Please Insert
Client Logo
e4e
Healthcare Services
Comprehensive Solutions
for the Healthcare Ecosystem
© e4e – Confidential and Proprietary
e4e Healthcare Business
• Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and financially
strong company. We maintain a right-shore business model executed from four delivery
centers located in the US, India and Philippines.
• With over 19 years of rich experience, e4e carries a strong heritage of providing end to end
Healthcare Services – through our Technology Platforms and Software IP.
• A cross-border Healthcare Company with proprietary Software Platforms
for Revenue Cycle Management, Claims Processing, Audit and
Process Automation.
IT
Enabled
Services
• Technology agnostic solutions – experience in working with over
30 Provider and multiple Payer platforms.
• Expertise in System and Platform Integration – System Interface,
Electronic Data Inter-change and Workflow Efficiency.
& BPO
• We process over 135 million transactions annually and code/audit
over 30 million charts.
• HIPAA Compliant systems and processes, e4e is also an ISO 9001:2008
certified & SSAE 16 Type II compliant Company.
© e4e – Confidential and Proprietary
3
Offices in
Countries
2500 +
Employees
Globally
Worked with over
6000
Physicians
2
e4e Healthcare Service Landscape
Revenue
Cycle
Management
Technology
Solutions
SERVICE
LANDSCAPE
Payer
Services
Value Added
Services
End to End Solutions for the Healthcare Payment Continuum
© e4e – Confidential and Proprietary
3
© e4e – Confidential and Proprietary
•Customer Support
centers
•Business Rules
Configuration
•Fraud , Waste &
Audit Solutions
•RAC Response
Management
Solution for
Providers
•Process
Improvement
Consulting for
Physicians
•Ancillary Services
for Payers
•Business consulting
Technology Solutions
•Front End Claims
Processing and
Management
•Claims Adjudication
and Error Suspense
Resolution
•HCC Coding
Services
•Enrollment
Membership and
Billing Services
•Customer Service
•Mailroom Service
•Grievance, Appeal
& Refund Posting
•Reports
Management
Value Added Services
•Patient Access
Management
•Charge Capture
including clinical
documentation
improvement
•Claims, Remittance
& Denial
Management
•Hospital, Physician
& Remote Coding
•HEDIS & DRG
Coding
•Revenue Recovery
& A/R Services
•Charge Integrity &
Compliance
Solutions
•Successful EMR
driven billing service
Payor Services
Revenue Cycle Management
e4e Healthcare Services
•Claims
Administration
Platform
•Scheduler
•Workflow Solutions
including OCR
•ICD 10 Transition
Support
•Document
Management
System
•Client Service Portal
•Member Portal
•Managed Services Network & Desktop
management
4
Geographic Presence
Baldwinsville
NY, USA
Towson
MD, USA
Noida
India
Bangalore
India
© e4e – Confidential and Proprietary
Taguig City,
Philippines
Chennai
India
5
Our Healthcare Service Footprint
Multi-State Presence
•
•
•
•
•
•
•
•
•
•
© e4e – Confidential and Proprietary
Illinois
California
New Jersey
Florida
New York
Georgia
Texas
Louisiana
Carolinas
Tennessee
6
Hospital Service Offerings
Patient
Access
Management
• Scheduling &
Registration
• Eligibility & Benefit
Verification
Billing
• Data Entry
• Cash Posting
• Credit Balance
Report
Medical
Coding
• Outpatient Visits
• Clinic Visits
• Emergency
Department
• Same Day Surgery
• Inpatient
Denial
Management
• Weekly review to
check on denials
A/R Follow
up
• Account
Receivables
Service
• Insurance Follow
Up
Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service
© e4e – Confidential and Proprietary
7
Provider Service Offerings
• Coding Audit
• Charge Master Management
• Billing and Coding Research to
plug areas of ‘Revenue Leak’
• Account Receivables Service
• Calculate projected A/R
collections f or outstanding
accounts
• Monitor, identif y and prevent
f uture payment abuses f rom
payers
• Underpayment Recovery
Services
• Seamless integration with
Provider Accounting Systems
• Electronic Claim Generation
and Transmission
• Payment Posting
• Denial Management
• Reconciliation
• Ref unds
• Provider Data Updates
• Patient Billing
© e4e – Confidential and Proprietary
• Scheduling & Registration
• Patient Data Entry
• Eligibility & Benef it
Verif ication
• Point of Service
Collection
Patient
Access
Management
Charge
Integrity &
Compliance
Solutions
Remote
Coding
Revenue
Recovery
& A/R
Services
Charge
Capture
Claims
Remittance
& Denial
Management
• Remote Coding
• Coding Staf f Augmentation
• Charge Capture
• Charge Audits f or accurate
& compliant billing
• Identif y missed charges on
retrospective claims
• Improvements in Clinical
documentation through
education session
8
Payor Service Offering
• Benef it Loading
• Provider Loading
• Fee Schedule Loading
• Member Inbound Calls
• Provider Service
• Online Claim Status
Query
Member
Enrollment
Configuration
Support
Mail Room
Services &
Claims
Management
Customer
Service
• Member/ Provider
• Provider/Hospital DirectoriesReport generation
• UM , Statutory, Canned Reports
• High Dollar Value Audits
• Recovery Audit Contract (RAC)
Audits
• Durable Medical Equipment (DME)
Audits
© e4e – Confidential and Proprietary
• Member Enrollment/
Disenrollment
• Member Maintenance
Grievance
Handling &
Refund Posting
Reports
Management
&
Compliance
Solutions
• Scanning and Batching
• Optical Character Recognition
Conversion
• Data Capture
• Claim Inf ormation Capture
• Claim Data Audit
• Member Validation
• Benef it Validation
• Fee Schedule Validation
• EOB Generation
• Front End Rules Application
and Data Verif ication
• Receipt and Records of Appeals
• Analysis of Appeals
• Amount Payable f or f avorable
cases
• Process f or payment / generate
check
• Generate provider letter if
original denial is upheld
• Ref und Posting
9
Technology Services
Practice
Management
System
• Velocity PBS
Claims
Management
Systems
Electronic
Medical
Records
• Through Partner’s
RCM Tools
• PriceFast - Medicare Quick
Pricer
• OCRAS – Optical Character
Recognition and Audit
System
• Workf low Solutions
© e4e – Confidential and Proprietary
Payer
Processing
Tools
• Velocity CPS
• HoCAS – DRG Coding
Audit System
• CodED – Auto
Coding Solutions
• ACES – Automated
Coverage Check
• HITS – Hospital
Interconnectivity
Tools
• I DOS – Document
Management
Solutions
• Workf low Solutions
10
Value Added Services
•Conducting focus assessments
of HIM workflow challenges,
staffing, and performance
improvement needs.
•Improving revenue cycle,
outcomes reporting, release of
information, issues with
working DRGs & ICD-9 codes.
HIM Operational
Review Services
•Providing comprehensive suite
of products and services to
enable a smooth transition to
ICD 10.
•ICD-10 Readiness Assessment,
ICD-10 Impact Assessment
Service supported by
applications
ICD-10 Transition
•RAC risk assessments
•Transition auditing,
hospital-specific MS-DRG,
hospital outpatient, and
physician service accounts
•Support in deployment of
RAC management programs
RAC
Management
© e4e – Confidential and Proprietary
•Improving the accuracy of
clinical documentation and
DRG coding through the
coordinated efforts of
caregivers, physicians and
coding professionals, guided
by experienced e4e
consultants
DRG Assurance
•Sustaining the benefits of the
DRG Assurance with leavebehind software that provides
guidelines for concurrent chart
review and identifying
potential compliance risks,
frequently missed concepts,
and issues with working DRGs
and ICD-9-CM codes
Clinical
Documentation
Improvement
•Inpatient coding validation
services provide
comprehensive reviews to
assess DRG code
assignments, improve
documentation, and
quantify the impact of
coding changes.
•e4e has a suite of
proprietary technology
platforms primarily
designed as an enabler to a
more efficient and
effective operating model.
DRG Validation
Services
Technology
Services
•Velocity – RacER - CodED
11
Technology & Platform
Agnostic Solutions
Multi - Platform
Hospitals
• Epic
• Cerner Systems
• IDX
• Paragon
• McKesson
• Meditech
• Medicare DDE
• TMHP (Medicaid of
Texas)
• Next Gen Hospital
System
Providers
•
•
•
•
•
•
•
•
•
•
•
•
•
3M
Allscripts and Misys
Meditech
Cerner Systems
Siemens Signature
Image Flow/ Image Star
e ClinicalWorks
GE systems
Amicas
McKesson
QMS
Kareo
NextGen
• HMS Hospital System
Payers & TPAs
• MS4 Hospital System
•
•
•
•
© e4e – Confidential and Proprietary
Multi - Specialty
EZCap
Power MHS
Diamond
Health trio
Hospitals
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Neurology
Gastroenterology
Rheumatology
Radiology
Neurosurgery
Emergency
Cardiology
Birthcare Healthcare
Radiology
Obstetrics
Oncology
Physical Therapy
Ophthalmology
Pain management
Rehab therapies
Acute Internal Medicines
Orthopedics
Providers
•
•
•
•
•
•
•
•
•
•
•
•
•
Acute Care
Women’s Health
Dialysis Centers
Cardio Surgery
General Surgery
Emergency Department
Ambulatory Services
Pathology
Orthopedics
Anesthesiology
Nephrology
Hospitals
Radiology
Payers & TPAs
• HMO Plans (include
Medicare, Medicaid and
self funded plans)
12
Delivery Strategy
Best of Outsourcing outcomes with “Right-shoring” – a
customized combination that combines efficiency and savings
US
Onshore
Rightshoring
US
Onsite
India
Offshore
Philippines
© e4e – Confidential and Proprietary
13
The Numbers Speak
Process
2011
2012
2013
September - YTD
Coding
20,576,183
30,361,972
20,374,731
Accounts
Receivables
2,214,116
3,301,539
2,275,187
Cash
9,835,229
10,854,505
10,141,648
Charge
6,157,716
7,358,441
5,091,301
Patient
Demographics
4,186,355
4,762,631
2,605,310
© e4e – Confidential and Proprietary
14
Our Performance &
Operational Scale
Delivering 100% on our Client SLAs & KPIs over several years
Outcome Measures
Metrics
Process Measures
Actual Targets
Collection as a % of Gross Charges
55%
Targeted Revenue Increase Y-O-Y
9%
AR days for Commercial
& Blue Cross
42 days
180 days + AR as a component of total AR
< 8.5%
Denials on patients with coverage and benefits
information
Denials & Transmission Rejects
AR Days for Medicare
Target
Financial Claim Accuracy (for RCM)
99.1%
Administrative Claim Accuracy
(for RCM)
99.7%
Coding Accuracy
< 0.25%
3%
Specific Target for a customer for a location
Metrics
TAT for Claims
$ 1.275 m
97% plus
Norm is 24 hours,
with exceptions
delivered even
with in
8 hours
< 20
Our Operational Scale
© e4e – Confidential and Proprietary
135Mn
Transaction processed per annum
30Mn
Charts coded & audited
5.79Mn
Claims processed per annum
$1.61Bn
Paid on claims per annum
15
Foundation for Success
•
•
•
•
Data Analytics
Optimal Staffing
Weekly, Monthly and Quarterly calls
Exclusive focus on TAT and revenue
collection
• Tight quality assurance measures
• HIPAA Compliance
Delivery
Excellence
• Project Scoping and opportunity
identification
• Analysis on key drivers affecting the
Process
• Cost effective solutions to improve the
system
• Structured approach to execution and
delivery
• US relationship Management
• Managing by Business Goals
© e4e – Confidential and Proprietary
Resource
Capabilities
Transitions
Governance
•
•
•
•
•
Hiring the right people
Employee longevity
Product and Process Level understanding
Contextual Training
Periodic Refresher Training opportunities
Business
Excellence
Infrastructure
& Automation
• Fact based decision making approach
• Provides transparency & build
controls on operations
• Ensures highest level of Data
Integrity, Security & Compliance
• Robust Infrastructure for uninterrupted
business
• State of the art delivery solutions
• In house application development
team to customize your solution
• Powerful Knowledge Management
tools
16
Why e4e ?
• Reduced costs by up to 40 %
by outsourcing to e4e.
• Consistent superior service
delivery against client SLAs
and KPIs.
Profitability
• We are flexible and nimble and
have a transitions methodology
to quickly ramp our operations.
• Continuous Process Innovation
leveraging Technology.
• Process Re-engineering with
customized automation
tools.
• Complementary Service
Offerings
Strategic
Initiatives
Growth
• Scalability & operational
flexibility
• SW platforms and skilled staff
to delivers significantly better
economies of scale for you.
Our values and commitments of Adaptability, Community, Excellence and Integrity is what will drive
the success of this engagement
© e4e – Confidential and Proprietary
17
Contact Us
e4e Healthcare Business Services
60 Oswego Street
Baldwinsville, NY 13027
Fax: (315) 638-6309
Thomas Renny George
Vice President – Sales
Mobile: +1 (813) 760 5126
thomas.george@e4e.com
e4e Healthcare Business Services
Fortune Towers
152, Thoraipakkam Pallavaram,
Radial Road
Kovilambakkam
Chennai - 600 117
Tel: +91 44 2268 1240
Fax: +91 44 2268 1244
Toll Free: +1 (877) 559 8176
e4e Global Services Philippines
Inc.
15th Floor,
Fort Legend Building,
Bonifacio Global City,
Taguig City 1634
Kathleen Maher
Associate Vice President
Sales
Mobile : +1 617 512 2318
Kathleen.maher@e4e.com
e4e Healthcare Business Services
Unit No.1303-1304, 13th Floor
Prestige Meridian - II
#30, M.G. Road
Bangalore 560 001
Tel: +91 80 3256 8763
e4e Healthcare Business Services
H33 Sector 63
NOIDA
Uttar Pradesh – 201301
Tel : +91120 6746666
Fax :+91120 6746688
Teresa Crawford
Associate Vice President
Sales
Mobile: 214-289-9822
teresa.crawford@e4e.com
e4e Healthcare Business Services
502 Washington Avenue,
Suite 200,
Towson, MD 21204
Tel: +1 (443) 275 1632
© e4e – Confidential and Proprietary
18