GSS Healthcare - RCM Services

1 © GSS Healthcare IT Solutions 2014

GSS Healthcare RCM Services


• A Global organization with operations in US, India and ME

• World-class delivery engine delivering solutions to Fortune 500 companies and Global 1000 companies

• SSAE 16 Type II & SEI- CMMi Level-5 company, ITIL compliant processes, ISO 9001 and 27001 certifications

• 8 Offices Globally including 3 Development Centers

• GSS offers its services to diversified verticals – BFSI, Healthcare, Technology, Retail & Manufacturing, Education and Government

• Global Operations Command Center (GOCC) and remote delivery center in Hyderabad, India

• Best-in-class top tier technology alliances and domain intensive Centers of Excellence

Snapshot of GSS Infotech


• Process driven organization for the last 10 years - a SSAE 16 and SEI CMM level 5 company, having an ISO 270001 and HIPPA compliant delivery infrastructure.

• Proven Expertise in Healthcare based automation solutions

• Onshore / Offshore Global Delivery models ensure financial improvements, reduced costs and superior operations

• Established and common back office processes like HR , Finance, Recruitment, Training and IT

• Proven “GSS Infotech” brand name for easy hiring in the Hyderabad market

• Capacity to utilize the IT process and infra to be applied

in BPO / ITES

Technology

People

Process

GSS Infotech Healthcare Business


• Immediate availability of over 100+ experienced billable resources with capability to support specialty areas including Radiology, Pathology, Anesthesiology and Orthopedics

• Specifically in the area of for Revenue Cycle Management specifically in the areas of Billing and Claims Management

• Facility has an additional 150+ plug and play seats to accommodate expansion .

• Capability to expand at over 28 lateral resources and 50 fresher resources a week

• Dedicated Training Infrastructure and Training resources to train over 120 to 180 resources per week.

Opportunity for your Organization

Healthcare Customer Engagements

Revenue Cycle

Management

Manufacturer’s

Licensing System

HIPAA 5010

Testing

Infrastructure

Solutions

Integrated Provider

Management

Pediatric /

Adult Patient Care

Personnel

Admin System

ICD 9/10 Testing ICD 9/10

Transformation

Impact Assessment

/ Remediation

CTMS,EDC,

Medical Imaging

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• Partner of choice for leading technology vendors

• Investments in joint IPs and joint solutions

• Vendor agnostic service delivery

Technology Alliances

• Domain knowledge, serving over 200+ Healthcare Provider Groups.

• Dedicated Business Support Unit and have more than 300+ BPO resources.

• Strong technology background delivering Process Automation and IT services including ICD-10 transformation, Application Development and Infrastructure Management.

$250mn

Collected Per

Year

600+ Man Years of RCM Experience

1mn Claims

Processed

Per Year

>40mn Transactions

Per Year

Our Expertise


Our Commitment PEOPLE PROCESS MATURITY

Delivering Sustainable Value

Establishing a strong

governance and

organizational structure that

generates a high degree of

transparency and effective

communication

Identifying and assigning key

people to establish

collaborative relationships

aligned with business

objectives

Establishing a timeline

consistent with the work

plan and focused on

ensuring client's Objectives

Providing Operational Stability

Developed and Implemented

a Performance Framework

that provides 360- degree

resource management

Ensuring Knowledge

Retention, strong Training

Methodologies and

automated Knowledge

Management Tools

Implementing joint

prioritization and diligent

change control procedures

through robust

Reporting and Reviewing

consistently through :

a. Weekly Operations Calls

b. Joint QA Calibration

Minimizing and Mitigating Risk

Assigning well trained and

experienced resources

based on a robust onsite

offshore transition

experience

Establishing a joint

governance structure and

implementing Client

Partnership Management

Framework

Using our existing expertise

in Technology, Process and

Automation to bring about

improvement in existing

Productivity and Quality of

Transactions

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GSS MedPlus Platform

• HIS/ PMS / EMR Product • MUII Certified product

• Proven implementation

• Cloud Based Environment

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Process Technology People

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RCM Delivery Model


Access to Talent Pools

• Our offshore facility is based in India’s premiere state of the art township known as Hi-tech city at Hyderabad.

• Major companies like Novartis, United Health Group, Deloitte and PAREXEL International have their back offices in Hyderabad.

• Further, Hyderabad has six state universities; two deemed universities and three central universities that deliver skilled professionals year after year.

Time-to-Recruit

• 20 laterals / 50 Freshers per week

Recruitment


The Training academy has dedicated trainers for healthcare and ensures that the training meets the required skillset needed by the Production floor.

2 Dedicated State of the art Classroom facilities with a capacity to train 120 - 180 students per day

Average Time to Train

• 2 - 4 weeks

Process Trainers

• Dedicated Trainers with instructional design and development capabilities

• Self Designed RCM Training Curriculum

• Assessment Designed for different Training needs

Training

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RCM Delivery Model


Associates

TL

Ops Mgr

Delivery Head

13 - 17 Years

7-9 Years

4-6 Years

1-4 Years

Delivery Prog. Managers

Quality Mgr

QL / Process Trainers

Quality Analysts

Delivery Governance


Ops Manager

Ops Manager

Team Lead

Team Lead

Support Teams

• 3 HR • 2 Recruiter

• 1 Finance Manager • 1 Finance Executive

Delivery Head

Billable Resources

CLIENT Interaction

• 1 Training Manager • 2 Trainers

• 1 Admin Manager • 2 Admin Executive

• 1 Quality Manager • 1:25 QA

Operations Governance


Performance Governance Sample Throughput & Quality Metrics across Customers

Customer Processes Throughput Accounts per day per associate

Quality TAT(In Hours)

Customer1 Patient Account 200 98% 48

Customer1 Payment Posting 250 98% 48

Customer1 Rejections 250 98% 24

Customer1 Collections 60 95% 24

Customer2 Correspondence 200 98% 72

Customer2 Insurance 400 98% 24


Customer2 Deposit Correspondence 200 98% 72


Customer2 Data Entry 300 98% 48

Customer3 Patient Account 100 98% 48


Customer3 Credit Balance 50 98% 24

Customer3 Patient Mapping & Phy. Referring 250 98% 24



Customer4 Charges 200 98% 48



Transition/Stabilization Plan for new users

Processes

Production Goal

50% 70% 70% 80% 80% 90% 90% 100%

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

<7 >7 >14 >21 >28 >35 >42 >48

Quality 95% 95% 95% 95% 95% 95% 95% 95%

Patient Account 100 50 70 70 80 80 90 90 100

Payment Posting 250 125 175 175 200 200 225 225 250

Credit Balance 50 25 35 35 40 40 45 45 50

Patient Mapping & Phy Reffering

250 125 175 175 200 200 225 225 250

Collections 80 40 56 56 64 64 72 72 80

Transition Governance Client Case Study

Processes / Headcount HeadcountFirst

Month of GO Live

Headcount Fourth Month from Go Live

% Headcount Reduction

Insurance Verification 8 7 13%

Billing Edits 3 3 0%

Demo and Charges 16 10 38%

Payment Posting 10 8 20%

Correspondence 9 7 22%

Deposit Correspondence 12 8 33%

AR Follow up 20 11 45%

Customer Service Calling 5 3 40%

Totals 83 57 31%

A Sample Case Study on the Process Optimization provided during the transition from a New Physician Group in the first four months . Meeting both the SLAs while providing a 30% reduction on initial headcount.

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RCM Delivery Model


Slide | 20

Training Quality

Process Quality

ISO 9001 Based – Quality Management System

ISO 27001:2013 Information Security Management

HIPAA Compliant Delivery Structure

SSAE 16

Certified SEI CMM Level 5

Infrastructure &

Data Security

Quality Framework

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RCM Delivery Model


Security • Manned and un-manned security • Independent Security Checks for each wing • Biometric Card System

Capacity • 300 per shift capacity, with over 50% availability • Four independent Wings across 2 floors • State of the art 24X7 NOC • Server Rooms with gas based fire retardant systems

Facilities • Hyderabad India; 30000 sq.ft Operational area • Modern Facility with four wings and Independent healthcare floor of

over 300 seats

Utilities • 2 Government-run power connections (different plants) • 2 Diesel Generators • Dedicated UPS for facility and individual UPS for each floor

and dedicated back up UPS for Datacenter

IT & Infrastructure

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IT Security • Datacenter is equipped with CISCO devices • Monitored 24x7 by a dedicated team • Accessed only by authorized IT personnel

Connectivity

• Secured site-to-site VPN tunnel for all healthcare clients

• Dedicated VLAN for healthcare facility

• 4 separate and unique ISPs with ISP failover at the Load balancer

• 3 separate voice line providers

Governance • Proven methodologies and best practices • SSAE 16 SOC Type II, ISO 27001 for Security Management, ISO

20000 for IT Service Management

IT & Infrastructure

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Next Steps

• GSS Healthcare can provide resources in the area of Demos & Charge

Entry, Payment Posting and A/R collections

• Open to new business models that meet the relevant needs of Etransmedia

and will help expand its business

• GSS Healthcare would like to discuss how we can take the relationship

forward with Etransmedia


Sr. VP –Healthcare

Jeffrey S Peter US : 732 7983102 / E: [email protected]

Contact Information

GSS Healthcare - RCM Services

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