Provider Solutions. Sutherland Healthcare Solutions

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1 Provider Solutions Sutherland Healthcare Solutions

2 What is your TRUE RETURN? The financial strength you need to offer great patient experience today and tomorrow. Our healthcare experts are ready to partner with your team to create a custom, process-focused solution that is fast, accurate and designed to achieve your financial goals. As an extension of your team, we tackle your challenges on any scale whether a targeted solution to troubleshoot one part of your revenue cycle or a full-scale, sustainable platform for managing the entire process. Our first-hand, specialized knowledge of the healthcare revenue cycle is reflected in everything we do. Sutherland s team brings personal experience as healthcare leaders around the country, as well as experience in delivering the results our partners need. Our deep clinical domain offers unparalleled resources and experience Six Sigma methodologies facilitate measurable process improvement, beyond conventional limits Blended shore delivery offers lower cost without sacrificing quality Compliance program strictly adheres to HIPAA and other healthcare information regulations ISO:9001 certification ensures strict quality management standards in our daily operations Advanced, intelligent software ensures a strong return on investment End-to-end business outsourcing solutions span the healthcare market 2 3

3 Full Revenue Cycle Outsourcing Solutions Sutherland s solution-focused partnership enhances your team s resources every day. From pre-registration to bad debt pre-lists, our collaborative approach delivers long-term, sustainable results to your bottom line, and our speed to value is unsurpassed in the industry. Qualified uninsured patients get help finding an alternative payment source Policies and procedures that ensure fair and dignified collection for all patients Complete and smooth transition, quick ramp-up to full productivity, positive impact to cash flow, and timely billing of all third-party accounts Resolution of denials and delays in third party payment processing, ensuring the best A/R metrics possible State-of-the-art credit analysis, advice on patient payment agreements, and the best outcomes for self-pay collections Focused Outsourcing Solutions We quickly diagnose and fix specific processes that impact cash collections, allowing you to maintain control of the most sensitive parts of the revenue cycle. Sutherland Healthcare Solutions works on the more labor-intensive elements, such as the outpatient A/R, billing platform management, or credit balance resolution, so that you can focus its strengths on issues closer to your core mission. Laser-like focus on a specific area of your revenue cycle Attention to your chosen areas of focus Minimal ramp-up time Highly-trained, bi-lingual customer service specialists who carefully listen to every patient call and ensure the highest levels of satisfaction for your patient community 4 5

4 Third Party Solutions With extensive experience in all major billing platforms and information systems, Sutherland uses smart technology to work all third party accounts to completion. Our process-driven staff ensures the best use of tools and effective, comprehensive follow-up of accounts. Most importantly, Sutherland never loses sight of the goal - increased cash collections and reduced days in A/R. Management of all Return to Provider (RTP), Additional Documentation Request (ADR), and related information requests immediately Delays in payment addressed in the first 21 days Work lists defined within 48 hours of receipt of the denial information Sophisticated set of reports detailing final denial accounts Root cause analysis of third party denials by type, by department, by physician Medical Coding Our comprehensive medical coding meets the essential needs of hospitals, medical practices, and freestanding ambulatory surgical centers so that you are able to focus on your core mission of quality patient care. Sutherland fills the gap, whether that is working the backlog, coding your ED accounts, pitching in for vacations, or outsourcing your entire coding department. HIPAA-compliant electronic access to your EMR or courier exchange of medical records AHIMA- and AAPC- certified coding teams with experience in your specialty areas Coding backlog support Documentation deficiency reports and physician documentation training Pricing models that are lower than in-house costs Medical denial appeals and RAC audit preparation 6 7

5 EMS Billing, Follow-up, and A/R Management Combining our network of dedicated healthcare experts with smart mobile technology, Sutherland s EMS solution works quickly and efficiently bill and follow-up on every 911 emergency and non-emergency transports. Our team knows the unique, on-the-go needs of EMS providers and offers training on data capture for your EMTs to eliminate back-end billing and collection edit failures. From medical coding to remittance processing to customer service and carrier relations, we offer a customized billing platform to handle every patient interaction your team encounters. Customized development and installation of EMS-specific processes that include detailed auditing and reporting Quick ramp-up to full productivity, positive impact to cash flow, and timely billing of all third party accounts Advanced technology providing real time access to patient transport data Dedicated, highly-qualified EMS service center accuracy ratings Managing the most complex COB and subrogation claims, with timely follow-up for those requiring long-term status reviews and updates 8 9

6 Private Pay Solutions Your uninsured patient accounts have a critical impact to your bottom line, so we offer onsite financial counseling, casework completion, and field service assistance. Above all, Sutherland handles collectible self-pay balances with dignity and fairness, working with the patient to establish reasonable payment plans. The result leads to reduced bad debt expenses by identifying and collecting accounts early. Denial Management Utilizing proprietary workflow software, we retrieve and interpret denial information, review HIM documentation, and prepare compelling appeal packages for review by the payer. Our skilled clinicians review medical records on clinical denials to complete appeals, confirm receipt of the appeal, and demand claim disposition as quickly as possible. Sutherland forwards technical denials to the clinical appeal team for medical necessity review and appeal, when warranted. Web-based technology sorts, refines, and evaluates denial details from 835s, paper EOBs, and correspondence Easily exportable reports to basic desktop applications. Timely and accurate workflow tracking Pre-implementation assessment to maximize benefits Careful review of each patient s situation, using the patient s financial and social indicators to determine proper workflows Automated dialers, interactive voice recognition, and online auto-pay tools for ease of payment and payment plan monitoring Process-driven, bi-lingual customer service representatives bring solutions to your patients problems, with one-stop calling Collaborative approach with your Patient Access and General Accounting departments to ensure a timely and complete Medicare bad debt log for your cost report Call recording for training, quality assurance, and compliance Account scoring techniques specifically designed for healthcare collections, which helps protect the patients from undue collection efforts Extended collection hours and patient-friendly payment technology Billed A/R over 90 days ratio 10 11

7 Patient Access Partnership Our Patient Access Partnership, a combination of technology solutions and services, addresses the inherent challenges present in Patient Access departments around the country. Sutherland ensures a complete review of all your daily registration and corrects any errors in patient data as well as demographics and other data that can impede the revenue cycle. Error identification before the first bill is dropped Accelerated receipt of outstanding revenue that is delayed due to registration errors and pre-authorization failures Cost to collect reduction, since errors are corrected prior to billing, rather than through labor-intensive review of EOBs, correspondence, and telephone inquiries Employee scorecards to provide staff accountability and training Robust internet-based reporting system to provide the data necessary for root cause analysis Instant accountability and rapid staff feedback to allow proactive management 12 13

8 ICD-10 Transition Sutherland Healthcare Solutions helps providers tackle the challenges in upgrading to ICD-10 Coding standards through assessment, design, implementation, training, go-live, and beyond. This transition impacts clinical documentation processes, encounter forms/superbills, practice management systems, electronic health records, medical coding and billing, contracts, and public health and quality reporting protocols. Fully customizable solution to meet ICD-10 compliance requirements Secure hosting and/or in-house deployments Initial cost estimates for the ICD-10 transition End-to-end project management through all phases that include the assessment, strategy development, remediation, testing, and implementation Increased understanding of ICD-10 implications on your operations and systems Reduction of the potential negative impact to cash and productivity Accountable Care Organizations Sutherland s unique understanding of the hospital, physician, health plan, and healthcare IT segments allows us to help ACO s quickly implement their setup process and manage costs while staying focused on quality patient care. The path to creating and operating an ACO can be very complex depending on your current infrastructure, technology capabilities, and ACO requirements as per the Centers for Medicare and Medicaid and the American Hospital Association. Our proprietary technology tools and six-sigma based methodologies will help offset those costs by creating or enhancing your information technology and data analysis infrastructure. Build prospective budgets and resource planning Calculate performance metrics Manage complex contracts Effectively distribute shared savings 14 15

9 Medicaid and Patient Advocacy Solutions Sutherland s dedicated team of eligibility advocates, financial counselors, and field resources staff helps patients navigate through the difficult eligibility process at every step, ensuring that your patients receive the highest level of dignity and respect. Our patient-friendly billing philosophy improves patient satisfaction, positively impacts cash flow, and further reduces bad debt. Legitimate third-party accounts like worker s compensation and liability to immediately reduce bad debt Medicaid eligibility to link the patient to the applicable state or federal program that best suits the patient s financial and medical status Medicaid billing to ensure timely payment from the state on all accounts under our supervision, further reducing bad debt by converting previously branded self-pay accounts to Medicaid Support programs available to non-federally-sponsored patients, including state-sponsored assistance, hospital-based community benefit programs, county and local funding, and other sliding-scale patient discount programs Proprietary workflow management software to ensure timely and compliant work Timely reports on all accounts assigned to ensure minimal impact on accounts receivable Patient Accounting Services Timely billing of all accounts is a cornerstone of an effective revenue cycle, and ensuring that all bills are submitted with the correct information is an underlying goal of any billing department. Once a bill is submitted, timely and appropriate follow-up across the entire A/R process will play a major role in ensuring that the total cash reimbursement is maximized. Identification and tracking of errors prior to claim submission to minimize delays Unique insight into the upstream areas that are the underlying causes of downstream billing delays Propietary workflow management and reporting tools, which incorporate our best-in-class A/R follow-up techniques Systematic account management process ensures all claims are worked timely - regardless of amount outstanding 16 17

10 Physician Consulting Services Sutherland provides a variety of qualified professional consulting services to support physician practices. Our team offers web-based claims processing, enrollment assistance, training and implementation, and business office support to help your office run smoothly so you remain focused on patient care. Implementation of internally developed Health Level 7 (HL7), an ANSI-accredited standard for electronically defining clinical and administrative data in the healthcare industry tool Integration of clinical and patient demographics with EHR PM and EHR data conversions, including demographics, clinical data, encounter notes, and document and image conversions Eligibility verification where the provider, payer, and user details are setup and the client is then trained on how to check on eligibility Transaction Service Solutions We offer a full array of technologies to deliver accurate transaction services at the highest quality level. Solutions range from the most basic double-key data entry work to the most sophisticated electronic transaction processes. Sutherland Healthcare Solutions brings a rdepth of experience and elationships with many technology platforms to deliver our solutions cost-efficiently. Remote desktop with the most sophisticated VPN (Virtual Private Network) tunnels to send and receive secure, accurate transactions Completely digitized payment records (paper EOBs, various correspondence, etc) as well as 835s, to automate cash posting Leading-edge experience in physician and hospital coding using ICD-10-CM conventions 18 19

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