Medical Billing and Collection

• CORPORATE OVERVIEW

• India BPO Advantage

• About Scandent

• Corporate Structure-IR/PM/SN

• WHY SCANDENT?

• Medical Billing & Collections Value Proposition

• Quality Management

• Infrastructure, Facilities & Data Security

• Scalability

• HIPAA AND REGULATORY COMPLIANCE

• HOW WE WORK WITH YOU

Contents

4

Advantages of a Global Services Delivery Model

§ Deep Domain ExpertiseHealthcare is a complicated industry witharcane methodologies, mentalities andregulations. This requires a player withdeep domain expertise to navigatesuccessfully

§ Customer ServiceIntense customer service is required andcan be delivered only by a US basedcustomer oriented client service team

§ Perception of DependabilityUse of a US client service team creates theperception of dependability that is criticalin the healthcare sector

United States India

Provides for clear value creation on operating margins, speed of operationalscalability and rigor of service levels to customer base

§ World Class Labor Pool2nd largest English speaking labor pool

Cost of labor ~ 1/10th of US

Largest tech pool in the world

6 million graduates seeking work annually

§ Significant Cost SavingsCompanies save 40-50% of labor costs bymoving work to India

Allows up to 2X the profit margins of similarservice US plays

Savings may grow as India telecom costscontinue to drop

§ Foreign Export Friendly Govt.Technology and global services enablinggovernment policies

Extended 10 year tax holidays

Strong local investments into infrastructuresupport

5

§ Business Process Outsourcing (BPO) is migration of Critical but non-core

activities of business to a 3rd party provider

§ Standardised,centralised and high volume transactions with defined service

levels are ideal for BPO

§ Some examples are:

ü Policy and Claims administration

ü Accounts reconciliation

ü Billing and Collection- coding, charge entry, payment posting, A/R Follow up

ü Web services (email response, co-browsing, etc.)

ü Transaction processing

ü Transcription/Translation services

ü Call center

What is Business Process Outsourcing (BPO)?

6

BPO Solution componentsIncludes…

7

Major reasons for outsourcing

1%

4%

10%

13%

36%

36%

0 5 10 15 20 25 30 35 40

Conserve capital

Foster innovation

Increase speed to market

Improved quality

Focus on core competence

Cost reduction

Source: The 2001 world summit, Michael F.Corbett & Associates

Reasons companies use BPO

8

Distinct Advantages of BusinessProcess Outsourcing

• Move non-core cost center off P&L and Balance Sheet. Replace withlong-term outsourcing contract and/or equity participation.

• Monetize investment in back office operation. Receive stockpotentially worth more than if sold the back office operation whileretaining control of business.

• Reduce overhead costs. Re-deploy supervisory management tomore productive endeavors.

• Reduce capital costs. Obviates need to acquire/upgrade IS.

• Access to best practices and technologies.

• Ability to redirect Management Bandwidth to core businessactivities

Value to Clients

9

Services out of India now a major trend with globalbrand

• Global BPO industry is expected to grow to US $301 billion in 2004(source :

Gartner-Dataquest)

• India share (for global customers) estimated at a revenue of US $ 8.9 billion by

2004

• The share of India growing from 2% in 1999 to 12% of global IT enabled

services market - 64% CAGR

• Growing skills in working with sophisticated process tools like six sigma,

kaizan, etc.

• Over 50% of SEI CMM level 5 entities world wide out of India

• 266 of Fortune 1000 companies have outsourced mission critical

software related functions to India

• Strong support of Central and State Governments

10

Scandent Network is an operating company chartered to build cross border servicebusinesses by providing off shore delivery platforms to enable innovative servicesolutions for global markets.

Company was originated by the senior professionals who helped build the captiveOutsourcing businesses for GE, Pepsi, SAP, Motorola and Microsoft in India. They are nowaligned with a Board of seasoned and very successful multinational executives andinvestors.

q Investors :

Ø Edgar Bronfman Family Trust (Seagram Universal)

Ø Comcraft Group (Global Businesses with $3B sales)

q Board Representatives and Executive Team :

Ø Chairman of the Board – Chris Sinclair (ex Chairman and CEO of the Pepsi-Cola Co )

Ø Globally experienced Multi National Executives from GE, Microsoft, Pepsi, Nike and SAP

Ø Ramesh Vangal – Chairman ScandentNetwork, Chairman Seagrams Asia Pacific, FormerChairman PepsiCola Asia Pacific and CEO PepsiCola India

Ø Kannan Ramasamy – CEO ScandentNetwork, former CEO GE Capital Indiia

About ScandentNetwork

11

Technology and information services

HealthCare

InsuranceFinancialServices

Corporate Structure

Business Process Outsourcing



• About Scandent

• Corporate Structure

• WHY ProcessMind?




• Scalability



Contents

13

Medical Billing, Collections and A/R management

ProcessMind has the Superior Value Proposition to Clients

Revenue Improvement

Cost Savings

Data Analytics

Encapsulation of Intellectual Capital: practice/payorexperience, payor rules enable reduction in denials

Labor Economics: enable better follow up of denied andunderpaid claims

Risk Based Pricing: cost reduction for meeting historicalcollection rates with success fee upside

Process Re-Engineering: standardization andsimplification of provider processes

Clinical Analytics: analysis and reporting on patientsegmentation for risk sharing and clinical usage.

Performance Analytics: analysis and reporting on keyfinancial, operational and payor indices for best practiceoperations

14

Revenue Enhancement Value Tree – Medical Billing

Benefit toClient

Reduced cost inbilling and recordsmanagement

Increased patientthroughput

Increase physicianproductivity

Reduce excessworking capital costs

Reduce records storagecost

Reduce billing system costs

15

Service Offerings

EligibilityVerification

ClaimsTransmission

CUSTOMERSERVICE

AccountsReceivable

Management

CPT/ ICD-9 Coding

Demographic &Charge Entry

PaymentPosting

Patient Follow-up

Insurance Follow-up

16

Service Offerings – Contd.,

Diagnosis Coding

Procedural coding

Modifier Coding

CODING

Demo &

Charge Entry

Eligibility Verification

Incompletes

Charts Tracking

CHARGE ENTRY

Posting Denials

Posting Payments

Claims Transmission

PAYMENT POSTING

Receivable Process

Denial Analysis

Appeals Process

AR MANAGEMENT

Account Balance

Verification

Handling Statement Enquiries

Update Coverage

Information

CUSTOMER SERVICE

Insurance Follow-up

Patient Follow-up

17

Coding- Value Proposition

Current Offerings

International Classification of Diseases codes released by the WHO- ICD-9CM &ICD 10 .

Current Procedural Terminology (CPT) codes released by the AMA-Americanmedical association.

Modifier Coding and External Cause coding using the E-codes.

Compliance Edit for every report we code to minimize denials, using the updatedLMRP’s (Local Medical revenue policies).

Team

Team of 5 coders certified from American Academy for Professional Coders(AAPC)

Experience in coding different modalities like:

Interventional Radiology, Surgery, Radiology, Emergency Room, SurgicalPathology

Compliance

The team updates itself regularly onLocal Medical Revenue Policies (LMRP) of different states in the USAmerican Medical Associates (AMA) Coding guidelinesCompliance issuesOIG Alerts

18

Current Offerings - Coding

We code in compliance to the coding guidelines released by theAMA and WHO using:

• Current Procedural Terminology (CPT) codes released by theAMA-American medical association

• International Classification of Diseases codes released by theWHO- ICD-9CM & ICD 10

• Modifier Coding and External Cause coding using the E-codes

19

Compliance

We perform Compliance Edit for every report coded to minimizedenials, using the updated LMRP’s (Local Medical revenuepolicies).

The team is regularly updated on:

• Local Medical Revenue Policies (LMRP) of different states inthe US

• American Medical Association (AMA) Coding guidelines

• Compliance issues

• OIG Alerts

20

AR Analysis

• Aged AR Analysis

• Denial Analysis

• Review of duplicate payments

• Monitoring changes in plan

• Tracking billing and payment patterns

• Demographic Issues, Upcoding, Unbundling, and Physician Profiling

21

AR Analysis and Follow-up - Workflow

• Set collection targets for the month

• Develop strategies to achieve the target

• Identify and review claims that are unpaidor inappropriately paid

• Speedy and corrective action on denials

• Effective follow-up with theinsurance/patient

22

Services notcovered

Duplicate claim

Bundled /inappropriatecode

Misseddeadlines

Outright denials

Missingdocumentation

Missing referral

Missing authorization

Patient not in plan

Improper place of service

Modifier not available

Wrong payor

An analysis of denial EOBs indicate the reasons for the “outright” denials.

CAUSES

•Lost claims•Payor error (checknever sent, etc)

•Services not covered•Patient not in plan•Wrong payor•Missed deadlines•Missing pre-authorization•Missing referral•Missing documentation

•Bundled / inappropriatecode•Modifier not available

SOLUTIONS

Follow up on every claim

•Improve patient registration process•Rapid response: Create initial /appeal claims within 2 days ofservice or denial. Notify of missingpre-auths/referals immediately•Provide specific feed-back tophysicians about need for pre-authsand documentation

•Use rules engine to identify:•Appropriate codes andmodifiers•“Improper place of service

3rd Party Denials

23

• “One Blue Cross / Blue Shield plan in the Northeast now offers morethan 5000 different benefit designs, each with its own pre-certification, pre-authorization and eligibility rules”

CodeCorrect press release 11 / 14 / 2000

• United Healthcare requirements in Texas• Medical records much be attached for 258 separate codes• Medical records must be attached for certain CPT code modifiers, such

as surgery and anesthesia

• Golden Rule Insurance requirements in Texas• Medical records must be attached for 6 specific conditions, including

“maternity (except routine)” and “schlerotherapy (exceptspiderveins)”

• Medical records for all claims during the first two years of a patient’sservice

• “MedUnite claims that 50% of claims contain mistakes, 80% of which arebecause the claim lacks one of the basic pieces of data on the billing form.”

AM News, Clean claim rules …12 / 4 / 2000

Another reason for the many mistakes are the complex and ever changing rules imposed by thepayors. Learning and applying all these rules consistently is beyond normal human capacity

Claims Rejections: Payor Driven Complexity

24

20

19

4

100

2

33

3

Most of the reasons for claims rejection are simple human data entry mistakes which are impossible tosolve without the help of technology

THE REASON?Claims Rejections: Provider Driven Administrative

Source: MGMA

9

Percent 10

Incompletepatientdemographicinformation

Incomplete orinaccuratediagnosticcode

Invalidaddress

Patientnotcoveredunderinsurance plan

HFCAForm1500containstoomanycodes

Filingclaimswithzerototals

IncompleteMedicare /Medicaidsubscribercodes

OtherTotal

25

Metrics SamplePareto Analysis for Error distribution

CE-Error Distribution Chart-Jul-2003

177

144

6256

48

34

20 19 167

30.4

55.1

65.7

75.3

83.5

89.492.8

96.198.8 100.0

0

20

40

60

80

100

120

140

160

180

200

P10 P6 P1 P7 P8 P5 P2 P3 P4 P9

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Occurrence Cumulative

26

Revenue Collection Process

Superbill andencounter formare deliveredfromreceptionist

Claim is createdand electronicclaims are tested,then redone

Claim isreviewedby payor

EOB isgeneratedand returned

If claim is paid,updatedatabase,adjustreimbursement

2. Handoff chartcharge capture toclaims creation &submission

1. Handoff caredelivery staff toback office

3. Handoffprovider topayor

4. Handoffpayor topaymentpostings

5. Handoffpaymentposting tocollections

Charge sheetsare separated

intoacceptableand wrong*

Claims aremanually keyed

Request foradditionalinformation

Claims submitted

•80% electronic

•20% manual

EOB isexaminedagainst payorcontract

If claim isrejected,enter intosystem

New claim isgeneratedandsubmitted

Key Issues:

Incorrect / problemclaims not discovereduntil at payor

Limited learning, e.g.,same mistake morethan once

2 month delay infollowing up ondenials

System inability totrack and escalate

*identified opportunistically by experienced charge entry personnel

27

Follow up-Underpaid & Denied Claims

Nu

mb

er

of

cla

ims

Claims size

63864

16827

2191 915 552

7301

0

10000

20000

30000

40000

50000

60000

70000

< $100 $101 - $200 $201 - $300 $301 - $400 $400 - $500 $501 +

29%37%

2% 3%5%

23%

< $100

> $501

$201 -$300

$101 -$200

$301 -$400

$401 -$500

Total Charges = $2.7mm

§ Given average collection rates of 40%, total collections on these claims is smalland unlikely to be followed up on if denied or underpaid.

28

AR Follow-up – Insurance & Patient

• Accounts Receivables Follow-up- Follow-up with insurance companies on Pending & Denied

claims

- Follow-up with hospitals for additional information

- Follow-up with EDI for electronic claims transmission

- Follow-up with provider office for provider enrollment issues

- Eligibility Verification

• Patient Follow-up- Soft collections

- Setting patients on budget plan

- Accept payment by phone

29

Customer Service

• Customer service (Inbound Contact Center)

- Handling statement enquiries

- General account verification from patients, insurance co’s,

provider’s office, Hospital & Attorney’s office

- Update insurance coverage information

- Accept payment by phone

30

• Full analysis is practiced on denials to understand rejection and denial patterns inorder to develop client experiential based technical rules that are then incorporatedinto the Claims Scrubbing Engine (e.g., all codes X for Payor Y require a letter ofmedical necessity).

• Full analysis and follow-up is practiced on all payor specific rules updates todevelop technical rules for the Scrubbing Engine.

•All learnings are captured and systematically shared across an individual practice,

•The Scandent billing advantage is the ability to allocate a significant amount of laborresources to claims creation and follow-up. All claims receive follow-up phone callsand review to insurance companies regardless of face value.

• All secondary claims are submitted. Scandent follows up on all third party as wellas patient funds owed which are traditionally a large component of write off revenuefor any group practice.

• All payment postings are compared against payor contracts for validity. If theamount is not as per the fee schedule, collections processes will be initiated tocollect the leftover amount, regardless of the missing dollar size. This amount wouldotherwise have been written off by most payments posting departments due to theinability of their software systems to track to this minute a level

• The billing system is AS400 based with the capability for system wide proactiveescalation, denials tracking and extensive management reporting

Experiential and Payor Specific Rules Database

Payor Fee Schedule Payment Measurement

100% Claims Follow-up

Intelligent BillingSystems

Billing & Collections Value Proposition

31

Training

• Various levels of training

• Basic Level – includes induction training 40 hrs

• Software driven

• Training on updates (continuous process)

• Mock call sessions (AR Follow-up & Customer service)

• Other trainings

• Accent Enhancement & Neutralization training for CSR’s

• Cross functional training

• We use various tools like CBT, Handouts & SupportingSoftware's

32

Current Project Stats30# of physician groups handled

$1,800,000.00Average collection

4.5 / 5.0Customer Satisfaction Index

Chart production

CodingCharge Entry

Tracking IncompletesPayment posting

AR Analysis & Follow-up,Collections

Customer service

Functions handled

$4,200,000.00Average value of charges

22000Total # of charts entered

280# of Physicians

33

Specialties Handled

• Radiology

• Interventional Radiology

• Surgery

• Emergency medicine

• Surgical Pathology

• Pathology

• Anesthesiology

• Otology

• Neurology

• Physical therapy

• Internal medicine

We handle various specialties for 30 hospitals and physician groups acrossUSA, which include

34

The Teamq The team has total experience of over 4 years in servicing the

providers network of US

q The team has worked on diverse medical billing software likeMedisoft, Medic+, Medic manager and Kredo

q The team members have certification from Brain Bench for medicalbilling and collections & HIPAA

q Certified coders from American Academy for Professional Coders(AAPC)

q Physicians with coding expertise

q Experience in handling diverse specialties

q Call center executives in the AR Follow-up and Customer Service teamare professional and well qualified

q Follow-up team trained on American Accent & Culture

q The team is process oriented and have obtained training in qualitystandards such as ISO, COPC & CMM

35

Benefits

• Accelerated Cash flow

• Coding recommendations for maximized reimbursement

• Provide highest level of Quality Services

• More effective use of highly trained staff

• 24/7 account management

• Proactive follow-up

36

ProcessMind – Team Strength

MeetHIPAA

Guidelines

ContinualTraining

ProcessKnowledge

Healthcare Experience

Strengths

37

Achievements

• Migrated the project in a short span of time i.e., 25 days

• Excellent quality maintained across all functions i.e., over 99%

• Implemented paper-free processing methodology

• Identified and solved pending issues which contributed to the

increase in collections

• Improved Customer Satisfaction Index from 3.0 to 4.5 on a

scale of 5.0 in a span of six months



• About Scandent


• WHY SCANDENT?




• Scalability



Contents

40

Billing Solution

•Testsagainstproprietaryrules engine

•Biller retrievesinfo from recordsdb•Creates claim

•Updates rules engine•Resubmits claim or appeal

EOBsent

•Checks againstpayor contract•Posts

The combination of specialized human knowledge andtechnology commonly achieves 98% clean claims withcollections of 80% of expected value on first pass throughwith significant revenue growth, and reduced DSOs for thecustomers

Defectiveclaims

Aggressivelyfollows up onevery claim

Cleanclaims

Topayor

Denials / inforequests

Claim paid

•Cash to customer

•Front office clinicoperations collectscharges entry fromphysician(electronic orpaper)

41

ProcessMind basic value proposition is to addressmajor issues in the healthcare administrative backoffice without altering physician workflow eitherduring implementation or ongoing operations

… Value Proposition

• We work with our clients to remain as workflow compliant as possiblewith medical and administrative staff operating workflows

•We understand the dramatic cost pressures our clients face every daydue to the rapidly evolving healthcare marketplace and therefore havestructured our pricing to include little to no start up investment costs

•Scandent delivers high impact solutions emphasizing cash flow,management control and client satisfaction through cutting edgetechnology and operational optimization

•Most of all, what differentiates Scandent is our commitment to resultsthrough the complete alignment of our team’s incentives with yours bytaking substantial performance based revenue risk

Low start upinvestment

Risk BasedPricing

High ImpactSolutions

WorkflowCompliance

42

Cost Savings

55

15

30

14

20

20

0

20

40

60

80

100

%

In-house outsourced

Employee Technology & Communication Other costsSource : McKinsey & Co., Edweiss

43

Performance AnalyticsProcessMind dedicates a practice analyst to provide the in depth key indicator reporting and comparativeanalysis critical for best practice management

• Physician Financials: Tracking by individual physician and across allphysicians of charges, collections, denials, DSOs, patient mix, topprocedure codes• Snapshot daily, monthly, quarterly financial reports, cash flow tracking,current, charges, future expected• Shortfall and write-off rationale reporting• Aged accounts receivables reporting

• Service analysis measurement by physician of number of patients perday, average charges per patient, average bundle of services per patient• Service analysis measurement across practice with comparables overtime• Patient volume by facility by financial class• Compliance alerts

• Tracking of net cash expected for each month’s charges, collections,DSOs, % of re-filed claims by insurance company

• Maximum procedure payment by insurance company across thepractice

Key Financial Metrics

Key Operational Metrics

Payor Contract Management



• About Scandent


• WHY SCANDENT?




• Scalability



Contents

QPresentation on Quality

46

Purpose

to appraise about• our customer care programs• our quality services

47

Total Quality

Quality checkDefect controlQuality improvement

ProcessDefect preventionInternal quality auditProcess Improvement

Quality assurance Quality control

Process Quality Product/service Quality

48

Our principles

• Quality is• accuracy• on-time delivery• performance• process compliance

• Customer satisfaction• Information security- compliance• Managed event• Improvement• Consistent, reliable service

49

Quality

Quality

Quality Control Quality Assurance

MetricsKnowledge

50

Quality

Quality


MetricsKnowledge

51

Documentation structure

Quality Policy

Quality Manual

Processes

Guidelines

Forms

Checklists

Templates

Master List

Log Register

52

What our group does?

• Represents customer• Do everything a customer would do

• Set benchmark• In house and international

• Develop processes• Process consultancy

• Represents management• Report the quality health of projects

53

Quality policy

“ProcessMind, a process driven organization,will achieve customer satisfaction by

complying to standards and requirements,ensuring delivery of cost effective productsand services. We maintain an environmentthat encourages continual improvement of

processes”

54

Our Goals

55

End to end process

• Seamless transitionThrough

• Project transition• Process definition• Process mapping• Process training• Process documentation• Operations• Deliveries

56

Identify The Prospective Customer

Go/ No-Go

Proposal

TerminateEngagement

Security AndDisaster Recovery Plan

Pilot Training India Team Setup Technology Track

Define Security Requirements& Disaster Recovery Plan

Deploy Pilot Team ForTraining

Recruit First Team InIndia

Visit Of Systems Team ToEach Other’s Sites

Design Security Infrastructure Pilot Team TrainingProcess Live Cases

Induction Training Design Systems AndConnectivity Solutions

Implement security infrastructureand DRP

Pilot team returns to India leavingbehind one coordinator

Pilot team conductsOperations training

Implement systems andconnectivity solutions

Contract

Project Initiation

Project Management Plan

Feasibility Study And Core Team OnsiteAnalysis

Live Processing

Project Closure

57

Internal quality audits

• Process compliance verification across thecompany• Projects• Support departments• As per standard ISO 10011

• Trained independent group• Identification of non conformances• Detection of process lapses and

improvement

58

Change management

• Change management process

• Any changes are controlled• Changes are reviewed before acceptance

• Changes are communicated across the group

• Changes are monitored additionally for maturity

• Changes are always through documentation• Change Control Board

• A set of people who review the changes required and approve

• Change Log• Changes are always logged for history

• Changes are tracked

• Change audits• Quality audits include change status

• Change management tool – VSS

59

Quality control

Service Quality


MetricsKnowledge

60

Quality checks• On-line quality checks (verifications)

• Demographics entry (registration, changes)• Charge entry• Claims filing• Cash posting• AR analysis and follow up

• Independent check personnel

• A QC per 10-12 CSRs

• Sampling criteria based on severity and status•• Rework before delivery

• Metrics collection

61

Quality organization

Project Manager

Quality coordinator

Quality rep

Quality manager

TC

CSR/IA

TL

62

Quality roles

• Quality rep• On line QC• Reporting defects• Re checks• Case clearance

• QC• Quality supervision• Metrics collection• Process consultancy• Reviews with PM and

Quality

• TC & TLs• Defect removal• Periodic team reviews• Preventive actions

• PM• Defect elimination• Project reviews• Preventive actions

63

Reviews

• Team reviews

• Project reviews

• Management reviews

• Client reviews

64

Feedback

• Customer feedback

• Customer complaints

• Customer satisfaction survey

65

Metrics

Quality


MetricsKnowledge

66

Metrics

• Organization specific

• Mandatory for all projects

• SLA specific

• Project specific

67

P-Q metrics

• Production

• Productivity

• Efficiency

• Volume

• Trend

• Level

• Backlog

• Amount collected (cc)

• Yield rate (cc)

• Abandonment (cc)

• Quality

• First time pass yield

• Accuracy

• Time (cycle and on)

• Verification effort

• Trend

• Level

• Call quality (voice)

• Compliance to law

68

Dash board concept

• Dashboard a tool for driving• Monitoring available to managers

69

Quality improvement

• Metrics collection across projects

• Analysis

• Identification of areas of improvement

• Improvement

• Plan

• Team assignment

• Implementation

• Process change

70

Knowledge

Quality


MetricsKnowledge

71

Knowledge

• No process, control or metrics can work withoutknowledge

• The important function in quality management

• Creation of knowledge bank

• Knowledge is shared across the organization

• Program wise

• Company wise

• Quality wise

• Information is shared in the drives under programs

72

Processes

73

Processes

74

Total quality

Quality


MetricsKnowledge

75

ProcessQuality

Metrics

Improvement



• About Scandent


• WHY SCANDENT?




• Scalability



Contents

77

The campus

• Centrally air conditioned independentmodular office to seat 700 employees ina single shift 1000 KVA state power

• State power backed up through diesel generators

• All computing and communication equipments poweredthrough UPS running in parallel redundancy mode

• In-house cafeteria, vehicle parking and other facilities

• Fully equipped auditorium with audio and videoconferencing

• Fully equipped training rooms for in-house training

• State of art access control system

• Security managed by Group 4 security

78

The campus

• 256k Internet link

• Two dedicated international lease lines through redundant routes

• Additional building with 400 seats capacity can be added in 6-8months in the same campus

• State of art communication equipment• CCTV provision

79

Redundancy

Satellite

TAT

TPATPA

Bangalore

New Jersey

80

Physical Connectivity

ProcessMind

Indianapolis

FrameRelay

Clients

Newport FinancialCenter

New Jersey

USA END

ProcessMindIndia

Koramangala

Bangalore

ProcessMind IndiaChennai

ProcessMind India

STPI

Bangalore

Fiber (Atlantic)

Fiber (Pacific)

E1 Fiber

E1 Fiber

Satellite

INDIA END

E1 Fiber

81

Physical Connectivity

Clients

Newport Financial Center

New Jersey

USA END

ProcessMindKoramangala

Bangalore

ProcessMindChennai

ProcessMind STPIBangalore

Fiber (Atlantic)

Fiber (Pacific)

E1 Fiber

E1 Fiber

Satellite

E1 PRI for Homeusers connectivity

Home User

SatelliteLink

ProcessMindIndianapolis

INDIA END

INTERNET

Frame relay

PSTN

PSTN

82

Features of our Voice and Data Network

• New technology standard for voice

• Centralized call processing deployment model

• Single Administrator to maintain voice and data network

• Digital IP phones

• Location Independent

• Extension Mobility assists in disaster recovery by allowing

employees to take calls at home or anywhere on the network

83

Physical security

• Access control• All entry and exit doors controlled by access

control system• Access to server room and other sensitive areas restricted

• Visitors• All visitors are required to declare personal belongings such as

cell phones, pagers, lap tops, CDs, floppies etc. at the security• Employees need to authorize and escort any visitors inside the

office

• CCTV

• Burglar & Intruder alarm system

• Emergency Rescue Team (ERT)

84

Data security

• Internet & e-mail security• Can be used for official purpose

only• Built-in system to monitor usage

• Restrictions• All employees are forbidden from carrying any

magnetic media inside the office• No desktops have floppy and CD drives• Desktops will have bio-metric login devices• Scanned images – no papers required

• Access• All logins are secure logins with audit trail

85

Disaster Recovery Management Plan

• All electronic data is backed up in two sets

• One set of back-up tapes in the fire proof safe at office

• Second set of back-up tapes is stored off site

• An incubation facility, outskirts of the city is ready withstandby servers, data links etc. so that critical work can startwithout loosing any time

• Vendors who can hire out PCs and other equipmentsat short notice have been identified

86

Disaster Recovery Management Plan

• Employees with home PCs will be asked to work from home incase of emergency

• Key employees are provided with high-speed net connection athome

• Critical operations will be shifted over to the unaffected units

• In case of civil disturbance, employees will be asked to report tothe nearest work place and operate

n CORPORATE OVERVIEW

Ø India BPO Advantage

Ø About Scandent

Ø Corporate Structure-IR/PM/SN

n WHY SCANDENT?

Ø Medical Billing & Collections Value Proposition

Ø Quality Management

Ø Infrastructure, Facilities & Data Security

Ø Scalability

n HIPAA AND REGULATORY COMPLIANCE

n HOW WE WORK WITH YOU

Contents

88

Scalability

• Management Team

• Capital

• Process Management

• Resources of a Corporate

• Communication



Ø About Scandent


n WHY SCANDENT?




Ø Scalability



Contents

90

Health Insurance Portabilityand Accountability Act

(HIPAA)

91

Briefing Objectives

• Provide an overview to the key elements of HIPAA

• Outline key principles to achieve timely HIPAAcompliance

• Discuss key elements of our HIPAA compliancestrategy

92

Why was HIPAA enacted ?

• Assure portability of Health Insurance

• Decrease healthcare fraud and abuse

• Improve efficiency and effectiveness of healthcare

• Enforce standards

• Guarantee security and privacy of Health Information

93

Who is affected?

• Health care providers• Employers• Public Health Authorities• Insurers• Clearinghouses• Billing Agencies• Vendors & Business Associates (Outsourcing Agencies like MBCs, Claim

Processing Units, Call Centres etc.)• TPAs

95

HIPAA – Titles

• Title 1 - Guarantees access, portability and insurability of healthinsurance.

• Title 2 – Preventing Health Care Fraud & Abuse• Fraud & Abuse Control• Administrative Simplification• Medical Liability Reform

• Title 3 – Tax related health provisions for Medical Savings Account.

• Title 4 – Application and enforcement of group health planrequirements.

• Title 5 – revenue offset provisions.

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Title II – Administrative Simplification

GOALS:

- Guarantee security and privacy of health information

- Enforce standards for health information andtransactions

- Reduce the cost of healthcare by standardising theway the industry communicated information

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Proposed Standards

• Electronic Transaction Standards

• Standard Code sets

• Unique Health Identifier

• Security Standards

• Privacy

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Electronic Transaction Standard

EDI standards accepted by HIPAA

- Claims/Encounter, Eligibility verification,enrollment and related transactions: ANSI X12N

- Pharmacy transactions : NCPDPTelecommunication Claim Version 5.1 or NCPDPBatch Standard Version 1.0

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Standard Code Sets

Code set standards defined

• ICD-9-CM volumes 1,2 and 3

• Physician CPT-4 which are HCPCS level 1

• HCPCS level-2

• NDC for prescription drugs

• CDT-2 for dental services

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Unique Health identifier

• National Provider Identifier

• Employer Identifier

• National Health Plan ID

• Patient Identifier

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Security Standards

• To protect confidentiality and availability of healthcareinformation• Administrative procedures• Physical Safeguards• Technical Security mechanisms & services

• Electronic Signature Standard

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Administrative procedures

• Purpose is to guard data integrity, confidentiality andavailability.

• Are documented formal procedures for selecting andexecuting information security measures.

• Also addresses staff responsibilities for protectingdata

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Physical safeguards

• To protect physical computer systems, buildings andequipments from fire, and other environmentalhazards as well as intrusions

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Technical Security Mechanism &Services

• Processes used to prevent unauthorized access todata transmitted over a communications network

• Processes used to protect, control and monitorinformation access.

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Electronic Signature Standards

“Electronic Signature” means an electronic sound,symbol, or process attached to or logically associatedwith an electronic acquisition or contract record andexecuted or adopted by an authorized person withthe intent to sign the acquisition or contract record.

(http://www.epa.gov/oam/ptod/ppn00-02.pdf)

Contd..

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Electronic Signature Standards contd..

• The following three implementation features must beimplemented:

• Message integrity

• Non repudiation

• User authentication

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Privacy

Privacy regulation addresses the following:

• Consumer control

• Accountability

• Public responsibility

• Boundaries

• Security

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Key steps to achieve compliance..

• Step 1- Education and Awareness

• Step 2- Assessment and Planning

• Step 3- Compliance

• Step 4- Assurance

• Step 5- Periodic follow-up Audit & Assessment

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HIPAA Compliance Timetable

2000 2001 2002 2003

Education and Awareness

Assessment

Compliance

Assurance

Follow-up Audit and Assessment

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Compliance steps

Human Resource and general

Information System

Operations

1114.8.3.3 Digital Signatures4.8.3.4 Non-repudiation

Electronic Signatures- Digital Signatures5

4.4.3 Responding to security incidents and malfunctions4.6.5 Network Management4.6.7 Exchanges of Information & Software4.7.4 Network Access Control4.7.5 Operating System Access Control

Electronic Transmission- Communication & NetworkControls4

4.4 Personnel Security4.5 Physical & Environmental Security4.6.6 Media Handling & Security

Physical Data Security- Physical Access Control- Media- Secure workstation use &availability3

4.7 Access Control4.8 System Development & Maintenance

Technical Security- Access Control- Audit Control- Authorization Control- Entity authentication2

3.6 Records4.1 Security Policy4.2 Security Organization4.4 Personnel Security4.5 Physical & Environmental Security4.6 Communications & Operations management

Administrative Security- Contingency Plan- Information Access Control- Security Management Process1

ISO17799HIPAASl. No

Comparison of proposed HIPAA security requirementswith ISO17799

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HR and General

• Designated a Chief Privacy Officer and ComplianceOfficer

• Assign responsibility for tracking progress ofregulations

• GAP analysis of existing policies compared toproposed standards

• Outline employee responsibilities for protecting theconfidentiality of health information in the employeehandbook.

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Information Systems

• Familiarity with Information Security Standards andStandards Development Organizations

• Identify existing organizational structures to aiddevelopment and implementation of an informationsecurity program

• Familiarize the organization and employees withnew and emerging information security technologies



Ø About Scandent


n WHY SCANDENT?




Ø Scalability



Contents

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How We Work With You

• What to Expect- Process & Methodologies

• Account Management- Communication and Levels ofInteraction

• Reporting and Access

• Exchange of Information/ Change Management

• Escalation

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Identify The Prospective Customer

Go/ No-Go

Proposal

TerminateEngagement

Security AndDisaster Recovery Plan

Pilot Training India Team Setup Technology Track

Define Security Requirements& Disaster Recovery Plan

Deploy Pilot Team ForTraining

Recruit First Team InIndia

Visit Of Systems Team ToEach Other’s Sites

Design Security Infrastructure Pilot Team TrainingProcess Live Cases

Induction Training Design Systems AndConnectivity Solutions

Implement security infrastructureand DRP

Pilot team returns to India leavingbehind one coordinator

Pilot team conductsOperations training

Implement systems andconnectivity solutions

Contract

Project Initiation

Project Management Plan

Feasibility Study And Core Team OnsiteAnalysis

Live Processing

Project Closure

Process

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Account Management: Communication &Levels of Interaction

Onsite support group

Project Manager

Processor

Team Leader

Team Coordinator

Customer

Account Manager

3-Tier Process

• CorporateAccountManager

• OperationsManager

• 24/7-helpdesk andweb reporting

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How We Work With You

• What to Expect- Process & Methodologies• Account Management- Communication and Levels of

Interaction• Reporting and Access• Exchange of Information/ Change Management• Escalation

119

Thank you

Medical Billing and Collection - PMG Global

Documents

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