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Breakthrough Revenue Cycle Solutions for Healthcare Providers

Breakthrough Revenue Cycle Solutions for Healthcare Providers

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Breakthrough Revenue Cycle Solutions for Healthcare Providers

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  1. Breakthrough Revenue Cycle Solutions for Healthcare Providers

  2. 2 Table of Contents Section Content Page 1 About eHealthTech 3 2 Revenue Cycle Solutions 10 3 Why eHealthTech? 20 4 Getting Started 25 5 Appendix A – Platform Details 27

  3. Section 1 1 About eHealthTech 3

  4. A New Approach to Revenue Cycle Excellence “eHealthTech is a provider of transformational revenue cycle automation and outsourcing solutions to the healthcare industry. Our clients enjoy revenue cycle performance levels that are the envy of their peers as well unfettered access to the very latest Internet based practice management software - all on an as needed pay as they go basis.” “Technology has the power to transform the medical group practice in ways that were unimaginable even as little as five years ago.” 4

  5. About eHealthTech • Who are we? • eHealthTech is one of the most innovative providers of healthcare revenue cycle automation solutions in the United States. • Owned by Dave Perkins, a pioneer in healthcare systems and services for over 30 years. • We are not a software company - though we do provide our client partners with access to the most technically sophisticated and functionally rich suite of Internet based revenue cycle management software in healthcare. • We are a billing company – but more than that. We can extend our practice management solutions to your office for on-site appointment scheduling, patient registration, eligibility verification, document imaging, electronic superbills, charge capture, payment posting and reporting. 5

  6. About eHealthTech • What do we do? • We deliver world class revenue cycle automation solutions and services across the Internet using the #1-rated web-based AdvancedMD Practice Management System, combining the capabilities of a highly sophisticated “virtual” IT department coupled with a highly capable centralized billing office. • We provide our client partners with a low risk and cost effective means of acquiring the technology and/or skills that they need to attain a state of peak operational effectiveness in their business office operations. • We collect and capture patient demographics both electronically or from paper. We capture patient charge data both electronically or from paper. We provide coding services, using our certified coders, for selected clients. We use state-of-the-art claim editors, including the Ingenix “scrubber” integrated into AdvancedMD to assure clean claims go out. We file insurance electronically through McKesson daily. We follow up on unpaid claims using automated, system driven paperless worklists. We send out patient statements on a cycle basis through McKesson, applying all of the U.S. Postal database edits to ensure accuracy. We send collection notices, turn accounts over for collection, with Client approval. We post all payments from insurance company’s, other third parties and patients, making necessary contractual adjustments. Insurance allowables are compared to the fee schedules to ensure accuracy. We work the denied claims diligently, using automated worklists generated in real-time by AdvancedMD. We balance all receipts. We run all month-end reports, producing a “package” for each client that also includes summary Excel spreadsheets showing A/R , charges, receipts, collections, collection rates, average A/R days, and other ratios, for the 12-month calendar year. Special reports may be run on request through AdvancedMD and Microsoft Access. 6

  7. About eHealthTech (Continued) • Why are we are different? • We are an all Internet-based revenue cycle solutions provider to the healthcare industry. • Our unique “plug and play” eHealthTech delivery platform is completely transparent and allows client-specific customization without sacrificing either scalability or cost effectiveness. • Our leadership team is comprised of seasoned veterans, experienced in practice management systems design, development, implementation, and support, plus certified billers and coders with years of service. We also have in-depth knowledge of electronic medical record systems from Greenway Medical Technologies and eClinicalWorks. • We are able to develop interfaces with hospitals to capture patient and charge data electronically using industry-standard HL7 protocols. • We care about your success. As your business partner, we will work hard to maximize your revenue, guarantee compliance with CMS and always reflect our principles of integrity, honesty, kindness, diligence, and respect for you and your patients.

  8. Who Needs eHealthTech’s Services? If your organization is faced with one or more of the following issues then the chances are we can help: • Collections are Low: You have a high level of dissatisfaction with the effectiveness of your current billing and collections process yet can’t seem to get your hands on what needs improving. • You Need a New System: You know you need to replace your existing practice automation system(s) however you are losing sleep just thinking of the time, expense, and risks involved with selecting the right solution and then successfully implementing that solution. • You Have Staffing Issues: You are experiencing issues with either high staff turnover and/or it is simply taking too much time to manage the billing office. • Your Billing Costs are Too High: If you are concerned that your billing and collections related expenses are higher than they ought to be. Note:Mild irritation is insufficient reason to consider a change. The current reimbursement environment in which you are expected to provide increasing levels of care for continually diminishing returns is guaranteed to produce some degree of irritation! eHealthTech offers a completely new approach to solving the revenue cycle dilemma! 8

  9. The eHealthTech Advantage • Software on Demand: When software is Internet accessible via a web browser it is possible for a geographically dispersed community of users to work on a common platform in the pursuit of a common objective – all in real time. • Shared Services: When a large number of companies share the need to achieve a commonly held business objective those firms can avoid duplication of effort by accessing a centralized pool of shared resources dedicated to the business objective in question. Centralization is particularly beneficial if creating the initial capability requires a large up-front capital investment and/or if economies of scale help to drive process efficiencies. • Pay As You Go vs Buying Up-Front: By using AdvancedMD with our contingency pricing ,users gain the benefits of our service without incurring the time and expense of re-creating and maintaining the capability in-house. • An Ideal Solution for Healthcare Providers: The healthcare revenue cycle is ideally suited to our model. Consider the following: • The new generation of Internet based software is extremely powerful however it is also extremely complex, expensive, and requires that the practice choose from a bewildering array of alternatives. • These new systems require vastly different staffing models and the creation of entirely new sets of business processes. The healthcare revenue cycle has a very low tolerance for error – traditional conversions are therefore expensive and highly risky. • Our AdvancedMD system can place the practice in the “best in class” category without a large investment of either time or money, with virtually no risk of failure, and with ongoing operating costs that are comparable to the cost of maintaining the capabilities in-house. 9

  10. Section 2 2 Revenue Cycle Automation Solutions 10

  11. Recent Changes.. • HIPAA – HIPAA includes requirements that all participants in the revenue cycle utilize and accept a common series of standard code sets for the electronic communication of claims and payment related information. eHealthTech will sign the HIPAA Business Associate Agreement to protect the privacy and confidentiality of your patient records. • The Internet - Internet based software architectures are designed to allow an application to be accessed via a browser from any location with a broadband Internet connection. This architectural breakthrough allows geographically dispersed teams to access a shared inventory of centralized software resources in real time. eHealthTech uses the reliable AT&T network with T1 line connections to ensure the fastest possible access to our server. • “Smart Software” – In software related parlance the term “rules engine” refers to an application that is capable of accumulating, storing, and applying a body of domain specific knowledge. When used to identify and eliminate transaction level mistakes the rules engine is termed a “scrubber”. eHealthTech uses the latest Ingenix “rules engine” within the AdvancedMD system and the McKesson clearinghouse to ensure clean claims always go out. • Ubiquitous broadband – Most of the United States now has access to inexpensive broadband Internet services. T1, cable and business-class DSL are all viable options for your own local access. • Changing attitudes at the carriers – In the current investment environment insurance carriers are no longer able to survive on the investment returns earned on the float. While the “breakage” related incentives to deny claims remain in place, the absence of a tangible return on the float has begun to shift the focus toward processing efficiency. These foundational changes have broad reaching operational implications for the healthcare industry. 11

  12. New Possibilities • End to end automation – it is now possible to assemble an Internet based business office automation platform that includes scheduling, registration, electronic charge capture, billing, claims scrubbing, claims submission management, automated payment posting, and automated contract matching. • Labor Efficiencies – it is possible to reduce the amount of clerical labor required to management the revenue cycle by more than 50%. Some functions such as data entry and payment posting can be almost completely automated. • Specialty specific customization – The Internet provides reach and allows the healthcare organization to seamlessly integrate geographically dispersed specialty specific service providers (such as coding companies and/or reimbursement consultants) into the day to day workflow. • Transparency – With Internet based solutions and real time reporting the entire end to end process from the highest level of abstraction down to the individual transaction can be viewed and managed from anywhere with access to broadband Internet service. • Exception management – The staffing profile of the business office moves from a heavy clerical concentration to a much smaller footprint of process managers tracking service levels and dealing with high level process exceptions. “The revenue cycle is moving from a labor intensive craft model to a systems intensive industrial model.” The only similarity between a traditional medical billing operation and the new model is that both turn clinical procedures into cash. 12

  13. The eHealthTech Platform “The most functionally rich revenue cycle automation platform in healthcare coupled with a suite of highly defined service packs equates to a complete range of revenue cycle solutions for our client partners.” 13

  14. A Process that “Learns” “All rejected claims are corrected. Errors are then communicated to the appropriate upstream process teams. If an error represents the violation of a business rule then that business rule is added to the appropriate rules engine to prevent future recurrence.” The process error rate rapidly trends toward zero as client specific business rules are added to the rules engines and upstream defects are identified and eliminated. 14

  15. Our Solutions • eHealthTech Platform: The eHealthTech Platform offering includes a complete suite of cutting edge practice automation and revenue cycle management software from industry leading vendors, the training required to take maximum advantage of that software, and ongoing systems support and software maintenance services. • eHealthTech Optional Service Packs: eHealthTech offers a range of service packs as optional add-ons to the eHealthTech Platform offering. Each of these service packs is designed as a turn key module that performs a complete function providing our clients with an easy modular approach to configuring their eHealthTech solution. See next slide. • eHealthTech Platform Premium: The eHealthTech Platform Premium service is essentially a combined practice automation and turnkey billing and collections offering. eHealthTech provides the revenue cycle management platform in addition to performing virtually all of the services required to rapidly and effectively convert clinical procedures into cash. eHealthTech reimbursement staff provides ongoing oversight over virtually every aspect of the revenue cycle. EMR integration is a separate, optional feature. Enterprise reporting services may not apply to all clients. All solutions are provisioned across the Internet on a subscription pricing basis! 15

  16. Our Solutions (Continued) • Hospital-Based Billing Services: eHealthTech has been very successful over many years in billing and collecting for radiology, emergency, pathology, hospitalists, surgery, primary care, and many other specialties.  Many of my clients have been hospitals who employ or contract with physicians where the hospital is responsible for billing those services.  In some cases, when the hospital does not actually assume responsibility for the billing, they act as a facilitator to help their physician(s) get set up with a third-party billing company – eHealthTech.  In many hospitals, the professional billing does not fit well in with the facility billing system and processes of the hospital billing office.  Also, because the fees for those services are relatively small, compared to the facility fees, outstanding insurance and patient balances for these services are not followed up on as quickly or aggressively as the hospital’s charges.  Further, because the coding is different (CPT vs HCPCS), the coding and billing staff of many hospitals do not have the familiarity or expertise in billing CMS1500 (Professional Claim Form), compared to their expertise in billing the UB04 (Facility Claim Form). Also, it is difficult in many hospital systems to actually track payments back to specific professional services (by CPT code), because they often bill those services, summarized by revenue code, on the UB form and send consolidated statements to patients for both hospital and physician services, which makes allocation of partial payments to specific services difficult or impossible.  Thus, knowing actual collection rates for professional services is almost impossible.  This makes it difficult to analyze profitability of contract arrangements, services provided by physicians under contract, effectiveness of billing and collections of pro-fees, etc. All solutions are provisioned across the Internet on a subscription pricing basis! 16

  17. Our Solutions (Continued) In this time of difficulty for many hospitals – as we well know of hospitals that are already in bankruptcy or struggling – to invest the resources which represent real fixed costs, to improve collections in the pro-fee area. Our company is able to assume responsibility for this, under a contingency agreement (percentage of what we collect), in a contract with the hospital.  We recommend setting up separate Tax ID (for banking purposes only).  We would handle the provider enrollment to link the physicians’ individual ID to the new entity’s Tax ID and group number, where applicable.  Usually, we recommend setting up separate P.O. Boxes (possibly a bank lockbox) for payments under this scenario that would be directed to eHealthTech.  The bank account would be a separate one, owned by the hospital, but eHealthTech would be allowed inquiry access through “on-line banking” to check deposits and reconcile payments posted to total deposits.  All professional service documents would be either scanned and forwarded, or copied and mailed, to eHealthTech on a regular basis.  We handle all billing, collection, payment posting, insurance followup, refunds, coding, patient calls and correspondence, A/R Analysis and Reporting, etc.  We don’t charge anything up front and bill clients for our services at the end of each month. All solutions are provisioned across the Internet on a subscription pricing basis! 17

  18. Our Solutions (Continued) • Accounts Receivable Cleanup Services: Another area we excel in is cleaning up “old” A/R – both insurance and patient balances, for physician services.  We will also provide “early-out” services for hospitals who do their own in-house billing.  Many hospitals, who do their own professional fee billing, have accumulated millions of dollars in uncollected A/R that they chose NOT to write off or turn over to a “collection agency”, for whatever reason.  eHealthTech can help them collect this using their own computer systems, in most cases, before writing the accounts off to bad debt or turning the accounts over to outside collection agencies at much higher contingency fees. All solutions are provisioned across the Internet on a subscription pricing basis! 18

  19. Optional Service Packs “Client partners may choose which functions they wish to perform with in-house staff and which functions, if any, they wish to outsource.” 19

  20. Section 3 3 Why eHealthTech? 20

  21. A Completely Different Approach….. • A Different Philosophy: • At eHealthTech we believe that there is simply a better way for our client partners to access the advanced information technology resources and economies of scale that they need to ensure peak operational effectiveness in their business operations. • To that end we really do think (and act) like partners. We are extremely easy to work with, we don’t make promises that we can’t keep, and if we can’t deliver better results we will say so. • Services That Make Sense: • There are some areas where economies of scale really do make a difference. It is in these areas that we have concentrated our services. • We provide our clients with easy access to cutting edge technology, sophisticated business processes, and economies of scale without requiring them to sacrifice their operational independence. • A Unique Business Model: • Our unique Internet based business model combines the highly personalized service of a small company with institutional stability and sophistication. 21

  22. Delivering Significant Tangible Benefits • Improved Financial Performance: A practice can expect to attain MGMA best practices standards (top 5% or better) in terms of the key financial metrics (AR aging and net collection percentages) within six (6) months from the commencement of service – provided of course that TQM defect identification and elimination guidelines are followed. • Dramatically Reduced Risk of Failure: The practice is able to immediately adopt a “best practices” approach to managing the revenue cycle with minimal risk of failure. The subscription service is already in full production with optimized systems, staffing, and business processes. • Better Information = Better Decisions: Practice leadership has real time access to the key financial performance metrics required to support strategic and tactical decision making.   • Capital Efficiency: There is little or no capital cost associated with accessing the service. Furthermore, the “pay as you go” pricing model minimizes fixed costs and ensures that expenses match revenue. 22

  23. Benefits Cont’d. • Clerical Staff Augmentation: The practice has the option of at least partially offloading the work associated with clerical tasks such as data entry, payment processing, and document scanning. • Operational Flexibility / Scalability:  The business is able to rapidly bring new locations on-line, to centralize and/or distribute functions at will, and to link in outside service providers (e.g. specialty specific coding services) into a seamless end to end business process. • Data protection: AdvancedMD backs you database up every two hours. Your database is safe and secure in AdvancedMD’s off-site data center. On premises I.T. staff ensures maximum “up-time” and optimum performance 24/7. eHealthTech’s approach represents a fundamentally new way of solving the revenue cycle automation problem! 23

  24. A Proven Solution…. • Leading Edge vs. Bleeding Edge: The eHealthTech platform is definitely leading edge in terms of the technologies deployed however it is by no means experimental. To put in bluntly, eHealthTech is not in the business of taking risks with our client’s revenue cycle. • Industrial Strength Systems: All components run on high availability fault tolerant systems housed in tier 1 data centers with 24 x 7 X 365 monitoring. Uptime service levels set at 99.9%. Throughput design specifications in excess of one million transactions per month. • Industrial Strength Processes: Each transaction is tracked from beginning to end. Each alternative path in the process is watched and managed. Nothing is left to chance. • Yes, but still not perfect: The harsh reality is that the healthcare revenue cycle is an inherently fragile and imperfect business process. Technology can dramatically improve the efficacy of the overall process however it cannot completely eliminate human error. Better Technology + Better Processes = Better Results 24

  25. Section 4 4 Getting Started 25

  26. Getting Started is Easy – and Risk Free! The following steps may not apply in all cases: eHealthTech and client execute mutual non-disclosure agreement ensuring that all information gathered remains the property of the client and will be held in the strictest confidence. Execute non-disclosure agreement eHealthTech gathers information regarding both revenues and expenses pertinent to the services footprint being considered. Gather current financial performance information Financial metrics are analyzed in light of both current eHealthTech performance metrics for the specialty in question and information regarding specialty specific best practices. The performance gap (if any) is quantified. Conduct gap analysis The business case is assembled outlining recommendations for closing the gap and the size of the expected benefits (economic and non-economic) that would accrue to the client. Prepare and present recommendations and proposal Should the client determine that the benefits are sufficient to warrant a change then the parties can begin working toward a contract. Agreement in principle 26

  27. Section 5 5 Appendix A - The Platform in Detail 27

  28. On-Line Document Management Option • The Problem: Hospital based practices rely on the hospital to provide access to the information drives the revenue cycle (demographics and charts). If this information is either missing and/or incomplete the integrity of the billing and collections process is be fatally compromised. • The Solution: The eHealthTech on-line document management system is an Internet based document imaging and workflow platform that automates and manages the front end of the billing and collections process. The functional footprint of the solution extends from obtaining the required billing information (charts and demographics) at the hospital though coding and concluding with automated data entry of the patient demographics and associated charges into the billing system (see diagram below). “Chart Mover 2.1 is an industrial strength solution that can be configured to address the site specific attributes of each location served by the practice.” 28

  29. Chart Mover v2.1 – Logical Process Flow EOB Processing OCR + Index “Chart Mover 2.1 is a functionally rich information capture and workflow management platform designed specifically for the multi-location hospital based physicians practice Secure FTP Server (images) Chart Indexing Exception Management Remote Scanning Demographics OCR + Indexing Log Reconciliation On-line Coding Auto Data Submission Chart Matching eChart Capture Scrubber / QA Secure FTP Server (data) Demographics Capture eLog Data Upload (hospital systems) Web Search / View Web Reports Web Dashboard – on-line production monitor 29

  30. Chart Mover v.2.1 – Schematic Architecture “Chart Mover is built on a Microsoft .NET / SQL Server technical platform and has been designed for optimal performance across the Internet.” 30

  31. Chart Mover v2.1 - Backup and Disaster Recovery “Chart Mover is a high availability application running in Tier 1 data centers for maximum security and reliability.” Identical data storage sites provide seamless performance and reliability. Automated failover and load balancing capabilities. 24 x 7 automated and human monitoring system. High bandwidth connectivity. 100% RAID storage means all of the files are available online in real time.  31

  32. Real-Time Dashboard Dashboard shows up-to-the-minute financial information for each practice. 32

  33. Automated Collection Worklists Automated worklists allow Insurance follow up to target accounts meeting selected criteria.

  34. Automated Denial Tracking Automated denial Worklists ensure all Denials are reviewed and corrections are made in the shortest time possible.

  35. Mobile solutions Take AdvancedMD with you • Patient scheduling information updated via wireless card or docking station. • Physician selects a patient from the synchronized schedule. The physician is able to view the demographic information before going to the appointment. • The physician enters professional services, diagnosis and procedures into the handheld device in real time. • The next time the device is in range of the wireless network the information is transmitted to the server. • With the TabletPC as a mobile device, the full screen AdvancedMD application can be used over the wireless network, including schedule review, patient information, and the online charge slip 38

  36. Imaging / On-line Coding Indexed database allows instant retrieval of original patient records throughout the process. Object level security ensures that access is limited to select team members. Entire repository protected by 128 bit encryption protocols. Charts are coded on-line by specialty specific coders. 39

  37. Claims Scrubbing Sophisticated rules engine ensures errors are identified before claims are submitted. Errors are placed in a work queue and assigned to appropriate staff members for resolution. eHealthTech staff can view the HCFA 1500 form on-line. 40

  38. Claims Repair and Re-submittal Errors are corrected on-line and resubmitted immediately. Claim errors are highlighted in a rendering of the HCFA 1500 form. 41

  39. Claims History / Insurance Follow-up Carrier acceptance of each claim is electronically attached to the claim, documenting the exact date and time the carrier acknowledged receipt of the claim. Acceptance begins the claims aging clock that drives the insurance follow-up process. The system maintains a complete log of the life of each claim. 42

  40. Extensive On-line Reporting Download Reports to Excel. Generate graphs with ease. • Over 100 standard reports. • User selectable filter/sort criteria. • Reporting A/R and financial activity by provider, location/facility, and practice. • All Reports can be exported to Microsoft Excel for further analysis. • Letters can be created that automatically import patient-specific data, utilizing Microsoft Word’s merge features.. • Collections module automates the process of "working" the collections oriented reports increasing collection staff productivity by allowing them to create patient and payer task lists and automated reminders. • Download full sets of data in Microsoft Access any time for more sophisticated analysis on your own. 43

  41. Extensive On-line Reporting – Excel/Graphs/Access 44

  42. Extensive On-line Reporting – Excel/Graphs/Access 45

  43. Extensive On-line Reporting – Excel/Graphs/Access 46

  44. Extensive On-line Reporting – Excel/Graphs/Access 47

  45. Extensive On-line Reporting – Access Database

  46. Extensive On-line Reporting Real time, any time access to financial data provides practice leadership with vital information for strategic decision-making. 49

  47. Enterprise Reporting Data warehouse with feature rich ad hoc reporting capabilities. Web accessible data cubes with “drill down” capabilities for analytical support. 50

  48. Quality and Scalability – Our Business Model Clients Client Services Central Services Local Office Global Service Level Management Account Service Level Management “Our innovative business model delivers superior results and superior service.” Practice/Account Management Compliance Coding Issue Resolution Legal, Accounting, HR Billing New Accounts Information Systems Denial Management Marketing Payment Posting Field Support Patient Services Client Services provides local relationship managers as a single point of contact for each client. All critical transaction processing and systems related processes are centralized in order to achieve economies of scale and consistency of service. 51

  49. Revitalizing the Revenue Cycle… Revitalized Revenue Cycle Pre eHealthTech Revenue Cycle - Dollars ($) Dollars ($) Reduced Aging Increased $’s Typical net results - 20% reduction in Gross AR days and 16% increase in collections! 120 150 180 120 150 180 0 30 60 90 0 30 60 90 A/R Aging A/R Aging • Before: • Comparatively flat curve due to revenue “leakage” and extended AR aging. • Extended AR due to “dirty” claims (wrong or incomplete) and lack of follow-up. • After: • Improved monthly revenues due to accurate and complete initial billing. • Improved collection percentages due to cleaner claims and more aggressive follow-up. • Faster claims turnaround due to clean electronic submissions and timely follow-up. 52

  50. Thank You! 53