Introduction TO

1. Introduction TO Speech Generating Device Medical Insurance Reimbursement Process

2. Our Mission O’Brien Technologies is committed to bringing communication alternatives to those who have lost or do not have the ability to speak. Our goal is to simplify the interaction process between survivors and their caregivers, speech language pathologists, as well as the general public. We are doing this by applying the latest technology to speech recovery.

3. How Do We Get Paid For These?

4. Medical Insurance Reimbursement • In order for us to approach private health insurance, Medicaid, or Medicare, we must first obtain all of the information needed to process our Client’s claim • This information is listed on the Medical Insurance Reimbursement Checklist

5. Goal of Presentation • The following pages cover the steps to be taken and items necessary for us to be able to process a claim. The goal of this presentation is to explain the sales and reimbursement process • We will start with the Medical Insurance Reimbursement Checklist • We will then take you through the process step by step • If you have any questions about this process or presentation, please contact: wade.fulton@obrientechnologies.com or ed.buchholz@obrientechnologies.com

6. Key Personnel • The key O’Brien personnel managing this process are the Client Care Coordinator (CCC), the Key Center Account Manager (KCAM) and our Medical Insurance Reimbursement Specialist (MIRS) • These items should be initiated by the CCC or KCAM and sent to the MIRS by Fax (888.645.8882) or scanned and emailed to claims@obrientechnologies.com

7. Reimbursement Checklist We offer electronic copies of the items listed below: • Complete the Referring SLP Profile (Form OBT-SLP1); This form contains information that the Client Care Coordinator (CCC) or the Key Center Account Manager (KCAM) needs to determine if the client or SLP qualifies for our services • Deliver the HIPAA & Privacy Practices Statement (Form OBT-C1) to the Client, there is a box on Form OBT-C2 that needs to be initialed confirming receipt

8. Reimbursement Checklist • Have a Client Profile (Form OBT-C2) completed: This form contains the information our Medical Insurance Reimbursement Specialist (MIRS) needs to qualify the Client (so we will get paid) • We need a signed claims form CMS-1500 • We need a copy of both front and back of all the Client’s Insurance, Medicare/Medicaid ID Cards. These cards contain important information needed to properly file a claim

9. Reimbursement Checklist • A copy of any existing Letter of Denial: If the Client’s Private Insurance has denied the claim and they have Medicaid as their secondary insurance, we need a copy of the letter of denial: We cannot approach Medicaid without it • A signed Assignment of Benefits & Release: This form authorizes the payment of benefits from Medicare or other insurance companies to O’Brien Technologies, Inc. for equipment or services provided to the Client. (Form OBT-C3)

10. Reimbursement Checklist • A completed Speech-Language Pathology Evaluation For Speech Generating Device (SGD) (Form OBT-SLP2): This Form is a written evaluation by a speech language pathologist including: • client/patient diagnosis • prognosis • communication capabilities • ability to use the device • a comparison of AAC devices • examples of how denial of a communication device could endanger the Client/patient’s health and/or safety

11. Reimbursement Checklist • A Letter of Medical Necessity: This is a letter from the physician and/or speech language pathologist explaining the medical necessity of the device and is required by some states, but recommended in all (Form OBT-C4) • A Prescription: We need a prescription from the patient’s primary care physician listing the Survivor Speech Companion System™ and all other accessories recommended (Form OBT-C5)

12. Reimbursement Checklist • If applicable, a Rental Order Form & Rental Contract: If renting rather than purchasing, we need two completed and signed forms (Form OBT-C6) & (Form OBT-C7) • Misc.: The following items are not required, but may be beneficial in obtaining approval: • Professional Reports (OT, PT, Teacher, etc.) • Photos or Video of patient using device • Peer Review

13. Process Origination • The sales process begins when one of our Client Care Coordinators or Key Center Account Managers makes contact with a Speech-Language Pathologist who is interested in performing a Client evaluation with our Survivor Speech Companion System. This contact can originate from either an inbound or outbound call or email. • Due to the expense and limited amount of loaner devices, we have established minimum standards for SLP participation. The SLP should meet these requirements and have a prospective Client who they feel is a good candidate for evaluation and purchase of our system.

14. SLP Qualification Process • The Client Care Coordinators or Key Center Account Manager determines if the SLP is qualified after receiving a completed SLP Profile (OBT-SLP1) • After a review of this document, the SLP is informed of acceptable status into our loaner program with Ambassador service

15. Loaner Outreach Program • This program is designed to allow Speech Language Pathologists and other Augmentative and Alternative Communication and Assistive Technology Evaluators access to hands-on use of our products • They may borrow a pair of our speech generating devices for up to 5 days • The purpose of this program is to give SLPs the ability to evaluate the augmentative communication needs of their Clients and recommend a specific communication device, if appropriate

16. Ambassador Program • This service is designed for individuals using our Survivor Speech Companion System for the first time • The program provides individuals with a personal concierge that will help ensure that anyone using our system will receive top-notch customer service, proper setup, and training • The one-on-one training for healthcare professionals, as well as caregivers, is provided at no cost to the user • The goal is to ensure that their first experience with our system is a pleasurable one

17. Client Qualification Process • If the SLP is determined to be qualified, the Client Care Coordinators or Key Center Account Manager assists the them with the completion of our Client Profile (OBT-C2) and obtains an Assignment of Benefits (OBT-C3) • The completed documents are then sent to one of our Reimbursement Specialist who attempts to obtain pre-authorization for reimbursement from the Client’s insurance carriers • Most Clients will have both a primary and secondary medical insurance carrier. This means we will be filing two claims on their behalf

18. Speech-Language Pathology Evaluation For Speech Generating Device (SGD) • In order for an individual to be eligible to receive Medicare, Medicaid, or private medical insurance reimbursement for a Speech Generating Device, it must first be recommended as appropriate by a Speech-Language Pathologist (SLP) • The SLP must complete a positive evaluation using a Speech-Language Pathology Evaluation For Speech Generating Device (SGD) (Form OBT-SLP2)

19. Letter of Medical Necessity &Prescription • The SLP then sends a copy of the evaluation to the Client’s Attending Physician • The Attending Physician confirms medical necessity, writes Letter of Medical Necessity (OBT-C5) and a Prescription (OBT-C4) for the device (including any required accessories related to Client’s condition), and sends to our Reimbursement Specialist

20. Filing for Reimbursement • One of our Medical Insurance Reimbursement Specialists (MIRS) now files a claim with the Client’s primary insurance carrier • After the primary claim is paid, the MIRS files any secondary claims the Client may have • The MIRS is responsible for tracking the entire process from pre-authorization to final payment

21. System Delivery & Setup • The Reimbursement Specialist also informs the Client Care Coordinator (CCC) or Key Center Account Manager (KCAM) that it is time to ship the Clients Survivor Speech Companion System • The Survivor Speech Companion System is shipped to Client and an Ambassador call is scheduled and completed

22. For Additional Information Ed Buchholz @ ed.buchholz@obrientechnologies.com Blackberry: 540.420.4115 710 Third Street SW, Suite 200, Roanoke, VA 24016 Toll Free: 888.285.8882 Web Sites: www.obrientechnologies.com & www.4strokesurvivors.com