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Please Insert Client Logo e4e Healthcare Services Comprehensive Solutions for the Healthcare Ecosystem © e4e – Confidential and Proprietary e4e Healthcare Business • Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines. • With over 19 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP. • A cross-border Healthcare Company with proprietary Software Platforms for Revenue Cycle Management, Claims Processing, Audit and Process Automation. IT Enabled Services • Technology agnostic solutions – experience in working with over 30 Provider and multiple Payer Platforms. • Expertise in System and Platform Integration – System Interface, Electronic Data Inter-change and Workflow Efficiency. • We process over 135 million transactions annually and code/ audit over 30 million charts. • HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified & SSAE 16 Type II Compliant Company. © e4e – Confidential and Proprietary & BPO 3 Offices in Countries 2500 + Employees Globally 6000 Physicians & 191 Work with over Hospitals 2 e4e Healthcare Service Landscape Revenue Cycle Management Technology Solutions SERVICE LANDSCAPE Payer Services Value Added Services End to End Solutions for the Healthcare Payment Continuum © e4e – Confidential and Proprietary 3 © e4e – Confidential and Proprietary •Customer Support centers •Business Rules Configuration •Fraud , Waste & Audit Solutions •RAC Response Management Solution for Providers •Process Improvement Consulting for Physicians •Ancillary Services for Payers •Business consulting Technology Solutions •Front End Claims Processing and Management •Claims Adjudication and Error Suspense Resolution •HCC Coding Services •Enrollment Membership and Billing Services •Customer Service •Mailroom Service •Grievance, Appeal & Refund Posting •Reports Management Value Added Services •Patient Access Management •Charge Capture including clinical documentation improvement •Claims, Remittance & Denial Management •Hospital, Physician & Remote Coding •HEDIS & DRG Coding •Revenue Recovery & A/R Services •Charge Integrity & Compliance Solutions •Successful EMR driven billing service Payor Services Revenue Cycle Management e4e Healthcare Services •Claims Administration Platform •Scheduler •Workflow Solutions including OCR •ICD 10 Transition Support •Document Management System •Client Service Portal •Member Portal •Managed Services Network & Desktop management 4 Geographic Presence Baldwinsville NY, USA Towson MD, USA Noida India Bangalore India © e4e – Confidential and Proprietary Manila, Philippines Chennai India 5 Hospital Service Offerings Patient Access Management • Scheduling & Registration • Eligibility & Benefit Verification Billing • Data Entry • Cash Posting • Credit Balance Report Medical Coding • Outpatient Visits • Clinic Visits • Emergency Department • Same Day Surgery • Inpatient Denial Management • Weekly review to check on denials A/R Follow up • Account Receivables Service • Insurance Follow Up Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service © e4e – Confidential and Proprietary 6 Provider Service Offerings • Coding Audit • Charge Master Management • Billing and Coding Research to plug areas of ‘Revenue Leak’ • Account Receivables Service • Calculate projected A/R collections f or outstanding accounts • Monitor, identif y and prevent f uture payment abuses f rom payers • Underpayment Recovery Services • Seamless integration with Provider Accounting Systems • Electronic Claim Generation and Transmission • Payment Posting • Denial Management • Reconciliation • Ref unds • Provider Data Updates • Patient Billing © e4e – Confidential and Proprietary • Scheduling & Registration • Patient Data Entry • Eligibility & Benef it Verif ication • Point of Service Collection Patient Access Management Charge Integrity & Compliance Solutions Remote Coding Revenue Recovery & A/R Services Charge Capture Claims Remittance & Denial Management • Remote Coding • Coding Staf f Augmentation • Charge Capture • Charge Audits f or accurate & compliant billing • Identif y missed charges on retrospective claims • Improvements in Clinical documentation through education session 7 Payor Service Offerings • Benef it Loading • Provider Loading • Fee Schedule Loading • Member Inbound Calls • Provider Service • Online Claim Status Query Member Enrollment Configuration Support Mail Room Services & Claims Management Customer Service • Member/ Provider • Provider/Hospital DirectoriesReport generation • UM , Statutory, Canned Reports • High Dollar Value Audits • Recovery Audit Contract (RAC) Audits • Durable Medical Equipment (DME) Audits © e4e – Confidential and Proprietary • Member Enrollment/ Disenrollment • Member Maintenance Grievance Handling & Refund Posting Reports Management & Compliance Solutions • Scanning and Batching • Optical Character Recognition Conversion • Data Capture • Claim Inf ormation Capture • Claim Data Audit • Member Validation • Benef it Validation • Fee Schedule Validation • EOB Generation • Front End Rules Application and Data Verif ication • Receipt and Records of Appeals • Analysis of Appeals • Amount Payable f or f avorable cases • Process f or payment / generate check • Generate provider letter if original denial is upheld • Ref und Posting 8 Technology Services Practice Management System • Velocity PBS Claims Management Systems Electronic Medical Records • Through Partner’s RCM Tools • PriceFast - Medicare Quick Pricer • OCRAS – Optical Character Recognition and Audit System • Workf low Solutions © e4e – Confidential and Proprietary Payer Processing Tools • Velocity CPS • HoCAS – DRG Coding Audit System • CodED – Auto Coding Solutions • ACES – Automated Coverage Check • HITS – Hospital Interconnectivity Tools • I DOS – Document Management Solutions • Workf low Solutions 9 Value Added Services •Conducting focus assessments of HIM workflow challenges, staffing, and performance improvement needs. •Improving revenue cycle, outcomes reporting, release of information, issues with working DRGs & ICD-9 codes. HIM Operational Review Services •Providing comprehensive suite of products and services to enable a smooth transition to ICD 10. •ICD-10 Readiness Assessment, ICD-10 Impact Assessment Service supported by applications ICD-10 Transition •RAC risk assessments •Transition auditing, hospital-specific MS-DRG, hospital outpatient, and physician service accounts •Support in deployment of RAC management programs RAC Management © e4e – Confidential and Proprietary •Improving the accuracy of clinical documentation and DRG coding through the coordinated efforts of caregivers, physicians and coding professionals, guided by experienced e4e consultants DRG Assurance •Sustaining the benefits of the DRG Assurance with leavebehind software that provides guidelines for concurrent chart review and identifying potential compliance risks, frequently missed concepts, and issues with working DRGs and ICD-9-CM codes Clinical Documentation Improvement •Inpatient coding validation services provide comprehensive reviews to assess DRG code assignments, improve documentation, and quantify the impact of coding changes. •e4e has a suite of proprietary technology platforms primarily designed as an enabler to a more efficient and effective operating model. DRG Validation Services Technology Services •Velocity – RacER - CodED 10 Technology & Platform Agnostic Solutions Multi - Platform Hospitals • Epic • Cerner Systems • IDX • Paragon • McKesson • Meditech • Medicare DDE • TMHP (Medicaid of Texas) • Next Gen Hospital System Providers • • • • • • • • • • • • • 3M Allscripts and Misys Meditech Cerner Systems Siemens Signature Image Flow/ Image Star e ClinicalWorks GE systems Amicas McKesson QMS Kareo NextGen • HMS Hospital System Payers & TPAs • MS4 Hospital System • • • • © e4e – Confidential and Proprietary Multi - Specialty EZCap Power MHS Diamond Health trio Hospitals • • • • • • • • • • • • • • • • • Neurology Gastroenterology Rheumatology Radiology Neurosurgery Emergency Cardiology Birthcare Healthcare Radiology Obstetrics Oncology Physical Therapy Ophthalmology Pain management Rehab therapies Acute Internal Medicines Orthopedics Providers • • • • • • • • • • • • • Acute Care Women’s Health Dialysis Centers Cardio Surgery General Surgery Emergency Department Ambulatory Services Pathology Orthopedics Anesthesiology Nephrology Hospitals Radiology Payers & TPAs • HMO Plans (include Medicare, Medicaid and self funded plans) 11 Delivery Strategy Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings US Onshore Rightshoring US Onsite India Offshore Philippines © e4e – Confidential and Proprietary 12 The Numbers Speak Process 2012 2013 2014 YTD - January Coding 30,361,972 27,530,717 2,455,722 Accounts Receivables 3,301,539 3,091,395 Cash 10,854,505 13,934,574 1,277,912 Charge 7,358,441 7,397,076 838,549 Patient Demographics 4,762,631 3,664,214 414,779 © e4e – Confidential and Proprietary 266,200 13 Our Performance & Operational Scale Delivering 100% on our Client SLAs & KPIs over several years Outcome Measures Metrics Process Measures Actual Targets Collection as a % of Gross Charges 55% Targeted Revenue Increase Y-O-Y 9% AR days for Commercial & Blue Cross 42 days 180 days + AR as a component of total AR < 8.5% Denials on patients with coverage and benefits information Denials & Transmission Rejects AR Days for Medicare Target Financial Claim Accuracy (for RCM) 99.1% Administrative Claim Accuracy (for RCM) 99.7% Coding Accuracy < 0.25% 3% Specific Target for a customer for a location Metrics TAT for Claims $ 1.275 m 97% plus Norm is 24 hours, with exceptions delivered even with in 8 hours < 20 Our Operational Scale © e4e – Confidential and Proprietary 135Mn Transaction processed per annum 30Mn Charts coded & audited 5.79Mn Claims processed per annum $1.61Bn Paid on claims per annum 14 Foundation for Success • • • • Data Analytics Optimal Staffing Weekly, Monthly and Quarterly calls Exclusive focus on TAT and revenue collection • Tight quality assurance measures • HIPAA Compliance Delivery Excellence • Project Scoping and opportunity identification • Analysis on key drivers affecting the Process • Cost effective solutions to improve the system • Structured approach to execution and delivery • US relationship Management • Managing by Business Goals © e4e – Confidential and Proprietary Resource Capabilities Transitions Governance • • • • • Hiring the right people Employee longevity Product and Process Level understanding Contextual Training Periodic Refresher Training opportunities Business Excellence Infrastructure & Automation • Fact based decision making approach • Provides transparency & build controls on operations • Ensures highest level of Data Integrity, Security & Compliance • Robust Infrastructure for uninterrupted business • State of the art delivery solutions • In house application development team to customize your solution • Powerful Knowledge Management tools 15 Why e4e ? • Reduced costs by up to 40 % by outsourcing to e4e. • Consistent superior service delivery against client SLAs and KPIs. Profitability • We are flexible and nimble and have a transitions methodology to quickly ramp our operations. • Continuous Process Innovation leveraging Technology. • Process Re-engineering with customized automation tools. • Complementary Service Offerings Strategic Initiatives Growth • Scalability & operational flexibility • SW platforms and skilled staff to delivers significantly better economies of scale for you. Our values and commitments of Adaptability, Community, Excellence and Integrity is what will drive the success of this engagement © e4e – Confidential and Proprietary 16 Contact Us e4e Healthcare Business Services 502 Washington Avenue, Suite 200, Towson, MD 21204 Tel: +1 (443) 275 1632 e4e Healthcare Business Services 60 Oswego Street Baldwinsville, NY 13027 Fax: (315) 638-6309 Mihir Bhuta Vice President - Sales Mobile : +1 646 431 4540 [email protected] e4e Healthcare Business Services Fortune Towers 152, Thoraipakkam Pallavaram, Radial Road Kovilambakkam Chennai - 600 117 Tel: +91 44 2268 1240 Fax: +91 44 2268 1244 Toll Free: +1 (877) 559 8176 e4e Global Services Philippines Inc. 15th Floor, Fort Legend Building, Bonifacio Global City, Taguig City 1634 e4e Healthcare Business Services Unit No.1303-1304, 13th Floor Prestige Meridian - II #30, M.G. Road Bangalore 560 001 Tel: +91 80 3256 8763 e4e Healthcare Business Services H33 Sector 63 NOIDA Uttar Pradesh – 201301 Tel : +91120 6746666 Fax :+91120 6746688 © e4e – Confidential and Proprietary Thomas Renny George Vice President - Sales Mobile: +1 (813) 760 5126 [email protected] Paul Arvantides Vice President & Head US Coding Services Mobile : +1 315 254 4268 [email protected] Kathleen Maher Associate Vice President Sales Mobile : +1 617 512 2318 [email protected] Teresa Crawford Associate Vice President Sales Mobile: 214-289-9822 [email protected] 17