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 CLAIMSDATA 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 ofthe 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 Updates10.52%

APG Reimbursements

10.25%

APR DRG Reimbursements

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 Proposition

Revenue 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

ENHANCEMENTS

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 Relationships

Learning Together

Knowledge Management

Process Improvements

Productivity Gain

Performance and Profitability

Organizational Fit

Openness and Accountability

Ownership and Responsibility

BEST

POSSIBLE

OPTION

Building Relationships

Learning Together

Knowledge Management

Contact me today to find out how TBS and

our solutions can improve your bottom line

with no upfront costs to your Hospital!

Tim Kirsch

Consulting Partner

Transnational Business Solutions, LLC

45 West 34th Street Suite 1107

New York, NY 10001

800-362-8691

tim@transbizsolution.com