GoTelecare Corporate Overview and Service Offerings

Corporate Overview
& Service Offerings
GoTelecare 41 Madison Avenue, 25th Floor, New York, NY 10010
CONTACT: RONNIE HASTINGS
(646) 661-7853 EXT. 304
1

© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Company Overview
 ‘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 of Eastern
India (facility inbuilt with all redundancies – power,
infrastructure and others)
 Sun Knowledge, our contracted company, is ISO
27001:2005 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
Key Facts Awards, Affiliations & Certifications
CALL: (646) 661-7853 EXT. 304
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Service Offerings
CALL: (646) 661-7853 EXT. 304
 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 O&P 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
Prosthetics & Orthotics and DME companies in Revenue Cycle Management
Physicians and Hospitals in Revenue Cycle Management
Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
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Advantages & Benefits
CALL: (646) 661-7853 EXT. 304
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 Significant decrease in operational expenses
• With over 5 years of successful O&P revenue cycle management experience, GoTelecare provides
professional consulting to best allocate resources to increase profit margins
• Significant operational savings that are effective immediately
 Increased Accounts Receivable collection
• 30% of O&P 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
 Demonstrated experience in handling O&P claims
• Medicare, Medicaid and Commercial Plans  Fee for Service and Capitated Plans
GoTelecare is currently servicing one of the largest O&P companies
for their Revenue Cycle Management in the state of Illinois and they have
achieved significant savings and increased A/R collection in year one.

Orthotics & Prosthetics Basics
CALL: (646) 661-7853 EXT. 304
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Prosthetists provide artificial limbs (prostheses) to people who have all or part of a natural limb missing.
Orthotists provide supportive braces and splints (orthoses) to people with various conditions of the
limbs or spine.
Prosthetists and orthotists work with people of all ages and with different requirements.
Prosthetics
 Artificial limb
 Artificial hand
 Exo-skeletal
 Prosthetic knees
 Splints & braces
 Shoes & laces
 Collars
 TLSO
(Thoracolumbosacral orthosis)
Orthotics
E X A M P L E S

Coverage & Billing
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Prosthetics & Orthotics coverage may be subject to a copay or coinsurance. Authorization is required
for various devices and this varies from payer to payer. This is considered a part of the member’s
benefits provisions.
For Prosthetic & Orthotics devices to be covered, the general billing requirements are:
 A prescription from the ordering physician dated prior to delivery date
 Consideration of limitations based on time period within which the item can be covered if supplied earlier, e.g. a
pair of orthotic shoes are covered per calendar year by Medicare
 Appropriate modifiers must be billed, e.g. KX, LT / RT, NU etc.
 Letter of medical necessity and additional documentation may be required for some devices, e.g. PPR Form for
prosthetic devices, Diabetic Verification Form for diabetic patients etc. Coverage for such equipment is subject to
medical review by the payer
 Coverage of devices also subject to qualifying diagnosis, e.g. orthotic shoes are not covered
unless diagnosis states diabetic
 Repair, replacement and supplies may be eligible for separate reimbursement

Billing Cycle Overview
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Encounter
(SOAP)
notes
review
Superbill
generation
and code
review
Claims edit
checking
and
correction
EDI claims
submission
through
clearing
house
Rejection
management
ERA/EOB posting
and reconciliation
Automatic
secondary
payer billing
Denial
Management
AR
Follow-up

Orthotics & Prosthetics Billing Cycle Details
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 Order entry based on the Rx received from the physician
 Patient demographics & insurance entry
 Provider information entry
 Product code, Rx & Dx entry
 If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry process
 Eligibility verification and authorization requirement enquiry
 Patient’s appointment with Practitioner for Practitioner to assign codes
 Collection of detailed Rx from the ordering Physician’s office
 Collection of documents required by Payer for authorization approval, e.g. Diabetic Verification Form, initial
evaluation, medical notes to support K level, PPR Form
 Calculation of service estimates (Patient and Payer responsibility)
 Determination that Payer criteria are met before delivery of device (if criteria are not met, the Patient needs to
be contacted and informed of the additional financial liabilities)
 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

Challenges and 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 & payers to collect
documentation and obtain authorization
 Proper tracking mechanism
CALL: (646) 661-7853 EXT. 304
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 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
 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
CALL: (646) 661-7853 EXT. 304
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 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
 Accumulation of backlog
 Denials not posted
 Claims reconciliation issue
CALL: (646) 661-7853 EXT. 304
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Sample Reports
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0
20
40
60
80
100
120
140
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
96
83
94
98
96
29
11
6
31
32
125
94
100
129
128
41
32
26
30
28
ELIGIBILITY VERIFICATION
Number of New Patient Patient Brought Forward
Primary Checked Secondary Checked (if applicable)
0
5
10
15
20
25
30
35
40
45
50
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
45
25
38
44
46
20
15
26
22 21
25
10
12
22
25
AUTHORIZATION
Auth Required Auth Obtained Auth Pending
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Denial Management
CALL: (646) 661-7853 EXT. 304
Auth Related
14%
Coding Error
5%
OON Issue
8%
COB Issues
10%Patient info missing
6%
Exceeds Timely Filing
8%
Duplicate Claim
5%
Service Not Covered
6%
Primary Paid Max
7%
Pre-Existing Condition
5%
Others
26%
Distribution of Denied Claims
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Telemedicine Capabilities
CALL: (646) 661-7853 EXT. 304
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 Customizable telemedicine platform connects patients, healthcare providers and ancillary staff
members to complete face-to-face consultations
o Reduces healthcare costs
o Decreases patient wait times for patient appointments
o Increases patient satisfaction
o Simple, easy to use user interface
 Diabetic Verification Form
o Expedites the process to receive the returned, signed Diabetic Verification Form from the
primary care physician
 Prescription Refills
o For rental devices; decreases the time
associated with obtaining a prescription refill

REASONS TO
CHOOSE US
CALL: (646) 661-7853 EXT. 304
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Our Billing Service Highlights
 Above 95% Collection Rate
 Claims Submission TAT 24 – 48 hours max.
 Error-free Patient Entry
 Over 99.9% Coding Accuracy
 Real Time Audits
 Proactive Follow-up on Rejections
 Denial Management
 Methodical and Proactive AR Follow-up
 100% HIPAA Compliance
 Custom Reporting
CALL: (646) 661-7853 EXT. 304
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Advantage GOTELECARE
1
Over 8 Years
of Experience
in Working as
Vendors for
Major Health
Insurance
Companies
Across US
Deep
Knowledge of
both the
Payer and the
Provider Side
of the US
Healthcare
Spectrum
2
Consistent
Performance
in Delivering
97%
Collection
Rate to
Clients
Already
Recovered
over millions
in Account
Receivables
and
counting…
3
The Only
Medical Billing
Company with
Its Own State-
of-the-Art
Telemedicine
Platform
4
The Best
References
in Every
Segment
of US
Healthcare
Knowledge &
Business
Process
Outsourcing
5
The Lowest
Prices* in the
Market!
* Only $10 / hour
for a billing expert
working
exclusively on the
client account
OR
just 4% of total
collections realized
CALL: (646) 661-7853 EXT. 304
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A Simple Answer
But really, why us?
Because we do Six Sigma quality work, validated
by excellent client references, at the lowest
prices in the market!
CALL: (646) 661-7853 EXT. 304
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Our 4 Pillars of Strength
Highest
Quality
Excellent
References
Unique
Profile
Cheapest
Rates
Consistently delivering the best
quality, with the highest levels of
accuracy, efficiency & expertise
Glowing testimonials from every
client and not a single customer
churn in our 8 years of operation
Huge experience in working for
both Payers and Providers and
the only billing company with its
own Telemedicine platform
The lowest rates in the market,
with custom pricing options to
delight clients of all sizes
CALL: (646) 661-7853 EXT. 304
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Summary of Benefits
 Very Little Risk
• Proven track record in providing healthcare BPO/KPO services
• Highly experienced in providing services to both payers and providers
• Experienced in 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  increase in revenue collection
• Verification & authorization accuracy > 99.9%; TAT: 24 hours
• High accuracy in Eligibility Data Maintenance (in sync with CMS)
 Clear Communication and Quick Response at All Times
 ISO 27001:2005 & HIPAA Compliance for End-user Data Privacy and Protection
CALL: (646) 661-7853 EXT. 304
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Testimonials
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.
- Manager (Revenue Cycle) of a major US healthcare company
My firm has evaluated an outsourcing transaction with GoTelecare. 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 & CEO of a leading US healthcare company
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21

The Next Step
41 Madison Avenue,
Suite 2511, 25th Floor,
New York, NY 10010, USA
(646) 661-7853 EXT. 304
rh@GoTelecare.com
Ronnie Hastings
CALL: (646) 661-7853 EXT. 304
22

GoTelecare Corporate Overview and Service Offerings

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