gss healthcare - rcm services
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1 © GSS Healthcare IT Solutions 2014
GSS Healthcare RCM Services
2 © GSS Healthcare IT Solutions 2014
• A Global organization with operations in US, India and ME
• World-class delivery engine delivering solutions to Fortune 500 companies and Global 1000 companies
• SSAE 16 Type II & SEI- CMMi Level-5 company, ITIL compliant processes, ISO 9001 and 27001 certifications
• 8 Offices Globally including 3 Development Centers
• GSS offers its services to diversified verticals – BFSI, Healthcare, Technology, Retail & Manufacturing, Education and Government
• Global Operations Command Center (GOCC) and remote delivery center in Hyderabad, India
• Best-in-class top tier technology alliances and domain intensive Centers of Excellence
Snapshot of GSS Infotech
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• Process driven organization for the last 10 years - a SSAE 16 and SEI CMM level 5 company, having an ISO 270001 and HIPPA compliant delivery infrastructure.
• Proven Expertise in Healthcare based automation solutions
• Onshore / Offshore Global Delivery models ensure financial improvements, reduced costs and superior operations
• Established and common back office processes like HR , Finance, Recruitment, Training and IT
• Proven “GSS Infotech” brand name for easy hiring in the Hyderabad market
• Capacity to utilize the IT process and infra to be applied
in BPO / ITES
Technology
People
Process
GSS Infotech Healthcare Business
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• Immediate availability of over 100+ experienced billable resources with capability to support specialty areas including Radiology, Pathology, Anesthesiology and Orthopedics
• Specifically in the area of for Revenue Cycle Management specifically in the areas of Billing and Claims Management
• Facility has an additional 150+ plug and play seats to accommodate expansion .
• Capability to expand at over 28 lateral resources and 50 fresher resources a week
• Dedicated Training Infrastructure and Training resources to train over 120 to 180 resources per week.
Opportunity for your Organization
Healthcare Customer Engagements
Revenue Cycle
Management
Manufacturer’s
Licensing System
HIPAA 5010
Testing
Infrastructure
Solutions
Integrated Provider
Management
Pediatric /
Adult Patient Care
Personnel
Admin System
ICD 9/10 Testing ICD 9/10
Transformation
Impact Assessment
/ Remediation
CTMS,EDC,
Medical Imaging
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• Partner of choice for leading technology vendors
• Investments in joint IPs and joint solutions
• Vendor agnostic service delivery
Technology Alliances
• Domain knowledge, serving over 200+ Healthcare Provider Groups.
• Dedicated Business Support Unit and have more than 300+ BPO resources.
• Strong technology background delivering Process Automation and IT services including ICD-10 transformation, Application Development and Infrastructure Management.
$250mn
Collected Per
Year
600+ Man Years of RCM Experience
1mn Claims
Processed
Per Year
>40mn Transactions
Per Year
Our Expertise
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Our Commitment PEOPLE PROCESS MATURITY
Delivering Sustainable Value
Establishing a strong
governance and
organizational structure that
generates a high degree of
transparency and effective
communication
Identifying and assigning key
people to establish
collaborative relationships
aligned with business
objectives
Establishing a timeline
consistent with the work
plan and focused on
ensuring client's Objectives
Providing Operational Stability
Developed and Implemented
a Performance Framework
that provides 360- degree
resource management
Ensuring Knowledge
Retention, strong Training
Methodologies and
automated Knowledge
Management Tools
Implementing joint
prioritization and diligent
change control procedures
through robust
Reporting and Reviewing
consistently through :
a. Weekly Operations Calls
b. Joint QA Calibration
Minimizing and Mitigating Risk
Assigning well trained and
experienced resources
based on a robust onsite
offshore transition
experience
Establishing a joint
governance structure and
implementing Client
Partnership Management
Framework
Using our existing expertise
in Technology, Process and
Automation to bring about
improvement in existing
Productivity and Quality of
Transactions
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GSS MedPlus Platform
• HIS/ PMS / EMR Product • MUII Certified product
• Proven implementation
• Cloud Based Environment
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RCM Delivery Model
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Access to Talent Pools
• Our offshore facility is based in India’s premiere state of the art township known as Hi-tech city at Hyderabad.
• Major companies like Novartis, United Health Group, Deloitte and PAREXEL International have their back offices in Hyderabad.
• Further, Hyderabad has six state universities; two deemed universities and three central universities that deliver skilled professionals year after year.
Time-to-Recruit
• 20 laterals / 50 Freshers per week
Recruitment
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The Training academy has dedicated trainers for healthcare and ensures that the training meets the required skillset needed by the Production floor.
2 Dedicated State of the art Classroom facilities with a capacity to train 120 - 180 students per day
Average Time to Train
• 2 - 4 weeks
Process Trainers
• Dedicated Trainers with instructional design and development capabilities
• Self Designed RCM Training Curriculum
• Assessment Designed for different Training needs
Training
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RCM Delivery Model
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Associates
TL
Ops Mgr
Delivery Head
13 - 17 Years
7-9 Years
4-6 Years
1-4 Years
Delivery Prog. Managers
Quality Mgr
QL / Process Trainers
Quality Analysts
Delivery Governance
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Ops Manager
Ops Manager
Team Lead
Team Lead
Support Teams
• 3 HR • 2 Recruiter
• 1 Finance Manager • 1 Finance Executive
Delivery Head
Billable Resources
CLIENT Interaction
• 1 Training Manager • 2 Trainers
• 1 Admin Manager • 2 Admin Executive
• 1 Quality Manager • 1:25 QA
Operations Governance
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Performance Governance Sample Throughput & Quality Metrics across Customers
Customer Processes Throughput Accounts per day per associate
Quality TAT(In Hours)
Customer1 Patient Account 200 98% 48
Customer1 Payment Posting 250 98% 48
Customer1 Rejections 250 98% 24
Customer1 Collections 60 95% 24
Customer2 Correspondence 200 98% 72
Customer2 Insurance 400 98% 24
Customer2 Payment Posting 250 98% 48
Customer2 Deposit Correspondence 200 98% 72
Customer2 Collections 65 95% 24
Customer2 Data Entry 300 98% 48
Customer3 Patient Account 100 98% 48
Customer3 Payment Posting 250 98% 48
Customer3 Credit Balance 50 98% 24
Customer3 Patient Mapping & Phy. Referring 250 98% 24
Customer3 Collections 80 95% 24
Customer4 Collections 45 95% 24
Customer4 Charges 200 98% 48
Customer4 Payment Posting 250 98% 48
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Transition/Stabilization Plan for new users
Processes
Production Goal
50% 70% 70% 80% 80% 90% 90% 100%
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8
<7 >7 >14 >21 >28 >35 >42 >48
Quality 95% 95% 95% 95% 95% 95% 95% 95%
Patient Account 100 50 70 70 80 80 90 90 100
Payment Posting 250 125 175 175 200 200 225 225 250
Credit Balance 50 25 35 35 40 40 45 45 50
Patient Mapping & Phy Reffering
250 125 175 175 200 200 225 225 250
Collections 80 40 56 56 64 64 72 72 80
Transition Governance Client Case Study
Processes / Headcount HeadcountFirst
Month of GO Live
Headcount Fourth Month from Go Live
% Headcount Reduction
Insurance Verification 8 7 13%
Billing Edits 3 3 0%
Demo and Charges 16 10 38%
Payment Posting 10 8 20%
Correspondence 9 7 22%
Deposit Correspondence 12 8 33%
AR Follow up 20 11 45%
Customer Service Calling 5 3 40%
Totals 83 57 31%
A Sample Case Study on the Process Optimization provided during the transition from a New Physician Group in the first four months . Meeting both the SLAs while providing a 30% reduction on initial headcount.
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RCM Delivery Model
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Training Quality
Process Quality
ISO 9001 Based – Quality Management System
ISO 27001:2013 Information Security Management
HIPAA Compliant Delivery Structure
SSAE 16
Certified SEI CMM Level 5
Infrastructure &
Data Security
Quality Framework
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RCM Delivery Model
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Security • Manned and un-manned security • Independent Security Checks for each wing • Biometric Card System
Capacity • 300 per shift capacity, with over 50% availability • Four independent Wings across 2 floors • State of the art 24X7 NOC • Server Rooms with gas based fire retardant systems
Facilities • Hyderabad India; 30000 sq.ft Operational area • Modern Facility with four wings and Independent healthcare floor of
over 300 seats
Utilities • 2 Government-run power connections (different plants) • 2 Diesel Generators • Dedicated UPS for facility and individual UPS for each floor
and dedicated back up UPS for Datacenter
IT & Infrastructure
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IT Security • Datacenter is equipped with CISCO devices • Monitored 24x7 by a dedicated team • Accessed only by authorized IT personnel
Connectivity
• Secured site-to-site VPN tunnel for all healthcare clients
• Dedicated VLAN for healthcare facility
• 4 separate and unique ISPs with ISP failover at the Load balancer
• 3 separate voice line providers
Governance • Proven methodologies and best practices • SSAE 16 SOC Type II, ISO 27001 for Security Management, ISO
20000 for IT Service Management
IT & Infrastructure
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Next Steps
• GSS Healthcare can provide resources in the area of Demos & Charge
Entry, Payment Posting and A/R collections
• Open to new business models that meet the relevant needs of Etransmedia
and will help expand its business
• GSS Healthcare would like to discuss how we can take the relationship
forward with Etransmedia
25 © GSS Healthcare IT Solutions 2014
Sr. VP –Healthcare
Jeffrey S Peter US : 732 7983102 / E: [email protected]
Contact Information
26 © GSS Healthcare IT Solutions 2014