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healthcare providers with medical
billing companies,

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Our Business Understanding

CHALLENGES FOR PROVIDERS
  • Revenue Leakages due to incorrect and incomplete coding practices
  • High denial rates and low first pass rates leading to cash flow issues
  • Higher aging of AR and low collection rates of patient responsibility once patient has checked out of
    facility
  • No focus on accounts receivable management
  • Long and demanding Credentialling process that can lead to delayed payments

NEED OF THE HOUR

  • Certified Medical Coding Experts to monitor medical and procedural coding practices that incorporate the latest standards.
  • Models and algorithms that analyze data to improve the whole payment continuum.
  • Experienced Medical Billing staff to increase first pass rate, reduce penalties and follow up on claims till revenue is realized
  • Responsible dedicated AR management staff who follow up on every outstanding dollar

KEY DRIVERS

Pool of AAPC's Certified
Professional Coders

RCM acceleration
using experienced staff

Tailored integrated solutions
for RCM operations

Understanding of Provider
World and Challenges

OUTCOMES

Operational accuracy
and speed

Reduced Reworks
& overhauls

Streamlining
payment process

Delivery model
measured by outcomes

Streamline & improve financial results with accurate coding,
contractcompliance, and clinical appropriateness.

Value proposition

Our Strengths

  • Strong understanding of healthcare processes for providers
  • 10 plus years of RCM Experience and certified coding staff
  • Dedicated Healthcare CoE supporting our delivery across projects
  • Improve cost savings using tools and accelerators for process optimization
  • 98% Process and Transaction quality
  • Strong adherence to SOP and documentation
  • Root cause analytics dashboard
  • 100 % Process and Coding guidelines compliant
  • HIPPA compliance guidelines implemented in full
  • AR reduction with follow the sun coverage model
  • Flexible pricing model by graduating to outcome based pricing
  • Ready for fluid scope and schedule with fixed & flex team
  •  

Outcomes

Increased Cash
Flow by 30%
Reduced cost of
Operations by 60% at least
Reduced AR Ageing
below 60 days
Provider staff can concentrate
on clinical outcomes

Flexible Pricing Models

Our pricing models are designed to meet short-term and long-term needs of our
clients. We offer flexibility, scalability, efficiency and cost benefits at various levels and
throughout the engagement.

FTE Based

Based on average FTE rate per hour multiplied with the number of FTEs needed to complete the task (effort estimation)

Best Applicable When

  • Transaction volumes are unknown
  • Transaction volumes are not closely tied to service provider’s cost drivers

 

Advantages

  • Flexible, scalable and modular arrangement
  • Lower project costs
Percentage Of Revenue

This is outcome based pricing which benefits both the Provider and the RCM vendor. It incentivizes the RCM vendor to maximize the revenue of the Provider

Best Applicable When

  • Fixed percentage of the revenue is agreed for any or all services agreed with Provider
  • Desired outcome and accountability can be defined and captured

Advantages

  • Simple to understand and implement
  • Predictable and stable for contract length
Transactions Based

Based on the number of transactions completed in defined timelines (could be monthly). Pricing is a function of volumes committed and visibility is provided based on mutually agreed deliverables.

Best Applicable When

  • Output can be defined
  • Transaction volumes are known and predictable
  • Transaction volumes are tied to service provider’s cost drivers
  • Not applicable to transactions where the efforts change based on transaction

Advantages

  • Closely tied to customer’s business cycle (OPEX)
  • Enhances visibility into consumption patterns
  • Encourages productivity & efficiency improvements

HIPPA Compliance Measures

  • IDS and Firewall, Dedicated VLANs
  • Remote access prohibited, Secured connectivity
  • Personal laptops and devices not allowed
  • Vulnerability analysis, Penetration testing
  • Secured cabling
  • Biometric enabled data center
  • DOD wipe, Restricted admin rights
  • Hardware lock, USB & CD-ROM disabled
  • Centralized patch management, Hardened OS
  • Standardized software and servers at data center 
  • Centralized anti-virus, Regular backups
  • Non-Disclosure Agreements signed before accessing any Client or patient data 
  • HIPAA Training: Employee undergoes an online HIPAA training by the Virtuous & client/internally.
  • Paperless environment
  • 24/7 Security guards & CCTV recording
  • Photo IDs
  • Magnetic swipe-card and Biometric access controls
  • Restricted access to units, Visitor escorts
  • Formal approval for ID creation
  • Individual Mail & LAN IDs
  • Strong password policy
  • Encrypted passwords
  • Automated access release/deactivation process
  • Special access requires Client Data center and Compliance office approval.
  • Restricted internet access
  • Upload/download prohibited
  • Attachment restrictions
  • No free email / IM / social networking site access
  • Non-Compliant incidents reported to Data Security and compliance officer

Our Healthcare CoE

Readily deployable pool of RCM experts

Resource Mix

Certified Medical Coders

Pharmacist

Allied Health Professionals

Trained Professionals

  • CPC, CCS & BCHHC Certified
  • ICD-10 Proficient
  • Multispecialty Coding experts
  • Pharmaceutical Coding experts
  • Coding Audit experts

Core

  • Pre Process Training
  • US Healthcare domain Knowledge
  • Communication Skills

Competency

  • Coding Subject Matter Experts
  • HIPAA & Technology Compliance
  • Anatomy & Pathophysiology

Specialization

  • Anesthesia, Surgery (SDS), Inpatient DRG
  • HCC, E/M OP & IP, ED Profee & Facility, Pathology
  • Home Health Coding, Radiology

Critical Success Factors

Travel onsite by RCM specialist for Transition at cost to company

Quick onboarding of Program Management and operations Teams

Logistics planning and Team ramp-up/ramp-down

Shortened Learning Curve by leveraging existing process knowledge

Revenue Cycle Management Operations Experience

(Mid-size West Coast Hospital)

HIGHLIGHTS

  • Team of Certified Medical Coders & RCM Analysts
  • Foundation based Medical Coding & Billing edits/charge entry
  • Services – Charge entry and review, Medical coding, Manual charge entry, Posting and Payment posting
  • 100% of assigned charts/patient sessions processed daily

BUSINESS BENEFITS

  • Reduction in accounts receivables from $90 million to less than $20 million
  • Huge reduction in backlog – across lab, EKG, radiology, urgent care, and optometry
  • Achieved greater than 98% coding quality for outpatient medical coding
  • 100% charge capture to ensure every service performed is billed

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