Organizational Basics

Transcription

1 Leading the Way

2 Part I Organizational Basics

3 Executive Summary Medical Coding and Billing services currently exist to manage medical practices. These services relieve medical professionals of tedious detail work, but rarely do they offer a means to substantially maximize the practice's bottom line. National statistics show only about 70 percent of insurance claims, initially submitted on paper, are ever paid by insurance carriers. With electronic submission Physicians Claims can increase the percentage of claims paid to around 98 percent. Additional statistics indicate that it currently costs a medical practice between $8.00-$10.00 per claim (for independent clinics) to process insurance for their patients. Physicians 1st Billing and Claims can reduce these costs by 50 percent or more. Statistics also show a 30 percent suspension/rejection rate for insurance claims. But adequate profit margins allowed medical practices to ignore sound business procedures. Again the proposed change of ICD-10 and HIPAA 5010 will lead to the percent of productivity loss in near future. Physicians Claims is contributing over $9,000 to their business. Here we are requesting to borrowanother$5,000.wewouldliketohaveyourattentiontothisvalueadd. As a ****** we continuously work to overcome the solution by providing the adequate platform with promise to minimize the claim rejection by % (alternately gain in revenue by 20-30%). Our end to end expertise to healthcare domain and innovative approaches lead us to achieve and sustain the professional excellence.

4 Potential Innovators Snayhil Rana, Chief, BB, CPC-H, CPCO Snayhil has more then 10 years of experience in end to end healthcare deliverance. He managed transition and stabilization for several of high end healthcare project with top 10 Indian outsourcing providers.

5 Mission Statement To acquire one hospital account and 100 physician account to process 15,000 claims a month by month 3. To become recognized as a local industry expert in the field of medical reimbursement along with increase in revenue by 20% for our customer and 1.5 % bonus increase in business revenue by assessment and fixation of overall denial. To add several additional services to our To add several additional services to our initial offering of electronic claims submission, including: -Code optimization, Denial Reduction. -Managed care contract analysis. -Full practice management. -Customized reporting. - Fee analysis. - Medicare financial impact analysis. - ICD-10 Implementation services.

6 Organizational Value Customer First Team Synergies Human Value Purpose Oriented Leading Innovation Knowledge Centricity

7 Target Market Segment Independent Physician Healthcare Software Vendor Healthcare Payers Healthcare Consultant Hospitals

8 Part II Technical Strategy

9 Services Offered Medical Coding/Billing E-2-E Practice Management ICD-10 Transition Healthcare Consultation

10 Process Flow Patient Visit Patient Eligibility Verification Medical Coding Provider Payer Medical Billing EOB Follow-up Denial/AR Management Payment Capture, Posting

11 Expected Process Flow Human Resources Technical Data Input Via FTP/SMTP/ EMR Required software Inventory Infrastructure & Logistics Medical Coding Medical Billing Practice Management Healthcare Consultation Processed/ Coded Files upload on FTP/SMTP/ EMR Compliance adherence Production - 100% Accuracy - >98.5 % TAT 48 hrs.

12 Expected Project Execution W - 2 W-4 W-6 W-8 W-10 W-12 W-16 W -20 W-24 Facility Start Up Milestone - 0 Training and Testing Project Transition M -1 Ramp-Up Plan (E-20) ( Q-95%) (P 75%) Project Stabilization, Process Standardization Ramp-Up Plan (E-50) ( Q-97%) (P 90) Process Standardization, Continuous Improvement M -2 M -3 Ramp-Up Plan (E-50) ( Q-97%) (P 90) Continuous Improvement, Business Development M-4 Key : E-Employee, Q- Quality Measure, P-Production, M-Milestone

13 Part III Cost Benefit Microanalysis

14 10-18 % 1-2 % 5-9 % 1-2 % 3-5 %

15 Market Research Analysis The average cost that physician expends on their claim processing is % of their revenue, which goes to third party for claim processing, however 5-9% of the total physician revenue expanded on Medical Coding only. Type of Healthcare services Current expanses in percentage of revenue Expected Expanses (in percentage) Medical scheduling/front office 1-2 % 1-2 % Medical Transcription 1% 1% Medical coding 5-9% 4 to 7 % (10 % lower then current expanses) Medical Billing 1-2% 1-2% AR Follow Up 3-5% 1-3% Total Direct Saving Approx 20 percent of the current expanses

16 Practice Expanses Direct Benefit Analysis Practice Expanses* Practice (in percentage) Current Future Medical Coding AR Follow UP Total All the benefit reflected above is based upon the current medium level of surgical practice ad the value shown here is just the approximate figure only. Depending upon the complexity, the Practice expanses may change significantly which is subject to the several operational factors.

17 Practice Expanses Direct Benefit Analysis

18 Practice Expanses Indirect Benefit Analysis ReductioninDenialPercentageby50%,whichcanadd 10%morevaluetothephysiciantotalrevenue. Increased First Pass Claim. HIPAA Complaint Platform. Less TAT(Turn-around-time) FreeICD-10Transitionsupport***. 24x7 Customer support(you will be provided access to the higher authorities).

19 Thank You Snayhil Rana