Enterprise Deck Burke Presentation

Copyright © 2014. ZirMed®. All rights reserved.

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RCM Solution Overview


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• ZirMed’s approach to healthcare challenges

• ZirMed’s case studies and accolades

• Why healthcare organizations choose ZirMed

• ZirMed corporate overview and solution offerings

• Q & A

• Next Steps

Agenda


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We get providers paid.


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Industry Overview

IndustryChallenge

Lower reimbursement rates

Denials rates are increasing1

HDHPs growing 15% per year2

Reduce expenses

ExistingTools

Treat all providers the same

Reports are not actionable

Overtaxed IT resources required

Workflow is extremely rigid and limited

ZirMedSolutions

Predictive Analytics & Embedded Rules Engine

Comprehensive solution

Exception based workflow

Quick and noninvasive implementation

Provider Opportunity

Immediate cash recovery

Automates repetitive work

Reduces 3rd party vendor expenses

Analytics to drive process improvements

1 American Hospital Association (“AHA”) 2013 Denial Report - $6.4B targeted by Medicare in the area of medical records

2 Modern Healthcare August 17, 2013

ACA / State & Federal Regulations Competition Pressures


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Results

3%

Highlights:

• Seamless integration with installed Epic systems

• Payments received within 45 days from the date or service increased by 15%

• Paper claims submissions reduced by 70%

• 98.5% First Pass Clean Claims Rate

AccelerationOf Payments15%

“ZirMed was able to automate our claims management and create customized, highly efficient workflows for our staff – which was a real challenge given the

extreme specialization of some of our physicians.”Andrew Ray, Manager of Revenue Cycle


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Results

3% IncreaseNet Revenue

Highlights:

• $100M+ generated through Charge Integrity, Denials Management, and Underpayment Recovery

• 150% productivity improvement

• 11 to 1 ROI


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Results

Highlights:

• In the first month identified cash equally the first year fees

• Rebilled $1.3M net within first 3.5 months

• Turned $2.5M net to-date w/ 4 part-time business office users

600% ROIAchieved in 18 months


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“ZirMed's solution helped us view and work our revenue cycle in ways we had been dreaming about for years.” – Presbyterian Healthcare Services

Predictive Analytics Accolades

“We conducted a thorough evaluation of several revenue cycle solutions and selected ZirMed because of its superior technology, track record, and data mining algorithms.” – BayCare Health System“ZirMed's solution provided us with the analytics to drive process improvement and education across our facilities and departments.” – Catholic Health Initiatives

“ZirMed's implementation was as promised. They required minimal IT resources from us and were up and running on time with results.” – Northwestern Memorial Hospital


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Nationally Recognized Leader

3-time National Case Study Winner (2012, 2014, 2015)

Voted on by nationwide healthcare finance professionals and peers

Contest included 12 of the top healthcare revenue cycle and financial management companies

Selected for “creativity of approach, magnitude of results, and impact on hospital’s reform readiness and financial performance”


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Company Overview


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• Nationally recognized leader in healthcare data mining

Leverage applied mathematics and statistics

Identify hard to find pockets of revenue

Automate repetitive non-value added tasks

Financial Opportunity

Identifies net revenue improvements

Drives immediate cash acceleration opportunities

Increases staff efficiency and reduces outsourcing costs

Operational Benefits

Advanced analytics to proactively root-cause issues

Routes the right accounts at the right time to the right people

Measures workforce productivity on value and dollars collected

Company Overview

Sample of MethodCare Clients


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ZirMed Overview

270,000+Providers`

8,000+Customers

500+Software Systems

300+Hospitals/ Health Systems

4,900+Payers/Plans

1.2B+Transactions

$$3B

Patient Payments


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Our Clients Span the Continuum of Healthcare

Physician Groups & other

specialties

Hospitals & ASCs

Billing Services

Health Systems - Predictive Analytics

ADVANCED Solutions, LLC


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Solutions for Revenue Cycle and Population Health

► Pre-Registration► Registration

Integrity► Insurance

Verification► Financial

Counseling► Eligibility

Verification► Patient Estimation► Propensity to Pay► P-O-S Collections► Payment Plans

► Missing Charges► Coding Variances► Overcharging

Detection► CDM Analytics► DRG Anomaly

Detection

► Coding Tools► Professional Claims► Institutional Claims► Remittances► Contract Mgmnt.► Denial Mgmnt.► Underpayment

Recovery► Self-pay Mgmnt.► A/R Followup► Digital Lockbox► A/R Intelligence

► Risk Stratification► Disease Registry

Mapping► Provider Attribution► Provider

Benchmarking► P4P/FFV

Reimbursement► PQRS► Cost & Utilization

Reporting

► Care Gaps► Referral Mgmnt.► Provider-to-

Provider Communications

► Readmission Analytics

► Physician Analytics► Patient Analytics► Patient Safety and

Quality Analytics

► Patient Communications

► Patient Notebook Secure Portal

► Patient Statements► eStatements► Care Team

Workflow Management


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• On the forward-edge of healthcare Innovative and agile development

• Using true predictive analytics to optimize financial and clinical performance management

• Crowd sourcing results in networked knowledge – benefits all clients

• Identifies NET revenue improvements

• Drives immediate cash acceleration opportunities

• Increases staff efficiency and reduces outsourcing costs

• Dedicated “client first” culture

What Sets ZirMed Apart?

• Six Sigma - lean approach Incorporated into solutions and

services

• Direct connections with payers Increases speed and accuracy

• Embedded rules/edit engine Results in 98.5% first past clean

claims rate

Advanced analytics to proactively find root-cause

Routes the right accounts at the right time to the right people

Measures workforce productivity on value and dollars collected

Leveraging TRUE Cloud based technology to deliver the right products and services to the healthcare industry at the right time


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ICD 10Are you truly ready?


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ICD-10 and Predictive Analytics

5x

20x

ICD-9

ICD-10

ICD-9

ICD-10

ICD-10 provides a significantly higher volume of granular, specific data. More data makes predictive analytics more powerful and more accurate. That means greater precision in identifying missing and incorrect charging and coding practices

Diagnosis Codes

Procedure Codes


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Our user interface and system architecture allow for dual coding of ICD-9 and 10 codes today:

If a payer moves to ICD-10 early or remains on 9 (e.g., Worker’s Comp), ZirMed can accommodate and recognize both codes sets—and optimize charge integrity and coding accuracy at every stage.

ICD-10 and Predictive Analytics

Our competitors promise they’ll be ready—we already are.

ZirMed’s current machine-learning algorithms are built to recognize every possible combination of ICD-10 codes on every current ICD-9 account they see today—they’ve been learning and self-training for years.

The day a ZirMed client goes live with ICD-10, these historical learning's will be recognizable, well-established data points for our predictive analytics.


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Thank You!

Enterprise Deck Burke Presentation

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