Part – I
Part – I
Executive Summary
Medical Coding and Billing services currently exist to manage medical practices. These services relieve medical professionals of tedious detail work, but rarely do they offer a means to substantially maximize the practice's bottom line.
National statistics show only about 70 percent of insurance claims, initially submitted on paper, are ever paid by insurance carriers. With electronic submission Physicians Claims can increase the percentage of claims paid to around 98 percent. Additional statistics indicate that it currently costs a medical practice between $8.00-$10.00 per claim (for independent clinics) to process insurance for their patients. Physicians 1st Billing and Claims can reduce these costs by 50 percent or more. Statistics also show a 30 percent suspension/rejection rate for insurance claims. But adequate profit margins allowed medical practices to ignore rate for insurance claims. But adequate profit margins allowed medical practices to ignore sound business procedures. Again the proposed change of ICD-10 and HIPAA 5010 will lead to the 30-40 percent of productivity loss in near future.
Physicians Claims is contributing over $9,000 to their business. Here we are requesting to borrow another $5,000. We would like to have your attention to this value add.
As a ****** we continuously work to overcome the solution by providing the adequate platform with promise to minimize the claim rejection by 20-30 % (alternately gain in revenue by 20-30%). Our end to end expertise to healthcare domain and innovative approaches lead us to achieve and sustain the professional excellence.
Potential Innovators
S
nayhilR
ana, Chief, BB, CPC-H, CPCOSnayhil has more then 10 years of experience in end to end healthcare deliverance. He managed transition and stabilization for several of high end healthcare project with top 10 Indian outsourcing providers.
Mission Statement
►
To acquire one hospital account and 100 physician account to process 15,000
claims a month by month 3.
►
To become recognized as a local industry expert in the field of medical
reimbursement along with increase in
revenue by 20% for our customer and 1.5 %
bonus increase in business revenue by
assessment and fixation of overall denial.
►
To add several additional services to our
►
To add several additional services to our
initial offering of electronic claims submission,
including:
- Code optimization, Denial Reduction.
- Managed care contract analysis.
- Full practice management.
- Customized reporting.
- Fee analysis.
- Medicare financial impact analysis.
- ICD-10 Implementation services.
Organizational Value
Customer First
Team
Synergies
Human Value
Purpose
Oriented
Leading
Innovation
Knowledge
Centricity
Target Market Segment
Independent
Physician
Healthcare
Software Vendor
Healthcare
Hospitals
Healthcare
Payers
Healthcare
Consultant
Part – II
Services Offered
Medical
Coding/Billing
E-2-E Practice
Management
Healthcare
Consultation
ICD-10 Transition
Process Flow
Patient
Visit
Patient
Eligibility
Verification
Medical
Coding
Medical
Billing
Billing
Payment
Capture,
Posting
Denial/AR
Management
EOB
Follow-up
Payer
Provider
Expected Process Flow
Medical Coding
Medical Billing
Human
Resources
Technical Data
Input Via
FTP/SMTP/
EMR
Processed/
Coded Files
upload on
FTP/SMTP/
EMR
Compliance
Practice Management
Healthcare
Consultation
EMR
Required
software
Inventory
Infrastructure
& Logistics
Compliance
adherence
Production
-100%
Accuracy
->98.5 %
TAT – 48 hrs.
Expected Project Execution
W - 2
W-4
W-6
W-8
W-10
W-12
W-16
W -20
W-24
●
Facility
Start Up
●
Training and Testing
●
Project Transition
●
Ramp-Up Plan (E- 20) ( Q- 95%) (P – 75%)
Milestone - 0
M - 1
●
Ramp-Up Plan (E- 20) ( Q- 95%) (P – 75%)
●
Project Stabilization , Process
Standardization
●
Ramp-Up Plan (E- 50) ( Q- 97%) (P – 90)
●
Process Standardization , Continuous
Improvement
●
Ramp-Up Plan (E- 50) ( Q- 97%) (P – 90)
●
Continuous Improvement, Business Development
Key : E-Employee, Q- Quality Measure, P-Production, M-Milestone
M - 2
M - 3
Part –III
10 - 18 %
1-2 %
5-9 %
1-2 %
3-5 %
Market Research Analysis
The average cost that physician expends on their claim
processing is
10-18 %
of their revenue, which goes to third
party for claim processing , however
5-9%
of the
total physician revenue expanded on
Medical Coding only.
Current expanses in Type of Healthcare services Current expanses in
percentage of revenue Expected Expanses (in percentage) Medical scheduling/Front
office 1-2 % 1-2 %
Medical Transcription 1% 1%
Medical coding 5-9% 4 to 7 % (10 % lower then current expanses)
Medical Billing 1-2% 1-2%
AR Follow Up 3-5% 1-3%
