DME Billing & Coding Services

MEDICAL BILLING
& CODING SERVICES
GoTelecare 41 Madison Avenue, 25th Floor, Suite 2511, New York, NY 10010
Presented for Presented by
GoTelecare
CONTACT: RONNIE HASTINGS
(646) 661-7853

2© GoTelecare 2016-17| All Rights Reserved 41 Madison Avenue, 25th Floor, New York, NY 10010
Company Overview
 ‘Onshore /Offshore’ KPO & BPO Services
 Serving US healthcare industry since 2007
 Robust & scalable infrastructure
 State-of-the-art technology and systems
 Highly skilled and trained staff with good
communication skills and in-depth knowledge of process
 Structured training, feedback and coaching
 HIPAA-HITECH compliant
 Offices located in US & India
• New York City, US – Situated in Manhattan (facility
inbuilt with all redundancies – power, infrastructure
and others)
• Kolkata, India – Situated in the IT Hub of Eastern
India (facility inbuilt with all redundancies – power,
infrastructure and others)
 Sun Knowledge, our contracted company, is
ISO 27001:2013 and ISO 9001:2008 certified
 CMMi-SVC implementation in progress under KPMG
guidance
 Member of NASSCOM, the Governing Industry body for
IT/ITES in India
 Awarded ‘Best Emerging BPO Company of the year 2010’
by The Economic Times, India
 Recognized as one of the foremost 'Emerging companies in
Eastern India' by NASSCOM in 2011
 Awarded Asia-wide “Healthcare BPO Provider of the Year”
at the Asia BPO Excellence Awards ceremony hosted by
Asia BPO Summit on 14th February 2013 in Mumbai, India
 Awarded the prestigious “Outsourcing Service Provider of
the Year” award in the Asian Outsourcing Excellence
Awards ceremony hosted by CMO Asia on 1st August 2013
in Singapore
 Awarded “Highest New Job Creator (IT/ITES)” by STPI
(Software Technology Parks of India) on 3rd December 2015
Key Facts Awards, Affiliations & Certifications
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Our Service Offerings
 Provider Support
 Member Support
 Member Retention Program
 Clinical Help Desk
Contact Center
 Utilization Management
 Medication Therapy Management
 Hospital Re-admission Management
 Therapeutic Interchange
 Formulary Management
Clinical Services
 Enrollment Processing & Member
Fulfillment
 Claims Administration
 Coding & Medical Billing
 Credentialing
 Premium O&P Billing and Collections
Administrative Services
Analytics
 Telemedicine Services
 Application Development
 Data Modeling & Data Warehousing
 Technical Support
 Technical Documentation
IT Services
 Claims /Drug Utilization Analysis
 PDE Analysis
 RAF Analysis
 Payment Reconciliation
We provide services to
PROVIDERS – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies
PAYERS – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
CALL: (646) 661-7853

REVENUE CYCLE
MANAGEMENT
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Revenue Cycle Management Overview
360°
Revenue Cycle
Management
Services
Eligibility
Verification &
Authorization
Billing
Coding
Scheduling
Payment
Posting
Accounts
Receivable
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Revenue Cycle Management Overview
Physicians / Hospitals
DMEPOS
Pharmacy (WC/ PIP)
Work with physicians to enroll them with payers, setup billing systems
with fee schedules, review clinical notes, code CPT/ICD, submit claims,
payment posting and follow-up with payers and patients
Setup DME companies in DME billing system, receive orders, generate
claims, payment posting and follow-up with payers and patients
Setup billing systems for submission of WC/PIP claims, code and apply
correct modifiers, check eligibility with adjusters, generate claims,
payment posting and follow-up
GoTelecare provides medical billing & coding services –
promptly, perfectly and professionally!
We are 100% HIPAA compliant.
CALL: (646) 661-7853

Revenue Cycle Management Services
End-to-End Billing Services
 Hospitals / Physicians
 DMEPOS
 Pharmacy (WC/PIP)
Stand-alone Billing Services
 AR Follow-up & Collection
 Eligibility & Auth Verification
 Pre-Auth Service
 Credentialing
 Patient Collection
 Coding
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Practice Management & Billing System
GoTelecare billing executives have experience in working on several industry standard
practice management and billing software systems such as:
We can provide medical billing & coding services using customer’s billing system
or can set up customer’s practice in a billing system managed by us.
 Kareo  SOS
 Emdeon / Capario One  Meditech
 Brightree  Alpha Collector
 Fastrack  OPIE
 CPR+ HME  Futura
 DME Works  PrimeRx
 Team DME
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Medical Billing – Challenges and Our Approach
 Assignment of adequate staff
 Completion of secondary verification
 Rigorous audit
 Time consuming with limited staff
 Documentation collection requires
continuous follow-up
 Increased TAT
 Time consuming with limited staff
 Secondary verification not carried out
Checking Authorization
Requirement and
Obtaining Authorization
Eligibility Verification
Patient Demographics /
Insurance / Charge Entry
 Transaction audit to minimize errors;
reduces denial due to missing patient
information
TASK DESCRIPTION CHALLENGES APPROACH
 Missing information / Key-in errors
 Increased denial rate
 Increased TAT
 Assignment of adequate staff
 Systematic and regular follow-up with
physicians’ offices & payers to collect
documentation and obtain authorization
 Proper tracking mechanism
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 Defining KPI for rejection management
process and assigning responsibility
 Claims reconciliation and exception
report generation
 Unapplied balance
 Accumulation of backlog
 Manual posting
 Denials not posted
 Delayed correction and resubmission
 Possible loss of payment
Payment Posting
Rejection Management
Paper Claim Submission
 Proper tracking of every submission of
paper claims
 Moving to EDI based submission
whenever possible will reduce cost of
manual work and faster payment cycle
 Additional work for printing and
faxing/mailing
 Delayed filing leading to denials
 Lack of information about the actual
status
 Defining guidelines
 Review of patient payments
 Define KPI – TAT & Accuracy
 Denial posting and review
CALL: (646) 661-7853

 Proper documentation – process
manual, guidelines & checklists
 Defining proper tracking mechanism
through various reports -Ageing, Status,
Daily, Exception
 Generate exception reports and regular
audit of every process tasks
 Defining KPIs and assigning
responsibility
 Lack of clarity of claims volume and
current status affects management
decision making process
 Impact on overall billing process
performance and improvement
 Decreased productive efficiency
Process Administration
and Reporting
AR Follow-up &
Denial Management
 Regular analysis, follow-up and review
 Transaction audit
 Accumulation of backlog
 Denials not posted
 Claims reconciliation issue
CALL: (646) 661-7853

General Billing Highlights
 FREE Billing Software
 FREE EMR
 FREE Setup, upgrades and support
 Above 97% Collection Rate
 Claims Submission within 48 hours max.
 Error-free Patient Entry
 Over 99.9% Coding Accuracy
 Real-time Audits
 Methodical and Proactive AR Follow-up
 100% HIPAA Compliance
 Custom Reporting
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DME BILLING
SERVICES
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Billing for DME
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 CPAP / BiPAP Machines
 Insulin Pumps
 Continuous Glucose Monitor (CGM) Systems
 Nebulizers
 Negative Pressure Wound Therapy (NPWT)
 Breast Pumps
 Urology Supplies
 Hospital Beds
 Sleep Apnea
 Chairs
 Ostomy Supplies, and more…
We provide billing services for a wide range of DME product categories including:

DME Billing Coverage
CALL: (646) 661-7853
DME coverage may be subject to a copay or coinsurance. Authorization is required for various devices
and this varies from payer to payer. This is considered a part of the member’s benefits provisions.
For DME products to be covered, the general billing requirements are:
 A prescription from the ordering physician dated prior to delivery date
 Consideration of limitations based on time period within which the item can be
covered if supplied earlier
 Appropriate modifiers must be billed
 Letter of medical necessity and additional documentation may be required for
some devices, e.g. Diabetic Verification Form for diabetic patients; coverage for
such equipment is subject to medical review by the Payer
 Coverage of devices also subject to qualifying diagnosis
 Repair, replacement and supplies may be eligible for separate reimbursement

DME Billing Cycle
CALL: (646) 661-7853
The billing cycle for DMEPOS involves the following activities:
 Order entry based on the Rx received from the physician
• Patient demographics & insurance entry
• Provider information entry
• Product code entry
• Rx &Dx entry (with appropriate timeframe)
• If necessary, a telemedicine consultation can be completed to obtain a Rx to expedite the order entry
process.
 Eligibility verification and auth requirement enquiry
 Collection of documents required by payer for auth approval, E.g. face to face consultation notes,
Polysomnography / Titration report etc. and obtaining of authorization from payer.
 Determination that payer criteria is met before delivery of DME, E.g. some DME have time / frequency /
annual cost limitations for DME (if criteria is not met the patient needs to be contacted and informed of the
financial responsibility)
 Generation of delivery ticket (based on which delivery is made to the patient)
 Creation of claim after receipt of confirmation of delivery
 Submission of EDI / paper claim to payers
 Cash posting
 Rejection & Denial Management
 A/R follow-up

DME Billing – Key Facts
 Secure Information & Data Flow between GoTelecare and our partners, enabled with reliable
networking software & hardware (includes secured Virtual Private Networks and FTP sites)
 All low pay and no pays reports are sent to the client
 Work on re-processing of the denied claims starts immediately after receipt of ERA
 ERAs are posted to the respective patients’ accounts
 Quality check is conducted at all stages of process
 Turn Around Time for this process is 24 - 48 hours
CALL: (646) 661-7853

Order Entry – Sample Report
INVENTORY RECEIVED
Category
Breast Pump CPAP Nebulizer
Closet
Nebulizer
Integra
Month
Jun-15 330 114 34 45 0
Jul-15 664 265 0 55 447
Aug-15 957 278 0 49 552
Sep-15 867 248 0 35 400
Oct-15 835 303 0 74 722
Nov-15 923 244 0 105 632
Dec-15 947 299 0 133 637
Jan-16 779 230 0 142 655
INVENTORY COMPLETED
Category
Breast Pump CPAP Nebulizer
Closet
Nebulizer
Integra
Month
Jun-15 330 114 33 45 0
Jul-15 664 265 0 55 447
Aug-15 957 278 0 49 552
Sep-15 867 248 0 35 400
Oct-15 835 303 0 72 690
Nov-15 923 241 0 105 592
Dec-15 946 290 0 127 637
Jan-16 752 209 0 134 655
0
100
200
300
400
500
600
700
800
900
1000
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
INVENTORY RECEIVED
Breast Pump
CPAP
Nebulizer
Closet Nebulizer
Integra
0
100
200
300
400
500
600
700
800
900
1000
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
INVENTORY COMPLETED
Breast Pump
CPAP
Nebulizer
Closet Nebulizer
Integra
CALL: (646) 661-7853

Eligibility Verification & Authorization – Sample Report
GOTELECARE ELIGIBILITY VERIFICATION & AUTHORIZATION DETAILED FOR ABC - (7/10/2015)
Sl. No. Patient #
Equipment
Category
Eligibility
Checked
Primary
Checked
Secondary
Checked
Auth
Required
Auth
Obtained
Fax sent Auth Pending Comment
1 221359 Beds / Mattress Yes Yes No Yes No Yes Yes
Pending Auth# Ak-098651
Follow-up : 07/15/2015
2 328547 Beds / Mattress Yes Yes No Yes No Yes Yes Follow-up : 07/14/2015
3 190398 CPAP - Machine Yes Yes No Yes No No Yes
Sleep study report missing.
Dr.'s office contacted
Follow-up : 07/13/2015
4 215604 Diabetic Supplies Yes Yes Yes No Yes Yes No Follow-up : 07/14/2015
5 218219 CPAP - Machine Yes Yes No Yes No Yes No Follow-up : 07/17/2015
EIGIBILITY VERIFICATION & AUTHORIZATION SUMMARY REPORT FOR ABC - 07/10/2015
Equipment
Category
Number of New
Patients
Patients Brought
Forward
Total
Patients
Primary
Checked
Secondary
Checked
Auth Required Auth Obtained Fax sent Auth Pending
Beds / Mattress 25 0 25 25 4 19 2 2 17
CPAP (Supplies) 44 3 47 47 12 9 7 6 2
CPAP (Machine) 15 0 15 15 3 11 3 3 8
Other DME 50 12 62 61 18 23 5 21 18
Diabetic
Supplies
27 0 27 27 6 8 6 8 2
Total 161 15 176 175 43 70 23 40 47
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CPAP User Compliance & Tracking – Sample Report
CPAP USER COMPLIANCE TRACKING SUMMARY REPORT FOR ABC - 07/10/2015
Day No. of Patients
Compliant Patients
No. of Non-
Compliant
Patients
No. of Patients
with No Data
Available
PendingNo. of Compliant
Patients
No. of Patients
Compliant based on
best 30 days
90th
day Compliance Report 5 3 0 0 0 2
60th
30th
15th
5th
TOTAL 17 11 2 1 3
GOTELECARE CPAP USER COMPLIANCE TRACKING STATUS REPORT - 07/10/2015
S No.
Set Up
Date
5th Day
15th
Day
30th
Day
60th
Day
90th
Day
Patient # Patient Name Doctor System Status
Therapy
Report Imaged
Report
Faxed to Dr.
Email /Faxed
Sales person
Payer Name
Comment /
Notes
1 4/8/2015 N/A N/A N/A N/A 83.45% 213765 DOE, JOHN Paez Encore Complete Yes Yes No OXFORD HEALTH PLANS
2 4/8/2015 N/A N/A N/A N/A 65.60% 218619 ROE, JANE Smith Resmed Complete Yes Yes No OXFORD HEALTH PLANS
Best of 30 days-
73.3%
3 6/6/2015 N/A N/A 100% N/A N/A 125354 DOE, JANE Ricardo Encore Complete Yes Yes No MEDICARE
4 6/5/2015 N/A N/A 96.70% N/A N/A 295695 SMITH, JOHN Paez Encore Complete Yes Yes No HEALTH FIRST NY
5 6/30/2015 80% N/A N/A N/A N/A 233432 BLOGGS, JOHN Paez Encore Complete N/A N/A N/A HEALTH FIRST NY
6 5/27/2015 N/A N/A 100% N/A N/A 196476 SMITH, JOE Jones Resmed Complete Yes Yes No MEDICARE
7 5/23/2015 N/A N/A 73% N/A N/A 215604 EVERYMAN, A Jones ICODE Complete Yes Yes No AETNA HEALTH PLAN
8 6/3/2015 N/A N/A 57% N/A N/A 217849 SMITH, JANE Smith Resmed Complete Yes Yes No MEDICARE
9 6/27/2015 100% N/A N/A N/A N/A 168488 BLOGGS, JOE Jones ICODE Complete N/A N/A N/A MEDICARE
10 5/1/2015 N/A N/A N/A 67.00% N/A 214535 IPSUM, L Jones Encore Complete Yes Yes No HEALTH FIRST NY
CALL: (646) 661-7853

Accounts Receivable & A/R Calling – Sample Report
Payer
>120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days
Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining
AARP HEALTH CARE OPTIONS 26 23 3 17 16 1 44 41 3 37 32 5
AMERICAN TRANSIT INSURANCE
COMPANY
12 11 1 6 5 1 15 15 0 10 10 0
BCBCS 28 24 4 16 13 3 41 37 4 32 30 2
MAGNACARE 13 12 1 9 9 0 23 22 1 11 10 1
HIP_PALLADIAN HEALTH 6 6 0 12 9 3 12 10 2 15 15 0
MANAGED PHYSICAL NETWORK 12 10 2 8 7 1 10 10 0 10 8 2
MAGNACARE 7 7 0 2 11 -9 5 5 0 8 3 5
TOUCHSTONE HEALTH 5 5 0 8 6 2 6 4 2 16 12 4
UNITED HEALTHCARE 31 28 3 23 20 3 49 43 6 41 39 2
S
No.
Date Payer
Patient
Name
DOB DOS Claim No.
Charge
Amount
Status Comments Ref #
1 7/21/2015 Healthfirst Doe, John 8/29/1974 6/26/2015 1063051526 $195.00 Paid
Called Healthfirst spoke with Gary - Rep stated that claim received
on 06/30/15 and processed on 07/17/15. Per rep ins paid $173.47
on check# 3023659 having bulk amount $11909.23. Check was
issued on 07/17/15 and is not cashed yet.
1063051526
2 7/21/2015 Healthfirst Bloggs, Joe 5/3/1983 6/16/2015 1091527510 $195.00 Paid
Called Healthfirst spoke with Gary - Rep stated that claim received
on 06/19/15 and processed on 07/10/15. Per rep ins paid $173.47
on check# 3019387 having bulk amount $25091.99. Check was
issued on 07/10/15 and is not cashed yet.
1061915510
3 7/24/2015 Magna Care (Oscar) Smith, Mary 8/11/1942 5/26/2015 P0449302 $3,800.00 Paid
Per Ashley- rep stated that claim received on 06/05/15 and ins
applied $292.60 towards pt as coins and paid 2633.40 by ck#
69783. Check issued on 07/10/15 and not yet cashed.
CL725541
4 7/24/2015 Magna Care (Oscar) Smith, John 8/10/1952 6/17/2015 Q0487598 $252.11 In Process
Per Ashley - Rep stated that claim received on 07/06/15 and still
in process
CL8765541
5 7/29/2015
Health Republic
Insurance of New
York
Doe, Janine 3/4/1958 6/19/2015 16478355-01 $100.00 Allowed
Per Andriya stated that claim processed on 07/08/15 and ins
applied $82.89 towards in-network deductible, Per rep the annual
in-network deductible is $2000.
18441664
6 7/31/2015 Oxford Health Plan Peters, Joe 4/25/002 6/8/2015 5184T02894 $59.62 Paid
Per Kelly stated that claim paid $42.58 on ck# 13357299 having
bulk amount $221.32 issued on 07/28/15 and not cashed yet.
15298601
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Denial Management
Auth Related
14%
Coding Error
5%
OON Issue
8%
COB Issues
10%Patient info missing
6%
Exceeds Timely Filing
8%
Duplicate Claim
5%
Service Not Covered
6%
Primary Paid Max
7%
Pre-Existing Condition
5%
Others
26%
Distribution of Denied Claims
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Benefits Proposition
 Increased revenue – reduced collection time (97% collection rate)
 Claim submission within 48 hours of receipt of billing input
 Adherence to CMS billing requirements
 Proper records maintenance and visibility in reporting
 Standardization of billing operations
CALL: (646) 661-7853

TRANSITION, OPERATIONS &
COMPLIANCE FRAMEWORK
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Typical Transition Schedule
 The key resources of the
customer are available during
the transition phase.
 All documents and process
materials like P&Ps and SOPs
are available to the Service
Provider Transition team before
the start of transition.
 Any change in the Scope of
Work will require re-planning.
 All data files are made available
for data migration work.
 Any other assumptions made in
the “Statement of Work” are
applicable here.
 A more accurate plan will be
given at the time of transition
 Transition plan tasks may vary
depending on specific project
ASSUMPTIONSSr.
No.
Phase / Task Description
Start
Week
End
Week
Remarks
1. Project Initiation W + 0 W + 0
2.
Transition Planning and Solution
Identification
W + 1 W + 1
ABC to provide existing
SOPs/P&Ps/Flowcharts/Report
s before this phase starts.
3.
Knowledge transfer and detailed As-
Is Process Mapping
W + 2 W + 3 Onshore activity at ABC
4.
Validation of process mapping
document / SOPs / training materials
5.
Validation of solution customization
requirements
6.
Finalize SLA & reporting
requirements
7. Staffing & Training W + 4 W + 7
8. Solution customization W + 4 W + 7
9.
Solution testing and verify operation
Readiness
W + 7 W + 8
ABC to provide sample data
and participate in testing
exercise.
10. Conduct Pilot W + 9 W + 9
11.
Evaluate Pilot results and finalize
critical Quality parameters
W + 9 W + 9
12.
Handover to Operations & start “Go
Live”
W + 10
Transition work ends and
operations ramp-up
CALL: (646) 661-7853

Transition Success Factors
 Executive buy-in
 Foster win-win partnership relationship
 Strong project leadership for both companies
 Client’s involvement in approving key deliverables (i.e. project plan, process documents, etc.)
 Maintain key current subject matter experts until knowledge is transferred and the key
processes are stable
 Availability of key client personnel for training
 Accurate identification of desk procedures and processes is critical
 Effective governance structure
 Communicate, Communicate, Communicate
CALL: (646) 661-7853

Operational Framework
TRANSITION
 Project scoping
& planning
 Knowledge
transfer –
Process training
and assessment
 Process
documentation
 Solution
customization
 Infrastructure
set up
 Pilot/Transition
period
TRAINING
 Training Need
Identification
 Customized
training program
as per client’s
requirement
 Pre-process &
process training
 Voice & accent
and cultural
training
 Refresher
training
PRODUCTION
 Project
management
approach
 Exception
handling and
reporting
 Effective
coaching &
monitoring
practices
 Periodic review
and evaluation
 Service level
management
and reporting
QUALITY
 Regular audit for
process and
deliverables
 Identify and
analyze errors
to take
corrective
measures
 Flowcharting
and root cause
analysis for
process
improvement
measures
 Management
reporting of
quality
assurance
activities
 Capacity
planning
 Forecasting,
staffing &
scheduling
 Real time
reporting
 Billing and
revenue
management
MIS / WFM
 Ensure 100%
adherence to
federal / data
protection laws
 Governance &
compliance
audits
 Organization
preparedness
for client & third
party audits
 HIPAA
compliance
CONTROL &
COMPLIANCE
PROJECT MANAGEMENT & OVERSIGHT
IT INFRASTRUCTURE– TOOLS & TECHNOLOGY
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Governance Model
GoTelecare
Governance
Structure
Steering Committee
Program Management Office
Project Delivery Team
 Executive sponsorship
 Management oversight
 Ensure business goals and
engagement goals alignment
 Ensure tangible results and
demonstrable value
 Continuously educate & report
executive leadership on the
critical success factors of
engagement
 Plan and implement change;
define, establish performance,
metrics aligned to goal
 Review project scope, timeline
and budget and monitor project
progress
 Communication, status reporting
& escalation to steering committee
 Manage cross team
dependencies
 Identify, initiate & institutionalize
process improvements
 Oversee knowledge repository
building
 Project Management
 Scope Management
 Knowledge
Management
 Change Management
 Ensure successful
engagement startup
 Quality Management
 Resource Management
 Communication &
Status Reporting
 Issue Management
 Monitor & measure
knowledge transfer
process
 Incorporate industry
best practices
CALL: (646) 661-7853

Quality Assurance & Control
Our Quality Control & Assurance processes help us meet our client’s expectations and SLA target. We
use Quality Assurance program to set production and quality goals. Our daily quality audit activities
ensure that we evaluate our agents’ work on all relevant criteria.
The highest quality is ensured by carrying out rigorous quality assurance and control activities such as,
 Periodic process review
 Process audit
 Testing deliverables and root cause analysis
 Process improvement / re-engineering
 Incorporating customer feedback
 Internal quality audit of client deliverables & review reporting
 Weekly/monthly monitoring of productivity reports
CALL: (646) 661-7853

Training Methodology
• Process training and
refreshers
• Availability of training
documents in
‘Knowledge Net’ portal
• V&A, Soft skills training
• Post-training assessment
• Training feedback
• Review of training
program
• Preparation of training
Modules
• Preparation of training
Plan in ‘Knowledge Net’
training module
• Regular process test and
appraisals
• Work in-sync with
Operations & QA
Training Need
Identification
Training
Program
Planning
Conduct
Training
Training
Evaluation
CALL: (646) 661-7853

Compliance – Key Facts
 Well defined policies to cover compliance aspects
 Written procedures covering compliance aspects
 Proactive compliance reporting and issue escalation
 Action list for changes in rules and regulations by regulatory authorities
 Compliance evaluation framework
 Periodical training on compliance issues and update
 Periodic audit and review mechanism to address potential compliance risks
 Implementation of data privacy and security standards like HIPAA-HITECH and ISO 27001
 Incident reporting for data security violation
 Compliance awareness among the employees and reward on compliance reporting
 Compliance violation by employees leads to employee retraining and reassessment
GoTelecare has defined and established a process and system to avoid compliance risks while carrying
out operations and encourage employees to proactively report compliance issues to the higher
management.
CALL: (646) 661-7853

Compliance Escalation Structure
Service Delivery
Service Delivery Mgr
(Service Delivery POC)
Head of Operations
(1st Level Escalation
POC)
Operations
CEO & MD
(Final Escalation POC)
Executive Board
Board of Directors
Compliance
Compliance Mgr
(Compliance Escalation
POC)
Head of Compliance
Compliance
Team Lead
Process Team Lead
(Service Delivery POC)
Technology
Technology Mgr
Quality
Quality Mgr
HR/Training
HR/Training Mgr
Compliance
Issue
Trigger Point
 Process Team Leader will inform
Service Delivery Manager and
Compliance Manager immediately
after occurrence of the event
 Compliance Manager/ Service Delivery
Manager will assign the severity of the
compliance issue
Compliance Escalation Path
Severe Compliance Escalation Path
CALL: (646) 661-7853

IT Infrastructure
 Service continuity supported by BCP and disaster management mechanisms
 100% redundancy in all IT assets, providing high-availability and reliability
 12 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic failover
configuration
 Data protection and security provided by Fortigate® 310B firewall combined with other physical and
logical access controls
 Voice telephony infrastructure built using E1 lines provided by two IPLC
providers
 Avaya PBX with IVR, ACD and CTI functionalities and 100% call recording
& reporting features
 Data center with 13 IBM x3650 rack servers with rack mounted UPS
 Polycom VSX 7000A video conference system for remote training
and client communication
 24/7/365 IT-Infrastructure support personnel for user support, using ticket management system
 120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power
generator
CALL: (646) 661-7853

Data Security and End-User Privacy
 Information security management system is aligned with ISO 27001:2013 standard
 Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations
 Data replication between GoTelecare’s servers in NY and India via site-to-site IPsec VPN tunnels helps strong
business continuity management
 Daily off-site backup process to mitigate data loss risk in case of disaster
 Implementation of physical access control system in office premises restricts access to sensitive areas housing
application and database
 Physical and logical segregation of internal network into VLAN segments to control and protect data storage and
transmission between business/process units
 Implementation of perimeter security devices, like firewall and segregation of sensitive information systems
 Access to all information systems through two levels of authorization
 Implementation of two levels of end point malware protection network and system level anti-malware systems
 Use of secure e-mail system for e-mails with sensitive PHI information
 Implementation of access restrictions to prevent unauthorized deletion or movement of data using external
storage devices like optical discs, pen drives, etc.
 Security incident monitoring, reporting and resolution system
 Periodic employee awareness training on data privacy & protection and HIPAA regulations
CALL: (646) 661-7853

HIPAA Compliance Summary
SL. COMPLIANCE ASPECT HIGHLIGHTS
1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review
2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years
3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording
4 Vendor Access
Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during
all times
5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility
6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility
7
Network &
Application Usage
Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass
storage devices, printers – controlled by Domain Group Policy | No wireless access points
8 Firewall
Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) |
Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic
9
VPN (Virtual
Private Network)
Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization
controlled by Active Directory's authentication service
10
Redundancy
Management
Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS
and 750 KVA generator | 22 KVA UPS backup for server and network systems
11
Virus & Malware
Protection
Central anti-malware system | Automatic updates | Extra protection by gateway firewall |
Centralized OS patch management system (using Microsoft's WSUS server)
12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills
CALL: (646) 661-7853

WHY US?
CALL: (646) 661-7853

Why Us?
 Very Little Risk
• Proven track record in providing healthcare BPO/KPO services
• Highly experienced in providing services to both payers and providers
• Experienced in working with various software platforms
• Quick and efficient resource for special projects requiring technical and process expertise
 Significant Upside Potential
• Great understanding of the Healthcare Industry. Operation scale-up with a short notice
• Extremely competitive rates, greater productivity, improved quality, increased member
and provider satisfaction
 Proven Process Performance
• Low denial rate  increase in revenue collection
• Verification & authorization accuracy > 99.9%; TAT: 24 hours
• High accuracy in Eligibility Data Maintenance (in sync with CMS)
 Clear Communication and Quick Response at All Times
 ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection
CALL: (646) 661-7853

Advantages & Benefits
CALL: (646) 661-7853
 Significant decrease in operational expenses
• With over 7 years of successful DME and O&P experience, GoTelecare provides professional
consulting to best allocate resources to increase profit margins
• We guarantee > 50% operational savings effective immediately
For example, one of our clients reported a $2.1 million operational savings in Y1
 Heightened collection and increased Account Receivables
• 30% of DME and O&P Rx are incomplete when first received. We excel in completing Rx claims
quickly
 Cyclical Data Reporting
• Data reporting interval can be customized to meet the needs of the customer
 Demonstrated experience handling DME and O&P claims
• Medicare, Medicaid, and Commercial Plans  Fee for Service and Capitated Plans

Our 4 Pillars of Strength
Highest
Quality
Excellent
References
Unique
Profile
Cheapest
Rates
Consistently delivering the best quality,
with the highest levels of accuracy,
efficiency & expertise
Glowing testimonials from every client
and not a single customer churn in our
7+ years of operation
Huge experience in working for both
Payers and Providers and the only
billing company with its own
Telemedicine platform
The lowest rates in the market, with
custom pricing options to delight all
clients
CALL: (646) 661-7853

What are Our Clients Saying
"The professionalism I have experienced with GoTelecare’s
employees has made them very easy to work with and has
improved our operation processes. Any time I have a
question, they are literally just a phone call or e-mail away.
I love the accessibility!”
- CFO of a major US healthcare company
“I am starting to see an upswing with Medicare and
United cash flow”
- CEO of a leading US healthcare organization
“Your productivity is very
impressive for your first month.
Almost everyone has an
average of close to 40 accounts
per day. We have gone over a
few things with you and each
time we talk, I am impressed
with how quickly changes and
improvements are put in place.
I will continue to share
feedback as I get it on
additional improvements that
can be made and appreciate
your attentiveness and
questions that you bring to our
daily meetings.
- Manager (Revenue Cycle) of a
reputed US healthcare company
CALL: (646) 661-7853

Contact
41 Madison Avenue, 25th Floor,
New York, NY 10010
(646) 661-7853
rh@gotelecare.com
Ronnie Hastings
CALL: (646) 661-7853

DME Billing & Coding Services

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