Count Charge Avg Charge % Charge Count Charge Avg Charge % ChargePatient Insurance Benefits

Only Payable 1X Year 0 0 0 0% 0 0 120 0%Terminated Coverage 3 375 125 4% 8 1,008 126 5%Ineligible Dependent 2 274 137 3% 3 414 138 2%Prior/After Effective Date 1 155 155 2% 2 310 155 2%

Total Patient Insurnace Benefits 6 804 417 8% 13 1,732 539 9%

CodingBundled with Other CPT 0 0 0 0% 0 0 0 0%Needs Notes / Report 8 1,152 144 11% 18 2,556 142 13%Invalid CPT Code 0 0 0 0% 0 0 0 0%Invalid / Unrelated ICD 0 0 0 0% 0 0 0 0%Medical Necessity 10 1,200 120 12% 16 1,920 120 10%Service Not Paid Sep / Bundled 0 0 0 0% 0 0 0 0%Missing Modifier 0 0 0 0% 0 0 0 0%

Total Coding 18 2,352 264 23% 34 4,476 262 23%

ContractingOut of Network 0 0 0 0% 2 262 131 1%Hospital only Plan 0 0 0 0% 0 0 0 0%Dr. Not Contracted 0 0 0 0% 1 0 0 0%Dr. Not Certified for Procedrue 0 0 0 0% 0 0 0 0%

Total Contracting 0 0 0 0% 3 262 131 1%

RegistrationMissing Ref Dr UPIN 3 282 94 3% 5 470 94 2%Missing Dr. ID# 0 0 0 0% 0 0 0 0%Insurance can't ID Patient 14 1,778 127 18% 23 2,921 127 15%Covered by Another Payor 18 2,394 133 24% 32 4,256 133 22%Patient Address Invalid 22 2,530 115 25% 43 4,945 115 26%Missing / Invalid Facility 0 0 0 0% 0 0 0 0%

Total Registration 57 6,984 469 69% 103 12,592 469 66%

Total 81 10,140 1,150 100% 153 19,062 1,401 100%

Month Year-To-Date

12/31/2007

Denial Summary Report

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Comparison: MDeverywhere vs. Traditional Companies

Billing Service: Posting, Denial Handling, AR, Patient Billing

Rules engine reduces denials

Knowledge base to enforce payor contracts

Increase patient volume through recalls & appt reminders

Tools to Increase Revenue

Web based and custom reports

Administrative Benefits: Visibility

Integrated patient registration & appointment scheduler

Patient financial ledger

EOBs & Correspondence scanned and accessible via web

Patient accounts receivable dashboard

Pay for Performance (PQRI) rules and automated coding

Electronic eligibility verification

MDe Trad Co.

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Our Start Up Process

No software license fees No maintenance or support fees No interface, training or conversion fees Deposit equal to one month of service is

refunded to client after start-up We get paid a percent of collection Implementation Time: 8 - 12 weeks