Medical_Billing_-_GoTelecare

Medical Billing Provided to GoTelecare by
Sun Knowledge
41 Madison Avenue, 25th Floor, New York, NY 10010

2© GoTelecare 2014-15| All Rights Reserved Private & Confidential
 Sun Knowledge is our closely affiliated company under
the same ownership.
 ‘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 process knowledge
 Structured training, feedback and coaching
 HIPAA-HITECH compliant
 Offices located in USA& India
• New York City, USA – 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)
 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
Overview
Key Facts Sun Knowledge Awards, Affiliations & Certifications

MEDICAL BILLING ADVANTAGES & BENEFITS
• Significant decrease in operational expenses
• With over 8 years of successful medical billing experience, Sun Knowledge/GoTelecare provides
professional consulting to best allocate resources to increase profit margins.
• Let us show you how we saved our clients >50% in operational savings.
• For Example: New York Home Health Care Equipment reported to Sun Knowledge a $2.1 million
operational savings in Y1*
• Heightened collection and increased Account Receivables
• Cyclical Data Reporting
• Data reporting interval can be customized to meet the needs of the customer.
• Demonstrated experience handling DME claims
• Medicare, Medicaid, and Commercial Plans  Fee for Service and Capitated Plans
* New York Home Health Care Equipment is the largest DME
company in New York City servicing residents in 13 counties in 3
states since 1982.

GOTELECARE 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
 Enrollment Processing & Member
Fulfillment
 Claims Administration
 Coding & Medical Billing
 Credentialing
 Premium 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 provide services to
Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
Private & Confidential© GoTelecare 2014-15| All Rights Reserved 4

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

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
MEDICAL CODING - PROCESS

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 report back according to the information provided
• Our coders have undergone extensive medical coding training and are well aware of updated coding guidelines
Our Specialties
• Emergency Room • Inpatient Hospitalization • DME
• Pathology • Critical Care • Radiology
• Ambulatory Surgery Center • EKG • Pulmonary
• Cardiology • ENT • Orthopedic Surgery
• Anesthesia • Family Practice • Internal Medicine
• Nursing Homes • Dentists • Home Healthcare Agencies

MEDICAL BILLING – KEY FACTS
 Review encounter (SOAP) notes and select appropriate CPT/HCPCS and ICD codes
 Claims generation and review of edits
 EDI claims submission through clearing house with TAT of 24 – 48 hours
 Claims rejection review and resubmission
 Payment and denial management
 Accounts receivables analysis and follow-up
 Quality check is conducted at all stages
 HIPAA compliance (Complete Data and Document Security)

MEDICAL BILLING - PAYMENT/DENIAL POSTING
Select Patient Account
Select EncounterSelect Encounter If not found
Refer Client SpecifiesDenial
Denial Code
Hold Transfer BalanceTransfer BalanceWrite-off
Post Payment
Payment
Payment Entry Process-Flowchart
 Receipt of ERA/EOB from payer triggers the payment/denial management process
 Payment posting is important with respect to payment reconciliation
 Effective and timely follow-up increase the reimbursement rate of the claims

CODING AND BILLING SYSTEM
Sun Knowledge/GoTelecare uses Emdeon system for coding and billing services that covers complete billing
cycle:
 Appointment scheduling
 Encounter (SOAP) notes review
 Superbill generation and coding
 Claims edit checking and correction
 EDI claims submission through clearing house
 Rejection management
 ERA/EOB posting and reconciliation
 Automatic secondary payer billing
 Denial Management
 Patient statement generation and mailing

 Very Little Risk
 GoTelecare is experienced in handling complex contracts/claims
 GoTelecare is experienced working with various claims & billing systems
 Quick and efficient resource for special projects when needed e.g. member retention program, etc.
 Quick and efficient temporary resource when needed e.g. inventory back up, annual enrollment period, etc.
 Significant Upside Potential
 GoTelecare has a good understanding of US Health Care industry. We work both for the payers and providers.
 Extremely competitive rates, greater productivity, improved accuracy of claims, increased provider
satisfaction, reduction in overtime cost  Reduced Admin Cost
 Leverage partial outsourcing to increase and/or create operational expansion opportunities
 Proven process performance
 Claims Processing: Accuracy > 98%; TAT: 5 - 10 days
 Efficient coding & billing process – special focus on rejection and denial management
 Contact Center: Abandonment Rate < 2%, ASA within 30 Seconds for 90% of calls, High CSAT
 Clear Communication And Quick Response Time At All Times
 End user data privacy and protection through implementation of industry standard like ISO 27001:2005 & HIPAA
ADVANTAGES OF UTILIZING OUR SERVICES

CUSTOMER TESTIMONIALS & ADDITIONAL
INFORMATION
"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 Chief Executive Officer
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
Leading MSO
Spencer Leany
St. George, UT 84790
Phone: 435.632.8355
Spencer.Leany@GoTelecare.com
For Additional Information, Please Contact
We Have 9 Years of Top Level Experience and Never Lost a Client!

Medical_Billing_-_GoTelecare

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