OUR FOCUS YOUR GROWTH

Transcription

1 HEALTHCARE SERVICES

2 OUR FOCUS YOUR GROWTH The last decade has seen the global healthcare market going through a lot of upheaval. The industry is facing unprecedented challenges in the form of stringent regulatory mechanisms, currency fluctuations, disruptive technologies and the burgeoning demand for patient-centric services. The US healthcare business processing market is undergoing a transformation, especially with the introduction of the Patient Protection and Affordable Care Act (PPACA). With the act expanding insurance access to more than 30 million US citizens, the increase in claims processing workload has led to large-scale outsourcing of these services by payers. According to latest industry reports, the US healthcare BPO market will be worth $141.7 billion by Irrespective of geography, healthcare enterprises are working towards financing and delivering the best quality care to the maximum number of people at the lowest possible cost. Leading healthcare companies are therefore, continuously engaged in improving their delivery mechanisms, while simultaneously controlling operating costs and streamlining their processes. In these challenging times, the industry is looking for insight and guidance from a trusted advisor, like Xchanging. With over 15 years of expertise in the healthcare industry, servicing leading vendors, brokers, third party administrators (TPAs) and insurers, Xchanging is ideally placed to enable you to optimize your business processes. At Xchanging, we focus on your outcomes by using technology enabled business processing services to increase automation, reduce manual processes and improve response and reaction time. We use a collaborative approach to first understand your business thoroughly before we look at optimizing the business processes. We also capture data to analyze it, derive business insights and then take specific initiatives based on them to improve operational performance. This closed loop cycle proactively identifies points of failure which in turn leads to more effective and efficient operational performance, including cost avoidance and improved adherence to regulatory compliance measures. XCHANGING HAS HELPED LEADING HEALTHCARE PLAYERS OPTIMIZE THEIR PROCESSES BY... Managing $200 Million in healthcare Accounts Payable (AP) transactions Handling $125 Million in healthcare Accounts Receivable (AR) transactions Processing $300 Million worth of claims annually Managing $375 Million in collections, cash applications and billing Answering over 1 Million inbound and outbound calls for leading healthcare providers XCHANGING

3 Xchanging has been managing business critical functions of the healthcare industry for over a decade including insurance verification, pre-registration, charge entry, payment posting, denial management, credit balance and AR management. XCHANGING S HEALTHCARE ECOSYSTEM HEALTHCARE SERVICE OFFERINGS BUSINESS SERVICE MANAGEMENT Payer s (Insurance Companies and TPAs) Provider s (Revenue Cycle ) Pharmacy Benefit Managed Care s BUSINESS ACTIVITY MONITORING AND BENCHMARKING Finance and Accounting ENTERPRISE SOLUTION HR and Payroll s Procurement (Source-to-Pay) PROCESS EXCELLENCE (PEX) AND QUALITY ASSURANCE (QA) Customer Relationship s Data and Content DATA ANALYTICS AND INFORMATION MANAGEMENT Application Integration BUSINESS PROCESS TRANSFORMATION Data Warehouse and Business Intelligence Master Data (MDM) Predictive Analytics Business Analytics Customer and Market Analytics CHANNELS AND TECHNOLOGY APPLICATION MANAGEMENT Web, and Chat File Transfer Protocol (FTP)/ Electronic Data Interchange (EDI) Interactive Voice Response (IVR)/Call Center Xchanging Applications FAX/e-FAX, White Mail Client Applications EMBRACING COMPLEXITY STIMULATING GROWTH 2014 XCHANGING 02

4 XCHANGING HELPS A US BASED ANCILLARY HEALTHCARE PRODUCTS COMPANY REALIZE PRODUCTIVITY GAINS THE CHALLENGE To support our client in reducing its finance and accounting costs. The key focus was on reconciling accounts payable and receivables. The paper-based filing system was dependent on manual inputs and was unable to handle the increased volumes that the client was dealing with as their business grew. THE SOLUTION We leveraged CORE, our proprietary workflow management tool, to streamline the workflow and allocate and track work items to completion. The new tool has replaced the paper-based version. Under the new system, all the received invoices are uploaded into the CORE database. There is a rigorous and well defined process for addressing instances of missing paperwork or erroneous manual entry. We now manage 22 end-to-end processes on behalf of the client. At Xchanging, we practice a philosophy of continuous improvement. We have implemented Six Sigma projects and Kaizen improvements to continue delivering efficiency gains beyond the early benefits of offshoring. BENEFITS Significant cost savings of approximately $216,000 per year Productivity gains of 116% over the engagement Transition from a non-standardized operation to an automated process with defined timelines XCHANGING HELPED THE CLIENT REDUCE COST-PER-INVOICE FROM $4 TO $ XCHANGING

5 OUR ASSETS YOUR ADVANTAGE We provide services across the entire healthcare spectrum from the time a patient walks in for treatment, until the time the claim gets settled by the insurance company. By collaborating with us, you benefit from our: SPECIALIST DOMAIN KNOWLEDGE Our healthcare practice comprises more than 1,000 talented professionals with expertise across the entire spectrum. We offer a wide gamut of services to payers, providers, medical service providers and medical billing companies. Xchanging has certifications and membership from relevant healthcare organizations in the U.S including: American Academy of Professional Coders (AAPC) American Association of Healthcare Administrative (AAHAM) Fellow of Life Institute (FLMI) TECHNOLOGY ENABLED BUSINESS PROCESSING SERVICES We use technology as a strong differentiator that underpins all our offerings. By trying to reduce manual processes where possible through increased use of automation and continually removing non-value added processes, we enable you to raise productivity levels. Our processes are Health Insurance Portability and Accountability Act (HIPAA) compliant. To illustrate our credentials, some facts: We are one of the leading providers of business processing services and software solutions to the insurance industry globally For the London Insurance market, we process insurance policies, premiums and claims. In addition, we also provide broking processing services in accounting and claims administration We have developed and delivered the Insurers Market Repository (IMR), a key part of the London Insurance Market, with over 6000 subscribers globally. The development of the IMR is a key part of the London Insurance market s effort to achieve more efficient business processing GLOBAL DELIVERY MODEL With over 10 service delivery locations and 25 centers across the USA, UK, Asia-Pacific and Australia, Xchanging offers follow-the-sun workflow model with global support capabilities for clients across 48 countries. In Australia, we provide workers compensation and claims management while in America, we provide services for workers compensation as well as professional, automotive, product, general and consumer warranty liability lines of business. XCHANGING S HEALTHCARE BPS OFFERINGS Client Profiling Benchmarking Renewals Client Assistance Programme Healthcare Consulting Network Pharmacy Conversion Provider Outreach Indexing/Data Capture Claims Administration Medical Bill Review Claims Adjudication Insurance Claims Payer Healthcare Offerings Pharmacy Benefits Managed Care s Provider Revenue Cycle Patient Demographic Entry Medical Coding Charge Entry Claim Submission Payment Posting Accounts Receivable Denials Policy Loading Policy Maintenance Enrollment Policy Administration Patient Care Inbound and Outbound Voice Support Letter of Medical Necessity (LOMN) Intake and Reorder Documentation Preparation SCANNING AND DOCUMENT MANAGEMENT WORKFLOW MANAGEMENT MANAGEMENT INFORMATION AND ANALYTICS PROCESS EXCELLENCE EMBRACING COMPLEXITY STIMULATING GROWTH 2014 XCHANGING 04

6 OUR CORE HEALTHCARE SERVICES MANAGED CARE SERVICES AND PHARMACY BENEFITS MANAGEMENT Xchanging provide end-to-end services in the Managed Care and Pharmacy business. We work with stakeholders across the spectrum from patients and employers to insurance carriers and third party administrators, injecting efficiency and cost-effectiveness into the value chain. We provide telephone, and instant message based support, in addition to transaction processing and other back-office fulfillment services to four of the top workers compensation service providers in North America. PHARMACY AND MANAGED CARE OFFERINGS Diagnostic Therapy Pharmacy Benefit Transport and Translation Durable Medical Equipment and Medical Supplies Home Health Critical Care Home and Vehicle Modification Nursing B U S I N E S S SETTLEMENT SOLUTIONS Vendor Setup Intake Referral Billing Accounts Payable Accounts Receivable U N I T S New Vendor Setup Vendor Credentialing Contract Setup Contract Compliance New Intake Modifications Extension of Cancellations Exception Approval Follow-up Case Referral Scheduling Authorization Follow-up Confirmation Notes Carrier Billing TPA Billing Contract Pricing Review Authorization Review Medical Record Appeals Bill Review Adjustor Contacts Case Manager Contacts Invoice Processing Medical Report Payment Posting Denial Credit Adjustments Refunds Payer Follow-up Reconciliation S E R V I C E O F F E R I N G S XCHANGING

7 PROVIDER SERVICES Our services support the end-to-end activities in the Revenue Cycle (RCM). Our specialized RCM methodology delivers significant business impact to the service provider with focus on improving cash flows and increasing savings. Our efficient processing methodology has enabled clients to reduce their Days Sales Outstanding (DSO) and AR dues significantly. Claim problems are identified and resolved for payment Insurance Verification Verifies the patient s insurance details Inputs the payment details into the billing software against the appropriate patient account The audited medical claims are submitted and followed-up with insurance companies AR Analysis Payment Posting PROVIDER Claim Submission Demo and Charge Entry Coding and Audits Enters the patient s personal information from the demographic sheets Assigns numerical codes for current procedural terminology and the diagnosis code. Entries are checked for accuracy based on carrier requirements PAYER SERVICES In addition to regulatory compliance, healthcare payers are driving more focus on the patient. Xchanging s Payer s enables you to align your internal processes, to offer an enhanced customer experience, while at the same time keeping an eye on the cost of operations. We specialize in Agent and Broker, Policy Administration, Claims, Billing and Collection and Provider s. Identify Contribution Subrogation Provider Credentialing Provider Contract Provider Maintenance Provider Coordination of Benefits Claims Profitability Analysis for Portfolio Underwriting Forecasting Budgeting Risk Analytics Statistical Modeling Actuarial PAYER Agent and Broker Underwriting Policy Administration Commission Performance Agency Data Quote Issuance Quote Binding Plan Document Generation Certificate of Coverage Processing Scanning and Imaging Pre-adjudication Adjudication Collections Billing and Collection Premium Accounting Premium Reconciliation Premium Follow-ups Regulatory Reporting Enrollment Processing Issuance of Certificate Renewals Processing Policy Termination Refunds EMBRACING COMPLEXITY STIMULATING GROWTH 2014 XCHANGING 06

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9 OUR HEALTHCARE ANALYTICS EXPERTISE The development of healthcare insurance exchanges in countries like the US will lead to greater sharing and availability of data as well as bring down healthcare costs with the ability to predict future healthcare needs continually improving. During the last decade, there has been a significant progress in digitization of medical records and putting more patient history online in the form of electronic databases. However, hospitals too have adopted information systems such as Electronic Medical Records (EMR), Integrated Information Systems and Hospital Systems (HMS) to improve clinical care and operations. This is adding real-time data to the electronic database. Hospitals now need to analyze this data in order to improve the quality of healthcare and identify the health risks of the population. Xchanging s Analytics experts can help you strike a perfect balance between offering high quality services and affordable costs. Our Vendor Performance Scorecard can help you identify top vendors and key parameters influencing performance by simultaneously helping you select the right vendor for a specific task. Through Analysis of Intake Requests, we can help you understand the flow of service intakes by type, cost, frequency and geography and improve profitability by negotiating a higher percentage on vendor contracts. Through our First Call Resolution Analysis, you can identify and address any delays in proactively resolving customer issues. Our Revenue Cycle Analysis will help streamline the RCM process and minimize DSO and Daily Payment Outstanding. XCHANGING HEALTHCARE ANALYTICS BESPOKE SOLUTIONS BUILT AROUND AN END-TO-END RANGE OF DATA AND ANALYTICAL SERVICES Data Collection/ Aggregation Data Decision Support Analytics Predictive Modeling and Data Mining Business Interpretation Data s Analytical s OUR ANALYTICS SOLUTIONS FOR HEALTHCARE INDUSTRY PAYER Provider Performance Pharmacy Analytics Patient/Consumer Analytics Claims Analytics PHARMACY AND MANAGED CARE Cost and Quality of Product Launch Demand Forecasting Product Lines Profitability Market Segments PROVIDER Cost of Care Analysis Payment Models Health Outcomes Demand Analysis Pricing and Segmentation Patient Risk and Safety CONSUMER Plans and Pricing Segmentation Patient Demographics Customer Satisfaction Index CLAIMS Severity Analytics to Reduce Claims Cost Loss Reserves Forecast Process Optimization Cost of Settlement RISK Outcome based Pricing Models Collection and Delinquency Analytics EMBRACING COMPLEXITY STIMULATING GROWTH 2014 XCHANGING 08

10 At Xchanging, we focus on the business outcomes by using technology enabled business processing services to increase automation, reduce manual processes and improve response and reaction time. OUR CLIENTS BENEFITS INCLUDE: Reduced processing cost and increased productivity 100% invoice visibility in our workflow tool within 24 hours Faster approvals and detailed accrual reports provided Duplicate payment identification Reduced DSO Centralized archiving of all receivables data and documents Invoices linked to critical supporting information Facilitate reconciliation from invoicing to remittance Reduced operations and collection costs XCHANGING

11 HOW CAN WE HELP YOU STIMULATE GROWTH IN YOUR BUSINESS AND MANAGE THE MARKET COMPLEXITY? Contact us today by visiting: AMERICAS Phone: +1 (781) EUROPE Phone: +44 (20) ASIA-PACIFIC Phone: +91 (80) EMBRACING COMPLEXITY STIMULATING GROWTH 2014 XCHANGING 10

12 ABOUT XCHANGING Xchanging is a global business processing, technology and procurement services provider, with over 8,000 people serving customers in 48 countries. These three service lines are applicable across industries, as well as industry-specific offerings for insurance and financial services companies. We have a ten-year track record of innovation and reliable delivery, and anticipating and responding to our customers needs. Our service quality is reflected in the industry awards and world-class certifications we receive. FIND OUT MORE Transform your business, stimulate growth. AMERICAS 281 Winter Street Suite 380, Waltham, MA 02451, USA Phone: +1 (781) enterprise-us@xchanging.com EUROPE The Walbrook Building, 25 Walbrook, London, EC4N 8AQ, UK Phone: +44 (20) enterprise-eu@xchanging.com ASIA-PACIFIC Xchanging Towers, SJR ipark, EPIP Area, Whitefield Bangalore, , India Phone: +91 (80) enterprise-apac@asia.xchanging.com Realize more at: xchanging.com/us Business Processing/Technology/Procurement twitter.com/xchanginggroup linkedin.com/company/xchanging 2014 Xchanging 12/03/14