HEALTHCARE SERVICES DIVISION

TBS is a Strategic Advisory and Operations Consulting Firm, providing outsourcing solutions to our clients with quick scalability and delivery capability, having a committed and very talented team of professionals.

Within our Healthcare Division we help our clients by providing them with solutions that will improve their business processes so they can concentrate on providing better healthcare services. We have a history of client retention with successive years of contract renewals.

OUR HEALTH CARE SERVICES INCLUDE:

• Revenue Cycle Management• Compliance and Healthcare Content Management• Healthcare Process Improvement Consulting• Secure Healthcare Communications• Clinical Trial Management Solutions

TBS Healthcare Services

We want to earn your trust so we suggest beginning with our…..

Underpayment Recovery

Services • We audit your past 12 months zero balance accounts to identify under paid claims.

• After validation has been completed underpaid claims are resubmitted for payment.

• You only pay us a percentage of the recovery once the collection process has been completed

You collect additional revenues with nothing to lose!!

Underpayment Recovery Services - Overview

Reasons for Underpayment* Contractual misinterpretations & payments

* Fee-schedule changes

* Miscalculation/Errors in risk-payment reconciliations

* Inappropriate denials or down-coding of claims,

* Non-payments.

Our Approach* Partner with the Hospital to understand the claim billing & payment methodology,

* Retrospective verification of payment accuracy and recovery of lost revenue

* Analyze the paid claims considering multiple processing steps and various claim payment scenarios

Solution* Identify & recover underpayments, review closed claims & incorrect denials/rejections through efficient use of predictive analytics

* Manual analysis of the Billing/Coding practices & patterns to ensure that the billing processes are appropriate.

Results* Detect the claims payment errors leading to underpayments and classify the suspected underpayments for recovery

* Recovery of revenue from inaccurately paid contracts

* Identification and correction of contract management issues, providing critical insights into the complex payer contracts.

Underpayment Recovery – Process Flow

DATA EXTRACT OF PAID CLAIMS DATA MINING ANALYSTS

REVIEW

UNDERPAYMENT IDENTIFICATION

UNDERPAYMENT VALIDATION BY

CLIENT**

CLAIM REFILING / PROVIDER

APPEAL

UNDERPAYMENT RECOVERY

**Clients have the option of conducting a second level review of the underpayments identified, prior to initiating recovery efforts

Underpayment Recovery Areas

A ‘360 Degree review ‘ approach is adopted to identify underpayments from a billing, coding & reimbursement perspective

Billing Issues 40.55%

Coding Issues 13.64%

Denied as Duplicate

12.10%

Contractual Updates 10.52%

APG Reim-bursements

10.25%

APR DRG Reim-

bursements 7.96%

Freqency limits Exceeded 4.16% Denied for TFL

0.81%

* Sample underpayments for an existing client

Key Differentiators A decade of proven service track record

End-to-end expertise on Payer and Provider domains

Expertise spanning across the value chain ranging from low-end transaction services to high-end audit & analytical services

Thorough understanding of the claim life cycle, enabling us to understand the nuances of Claims Management

Experience & expertise in the niche segments of Code Review, DRG Audit & Payment Integrity Audit

Experienced staff comprising of certified analysts & Professional Medical doctors as DRG coders

Customer satisfaction through our ability to thoroughly understand the client business requirements and highly effective delivery capabilities

Recovered underpayments of over $6Mm in a period of 18 months for a leading hospital in New York

Revenue increase ranging from 5% to 8%, with improvements in collection days & FPCR

Achieved cost savings of over 40% for clients

Significant Improvement in TAT, Payment Realization & reduction of AR days for Providers

Benefits to Clients

Value Proposition

Value Propositio

nRevenue enhancements &

cost optimization

Improve collections by up to 5% through our RCM expertise

Our services can be used independently, or as 2nd or 3rd pass vendor in the Audit sphere

Experience in the Payment Integrity Audit services, recovering underpayments of Millions of Dollars

Comprehensive domain expertise spanning the entire spectrum of Provider services

PROCESS ENHANCEME

NTS

BUSINESS PROCESS

OPTIMIZATION

HIGH END NICHE

SERVICES

Payment Integrity Audit – Case Study

The client is a multi-site community healthcare system located in New York

Successful knowledge transfer / remote transition in 15 days

Identified $6 Mm in underpayments within the first 6 months, as part of the initial round of analysis.

Recovered underpayments of $6 Mm from the Government & Commercial insurance companies

Consistent recoveries averaging close to $300 K per month from outpatient claims

Improvement in billing accuracy, through the insights we developed

Implementation of the APR-DRG pricing methodology, leading to ambiguity in ascertaining the appropriate receivables

Changing reimbursement methodologies of Medicaid & Medicaid HMO due to the transition from traditional reimbursement to the APR DRG methodology

Limited success ratio in recovering the underpayments due to the age of the claims

Challenges in appealing the claims, as the client had a system transition

Offered an offshore delivery model with remote transition/knowledge transfer

Developed a data mining tool to analyze the claims data

Performed a retrospective review & verification of payment accuracy and recovery of lost revenue

Established contact with the Provider Relationship Officers at the top insurers, to coordinate & expedite the processing of the Appeals

Coding & Billing analysis to provide insights into coding practices resulting in lower reimbursement

Challenges ResultsSolution

Redefining Business Approach

Building RelationshipsLearning TogetherKnowledge Management

Process ImprovementsProductivity GainPerformance and Profitability

Organizational FitOpenness and AccountabilityOwnership and Responsibility

BEST

POSSIBLE

OPTION

Building RelationshipsLearning TogetherKnowledge Management

Contact me today to find out how TBS and our solutions can improve your bottom line with no upfront costs to the Hospital!

Paul Szklarski, FACHEConsulting PartnerTransnational Business Solutions, LLC45 West 34th Street Suite 1107New York, NY 10001609-515-0669paul@transbizsolution.com