e4e healthcare services © e4e – confidential and proprietary comprehensive solutions for the...
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e4e Healthcare Services
© e4e – Confidential and Proprietary
Comprehensive Solutions for the Healthcare Ecosystem
Please Insert Client Logo
2© e4e – Confidential and Proprietary
e4e Healthcare Business
2© e4e – Confidential and Proprietary
IT Enabled Services & BPO
Offices in
3 Countries
2500
+ Employees
Globally
Work with over 6000 Physicians & 191
Hospitals
• Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines.
• With over 19 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP.
• A cross-border Healthcare Company with proprietary Software Platformsfor Revenue Cycle Management, Claims Processing, Audit and Process Automation.
• Technology agnostic solutions – experience in working with over30 Provider and multiple Payer Platforms.
• Expertise in System and Platform Integration – System Interface,Electronic Data Inter-change and Workflow Efficiency.
•We process over 135 million transactions annually and code/ auditover 30 million charts.
• HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified & SSAE 16 Type II Compliant Company.
© e4e – Confidential and Proprietary
SERVICE
LANDSCAPE
Revenue Cycle Management
Payer Services
Value Added Services
Technology Solutions
End to End Solutions for the Healthcare Payment Continuum
e4e Healthcare Service Landscape
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Revenue Cycle Management
•Patient Access Management
•Charge Capture including clinical documentation improvement
•Claims, Remittance & Denial Management
•Hospital, Physician & Remote Coding
•HEDIS & DRG Coding
•Revenue Recovery & A/R Services
•Charge Integrity & Compliance Solutions
•Successful EMR driven billing service
Payor Services
•Front End Claims Processing and Management
•Claims Adjudication and Error Suspense Resolution
•HCC Coding Services
•Enrollment Membership and Billing Services
•Customer Service•Mailroom Service•Grievance, Appeal & Refund Posting
•Reports Management
Value Added Services
•Customer Support centers
•Business Rules Configuration
•Fraud , Waste & Audit Solutions
•RAC Response Management Solution for Providers
•Process Improvement Consulting for Physicians
•Ancillary Services for Payers
•Business consulting
Technology Solutions
•Claims Administration Platform
•Scheduler•Workflow Solutions including OCR
•ICD 10 Transition Support
•Document Management System
•Client Service Portal•Member Portal•Managed Services -Network & Desktop management
e4e Healthcare Services
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Geographic Presence
Towson MD, USA
Chennai India
NoidaIndia
Bangalore India
Baldwinsville NY, USA
Manila, Philippines
Patient Access
ManagementBilling Medical
CodingDenial
ManagementA/R Follow
up
Hospital Service Offerings
© e4e – Confidential and Proprietary
• Scheduling & Registration
• Eligibility & Benefit Verification
• Data Entry• Cash Posting• Credit Balance Report
• Outpatient Visits• Clinic Visits• Emergency
Department• Same Day Surgery• Inpatient
• Weekly review to check on denials
• Account Receivables Service
• Insurance Follow Up
Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service
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Provider Service Offerings
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• Scheduling & Registration• Patient Data Entry• Eligibility & Benef it
Verif ication• Point of Service
Collection
• Seamless integration with Provider Accounting Systems
• Electronic Claim Generation and Transmission
• Payment Posting • Denial Management • Reconciliation • Refunds • Provider Data Updates • Patient Billing
• Charge Capture• Charge Audits for accurate
& compliant billing• Identify missed charges on
retrospective claims• Improvements in Clinical
documentation through education session
• Remote Coding• Coding Staf f Augmentation
• Account Receivables Service• Calculate projected A/R
collections for outstanding accounts
• Monitor, identify and prevent future payment abuses f rom payers
• Underpayment Recovery Services
• Coding Audit• Charge Master Management• Billing and Coding Research to
plug areas of ‘Revenue Leak’
Charge Capture
Patient Access Management
Claims Remittance
& DenialManagement
ChargeIntegrity & Compliance Solutions Remote
Coding
Revenue Recovery & A/R Services
Payor Service Offerings
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Mail Room Services &
Claims Management
Reports Management
& Compliance
Solutions
Member Enrollment
Customer Service
Grievance Handling &
Refund Posting
• Member Enrollment/ Disenrollment
• Member Maintenance
• Member Inbound Calls• Provider Service• Online Claim Status
Query
• Member/ Provider• Provider/Hospital Directories-
Report generation• UM , Statutory, Canned Reports• High Dollar Value Audits• Recovery Audit Contract (RAC)
Audits• Durable Medical Equipment (DME)
Audits
• Receipt and Records of Appeals• Analysis of Appeals• Amount Payable for favorable
cases• Process for payment / generate
check• Generate provider letter if
original denial is upheld• Refund Posting
• Scanning and Batching• Optical Character Recognition
Conversion• Data Capture• Claim Information Capture• Claim Data Audit• Member Validation• Benef it Validation• Fee Schedule Validation• EOB Generation• Front End Rules Application
and Data Verif ication
Configuration Support
• Benef it Loading• Provider Loading• Fee Schedule Loading
© e4e – Confidential and Proprietary
Technology Services
• Through Partner’s
• PriceFast - Medicare Quick Pricer
• OCRAS – Optical Character Recognition and Audit System
• Workf low Solutions
Practice Management
System
RCM Tools
Claims Management
Systems
Payer Processing
Tools
Electronic Medical
Records • CodED – Auto Coding Solutions
• ACES – Automated Coverage Check
• HITS – Hospital Interconnectivity Tools
• I DOS – Document Management Solutions
• Workf low Solutions
• Velocity PBS• Velocity CPS• HoCAS – DRG Coding
Audit System
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•Conducting focus assessments of HIM workflow challenges, staffing, and performance improvement needs.
• Improving revenue cycle, outcomes reporting, release of information, issues with working DRGs & ICD-9 codes.
HIM Operational Review Services
•Providing comprehensive suite of products and services to enable a smooth transition to ICD 10.
• ICD-10 Readiness Assessment, ICD-10 Impact Assessment Service supported by applications
ICD-10 Transition
• Improving the accuracy of clinical documentation and DRG coding through the coordinated efforts of caregivers, physicians and coding professionals, guided by experienced e4e consultants
DRG Assurance
•Sustaining the benefits of the DRG Assurance with leave-behind software that provides guidelines for concurrent chart review and identifying potential compliance risks, frequently missed concepts, and issues with working DRGs and ICD-9-CM codes
Clinical Documentation Improvement
•RAC risk assessments•Transition auditing, hospital-specific MS-DRG, hospital outpatient, and physician service accounts
•Support in deployment of RAC management programs
RAC Management
• Inpatient coding validation services provide comprehensive reviews to assess DRG code assignments, improve documentation, and quantify the impact of coding changes.
DRG Validation Services
•e4e has a suite of proprietary technology platforms primarily designed as an enabler to a more efficient and effective operating model.
•Velocity – RacER - CodED
Technology Services
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Value Added Services
Technology & Platform Agnostic Solutions
© e4e – Confidential and Proprietary
• Epic
• Cerner Systems
• IDX
• Paragon
• McKesson
• Meditech
• Medicare DDE
• TMHP (Medicaid of Texas)
• Next Gen Hospital System
• HMS Hospital System
• MS4 Hospital System
• 3 M• Allscripts and Misys• Meditech• Cerner Systems• Siemens Signature• Image Flow/ Image Star• e ClinicalWorks• GE systems• Amicas• McKesson• QMS• Kareo• NextGen
• EZCap• Power MHS• Diamond• Health trio
Hospitals Providers
Payers & TPAs
Multi - Platform Multi - Specialty
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• Neurology• Gastroenterology• Rheumatology• Radiology • Neurosurgery • Emergency• Cardiology• Birthcare Healthcare• Radiology• Obstetrics• Oncology• Physical Therapy• Ophthalmology• Pain management• Rehab therapies• Acute Internal Medicines• Orthopedics
• Acute Care• Women’s Health• Dialysis Centers• Cardio Surgery• General Surgery• Emergency Department• Ambulatory Services• Pathology• Orthopedics• Anesthesiology• Nephrology• Hospitals• Radiology
• HMO Plans (include Medicare, Medicaid and self funded plans)
Hospitals Providers
Payers & TPAs
Delivery Strategy
Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings
Right-shoring
Onshore
OffshoreOnsite
US
USIndia
Philippines
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The Numbers Speak
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Process 2012 2013 2014
YTD - January
Coding 30,361,972 27,530,717 2,455,722
Accounts Receivables
3,301,539 3,091,395 266,200
Cash 10,854,505 13,934,574 1,277,912
Charge 7,358,441 7,397,076 838,549
Patient Demographics
4,762,631 3,664,214 414,779
Our Performance & Operational Scale
Metrics Target
Financial Claim Accuracy (for RCM) 99.1%
Administrative Claim Accuracy (for RCM)
99.7%
Coding Accuracy 97% plus
TAT for Claims
Norm is 24 hours, with exceptions delivered even
with in 8 hours
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Delivering 100% on our Client SLAs & KPIs over several years
Process MeasuresOutcome Measures
Metrics Actual Targets
Collection as a % of Gross Charges 55%
Targeted Revenue Increase Y-O-Y 9%
AR days for Commercial & Blue Cross
42 days
180 days + AR as a component of total AR < 8.5%
Denials on patients with coverage and benefits information
< 0.25%
Denials & Transmission Rejects 3%
Specific Target for a customer for a location $ 1.275 m
AR Days for Medicare < 20
135Mn Transaction processed per annum
30Mn Charts coded & audited
5.79Mn Claims processed per annum
$1.61Bn Paid on claims per annum
Our Operational Scale
Foundation for Success
© e4e – Confidential and Proprietary
• Data Analytics• Optimal Staffing• Weekly, Monthly and Quarterly calls• Exclusive focus on TAT and revenue
collection• Tight quality assurance measures• HIPAA Compliance
Resource Capabilities
Transitions Business Excellence
Delivery Excellence
GovernanceInfrastructure & Automation
• Hiring the right people• Employee longevity• Product and Process Level understanding• Contextual Training• Periodic Refresher Training opportunities
• Project Scoping and opportunity identification
• Analysis on key drivers affecting the Process
• Cost effective solutions to improve the system
• Structured approach to execution and delivery
• Robust Infrastructure for uninterrupted business
• State of the art delivery solutions• In house application development
team to customize your solution• Powerful Knowledge Management
tools
• Fact based decision making approach• Provides transparency & build
controls on operations• Ensures highest level of Data
Integrity, Security & Compliance
• US relationship Management• Managing by Business Goals
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Why e4e ?
© e4e – Confidential and Proprietary
GrowthStrategic Initiatives
Profitability
• Reduced costs by up to 40 % by outsourcing to e4e.
• Consistent superior service delivery against client SLAs and KPIs. • We are flexible and nimble
and have a transitions methodology to quickly ramp our operations.
• Scalability & operational flexibility
• SW platforms and skilled staff to delivers significantly better economies of scale for you.
• Continuous Process Innovation leveraging Technology.
• Process Re-engineering with customized automation tools.
• Complementary Service Offerings
Our values and commitments of Adaptability, Community, Excellence and Integrity is what will drive the success of this engagement
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Contact Us
e4e Healthcare Business Services 502 Washington Avenue, Suite 200, Towson, MD 21204Tel: +1 (443) 275 1632
e4e Healthcare Business Services Fortune Towers152, Thoraipakkam Pallavaram, Radial RoadKovilambakkamChennai - 600 117Tel: +91 44 2268 1240 Fax: +91 44 2268 1244Toll Free: +1 (877) 559 8176
e4e Healthcare Business Services H33 Sector 63NOIDAUttar Pradesh – 201301Tel : +91120 6746666 Fax :+91120 6746688
e4e Healthcare Business Services Unit No.1303-1304, 13th FloorPrestige Meridian - II#30, M.G. RoadBangalore 560 001Tel: +91 80 3256 8763
e4e Global Services Philippines Inc.15th Floor,Fort Legend Building,Bonifacio Global City,Taguig City 1634
e4e Healthcare Business Services 60 Oswego Street Baldwinsville, NY 13027 Fax: (315) 638-6309
Thomas Renny GeorgeVice President - SalesMobile: +1 (813) 760 [email protected]
Mihir BhutaVice President - SalesMobile : +1 646 431 [email protected]
Paul Arvantides Vice President & Head US Coding Services Mobile : +1 315 254 [email protected]
Kathleen Maher Associate Vice President Sales Mobile : +1 617 512 2318 [email protected]
Teresa Crawford Associate Vice President SalesMobile: [email protected]