TPA

NEWSLETTER

Editorial News

Third Party Administration also called as MCOs or HMOs

have been looked at suspiciously by the medical fraternity

since it was introduced in 1997. Many allegations have been

made including that it has failed in the United States where it

was conceptualized and originated.

e-MAS Sdn Bhd has customized this TPA to suit the needs of

the Malaysian environment with the support of the providers.

Many providers are unable to forget the bad taste of a HMO

which defaulted on payments to thousands of clinics.

Medical care and the healthcare industry is so complex that

administration can only be optimized by technology driven

solutions for accuracy, timeliness & cost containment to meet

the challenging economic & business demands. To succeed in

cost containment, cooperation of the providers & patients have

to be supplemented with an excellent IT based audit system

ensuring equitable benefit to all stakeholders. We shall feature

more articles by providers & medical groups so that all parties

understand their respective roles.

Editor

Dear Insurers and Payers,

Re: Introducing e-MAS as your Medical Claims Adminis-trator

Medical Claims Administration was introduced in Malaysia as MCO in 1997 & has been facing problems. Many systems make all kinds of claims, can they really deliver the promises? Our system answers the following questions;

Are only eligible persons utilizing the health benefits? Are patients getting the appropriate care? Are doctors paid promptly? Are medications accurately listed & fairly priced? Is more than one month supply of medication being given

when misplaced & who takes responsibility? What measures of cost containment be really achieved?

We shall be most happy for an opportunity to showcase our product which has features to reduce the direct and indirect costs of healthcare benefits and insurance premiums.

Our system is the brainchild of senior doctors & technology experts to provide paperless claims administration solution with automation & accuracy in patient treatment. This includes billing, claims re-imbursement, out-patient claims, white glove services, patient health record, wellness management & more features to guarantee cost containment.

Whilst our system handles administration in an automated manner we are backed by an excellent team of experienced professionals to ensure prompt claims adjudication and we have the complete support of the medical fraternity.

WE GUARANTEE OUR SYSTEM WILL DELIVER ALL THAT WE HAVE MENTIONED

Please call 012 2997239 or 03 21610440 for more discussions. With best wishes and warm regards, Thank you,

Yours sincerely,

Dr. P. Vythilingam, ceo@emastpa.com CEO, e-MAS Sdn Bhd

Contents

Introduction of eMAS Sdn Bhd

Letter from the CEO

TPA News

Corporate Healthcare

Health-Line & Health Tips

Nutritional Nuggets

2010 MARCH VOL 2010 ISSUE #1

WE ARE NEW BUT WE HAVE THE BEST SUPPORT IN THE MEDICAL FRATERNITY .

WE ARE NEW – BUT OUR ROOTS ARE 35 YEARS DEEP IN THE MEDICAL INDUSTRY

& WORKED WITH TPA-MCO-HMO SINCE 1997.

Health Line

AIDS……. stands for acquired immunodeficiency syndrome. It is

the most advanced stages of infection with the human immunodefi-

ciency virus (HIV). HIV is a virus that kills or...

View Article at http://emastpa.com/health_line.html

Hand washing

An easy way to prevent infection...

Although medical science is progressing by leaps and bounds, we

are still surrounded by incurable diseases and new strains of disease

causing organisms that are beyond our control. What is still under

our control though, is simple basic hygiene that still remains our

best armor against diseases....

View Article at http://emastpa.com/health_line.html

Take care of your joints! Take a minute and think about your joints too....

The joints in your body take a pounding every day of your life and

are still neglected by most people. After years of carrying your

weight, (sometimes overweight), there is bound to be wear and

tear; this is when you may notice the first signs of arthritis showing

up usually in your early 40's. ...

View Article at http://emastpa.com/health_line.html

Healthy Tips

Junk Foods…………. Why are they so appealing?

Michael Jacobson aptly coined the phrase junk food in 1972 as

slang for foods of use lessor no nutritional value.

Junk food is rich in sodium salts and/or sugar and fats which pro-

vide high calories yet

View Article at http://emastpa.com/healthy_tips.html

10 Great Ways to Get Motivated……And stay fit!...

Do you find yourself tired and lacking energy for the greater part of

the day? You may also be sleeping more and yet not feeling fresh.

Then this is your wake up call to take a hard look at your body

fitness and make some tough decisions.

View Article at http://emastpa.com/healthy_tips.html

Water-The Fountain of Life. Human body is made of 70% water.

The benefits of drinking water then should be apparent. We use

water in our bodies every time we move, breathe, sit or do any-

thing. The human brain is made up of 95% water; blood is 82% and

lungs 90%. But water is taken for granted and its benefits are left

unrealized....

View Article at http://emastpa.com/healthy_tips.html

Good Health for a Happy Life Tips and Guidelines

Ignore Your Health and It Will Go Away

The goodness of fruit, goes beyond its scent & flavor to

provide health benefits, eaten whole or processed

Delete text and

insert image here.

MARCH 2010 VOL 2010 ISSUE #1

WE ARE NEW BUT WE HAVE THE BEST TPA SYSTEM & SMART SITE

WWW.EMASTPA.COM

e-MAS is like a self regulatory audit system within the medical fraternity

Delete text and

insert image here.

MARCH 2010 VOL 2010 ISSUE #1

Healthcare costs can be managed efficiently through careful preventive planning,

employee empowerment thru healthcare education and with accurate medical audit.

The employees too will benefit with a better life and be more productivity

KUALA LUMPUR (March 8, 2010): Berjaya Corporation Berhad has

set up a fitness center as part of its corporate social responsibility (CSR)

initiative to promote a healthy lifestyle amongst its employees.

Named the Sports Toto Fitness Centre, the center takes up 16,000 sq ft in

Berjaya Times Square and is aimed at providing the group’s employees

with a channel for recreation, leisure and exercise.

"This idea of a fitness center was mooted because I personally believe in

maintaining a healthy lifestyle. We work hard, but we must also exercise

harder," said Berjaya Corporation Berhad chairman and chief executive

officer Tan Sri Vincent Tan.

Deputy Finance Minister Datuk Wira Chor Chee Heung, officiated the

opening and said the fitness center is a reflection of a forward-thinking

company which adopts a proactive role in creating a healthy working

environment for its employees. "Employees are the main asset of an

organization and by providing a conducive work environment, the organi-

zation will encourage higher productivity and job satisfaction to give its

employees a sense of work-life balance and fulfillment," said Chor.

Vaccination Program

According to the Centers for Disease Control and Prevention, an average

of 5% to 20% of the population gets the flu each year. This can mean

that up to 20% of your workforce could fall ill during flu season. Con-

sidering the loss in productivity for a flu infected employee, the flu vac-

cine becomes a valuable tool in enhancing your company's bottom line.

It's a Fact

Absenteeism related to the flu can last from 2 to 7 days, with cough and

fatigue lasting several weeks and slowing a full return to work. Many

employees won't take time to arrange their own flu shot, so providing on

-site vaccinations is key to keeping a healthy workforce.

On-site Corporate Flu Shot Program

e-MAS Sdn Bhd can conveniently provide influenza and other vac-

cinations to your employees directly at your worksite or through our

provider network along with educational exhibition at your premises.

Health Risk Analysis & Health Exhibition Program

This exhibition can be held along with the vaccine or as stand alone. It

will focus on mainly Chronic diseases management, Obesity and Smok-

ing. These problems caused by lifestyle practices can severely increase

healthcare spending costs. Smoking affects productivity as it frequently

increases morbidity due to respiratory diseases and affect productivity.

When chronic illnesses are well managed the complications and hospital

admissions are reduced and healthcare is then more affordable. Similarly

obesity too increases morbidity and productivity.

CORPORATE HEALTH Berjaya opens fitness center for staff

“We work hard, but we must also exercise harder” corporate social responsibility (CSR) initiative

Sports Toto Fitness Centre in Berjaya Times Square

Delete text and

insert image here.

Delete text and

insert image here.

A White House nurse prepares to administer the H1N1 vaccine to

President Barack Obama at the White House December 20, 2009.

(Official White House Photo by Pete Souza)

Health Risk Analysis is a web based questionnaire that will help to

analyze health status of an employee for predicting the health–

care trends to implement preventive health coaching & mentoring.

Megan Avenue 1, Block D-8-2,

189, Jalan Tun Razak, 50400, Kuala Lumpur,

Tel: 0321610440, Fax: 0321610431

email id : emascare@emastpa.com

WWW.EMASTPA.COM.MY

Support of doctors to ensure appropriate

investigations & treatment is vital for healthcare cost

containment….this has to be nurtured

e-MAS Research, Development & Innovation incorporates technology to medical administration

for continuous enhancement

WHY THE NEED FOR BILLING AUDIT?

A prominent Doctor quotes the following and provides much insight into private healthcare delivery...the Star 16th March 2010

“The cliché – prevention is better then cure – is stale, but true. If all of us looked after ourselves, there would be so much less suffer-

ing and so much less expenditure. Put more emphasis on preventive care. For starters, all males above 40 and all females above 50

should go and see his or her favorite GP for a full medical checkup. After all, healthcare is for making people well to return to soci-

ety, not to let them be pampered with luxury at our expense. There is no end to the cost of luxury and pampering, all done to boost

the bottom-line”.

“One easy way to cut the cost of private healthcare is to regulate the cost of treatment in private hospitals. Just as you can regulate

doctors’ fees (although you should not), you should also regulate the cost of staying in hospital to get well. Isn’t it possible to detail

how much a CT scan should cost? How much an endoscopy should cost? How much an angiogram should cost? How much a nor-

mal delivery should cost? How much a “lap-cholecystectomy” should cost? “CT scans are done left, right, and center for any

trivial excuse. Firstly, the scans are costly. Secondly, they are potentially hazardous (the radiation from a CT scan of heart arteries

may be the equivalent of 500 chest X-rays). Thirdly, they may not be as accurate as they are touted to be”.

Audit, Audit, Audit!

The economic slowdown has prompted both corporate and Insurance payers the need to increase compliance audit activity & vigi-

lance. Eximius Medical Administration Solutions (eMAS) has been developed with increased audit capabilities directly into the

system and deliver new tools to closely monitor & audit overall appropriate utilization with timeliness.

Some Audit Examples

1. Patient admitted for back pain was also seen for blocked nasal-lacrimal duct. Subsequently patient was referred to another hos-

pital where he was admitted. Subsequently patient was billed for admission in 2 hospitals at the same time and the doctor in

the previous hospital continued his 2X daily visits though the patient was not there any more.

2. Patient had undergone Right hemi-colectomy where right half of the colon was removed and the appendix is part of the re-

moved part. Patient was also wrongly billed for appendicectomy, Later the charges were reduced.

3. Patient admitted for wedge excision of the nail in the big toe and billed for admission & other charges. This was later reversed.

4. Wide excision of the simple growths like sebaceous cyst and lipoma though it should be simple excision.

5. Amount of medication billed by hospital is in excessive quantity and does not match the disease.

6. Patient was treated for viral fever and billed for medication as RM 956.00. On checking patient had been prescribed Viagra.

7. Patient was given medication costing RM 400.00 which he misplaced & the medication replaced at Insurers cost. Justified?

WWW.EMASTPA.COM.MY

Practice of defensive investigations & treatment can be very expensive, unproductive and detrimental for

healthcare provision & administration

All e-MAS Clinics will be accredited by the Academy of Family Physicians to ensure the quality

of service and medical care is excellent