Transnational Business Solutions Underpayment Recovery Services

1. HEALTHCARE SERVICES DIVISION

2. 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…..

3. 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!!

4. 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.

5. 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

6. 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
Reimbursements
10.25%
APR DRG
Reimbursements
7.96%
Freqency limits
Exceeded
4.16% Denied for TFL
0.81%
* Sample underpayments for an existing client

7. 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

8. 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

9. 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

10. 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

11. 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 the Hospital!
Jack Morrone
Regional Sales Director
Transnational Business Solutions, LLC
45 West 34th Street Suite 1107
New York, NY 10001
321-292-4746
jmorrone@transbizsolution.com