Using Technology to improve Your ASC Colorado Ambulatory Surgery Center Association

1. Using Technology to improve Your ASCColorado Ambulatory Surgery Center Association Contact Information: MediGain Inc. 1-877-237-9539 mel@medigain.com www.medigain.com MediGain Confidential

2. MediGainPreserving Healthcare Profits Some Technology Usage Facts Before • First IBM PC is launched in 1981 • Motorola releases first mobile phone for $3,995 in 1985 • Cellular Technology Industry is formed in 1988 • The world wide web as we know it today launched in 1991 • Hotmail is launched in 1996 • HIPAA Introduced in 1996 Now • Computer ownership in the USA – 80% of population • Mobile phone ownership in USA – 81% of population • Internet usage in USA – 73% of adults • Google maps show pictures of your street and house • YouTube used to watch movies and elections • More than 80% of ASC’s and Physician practices still use paper medical records MediGain Confidential

3. MediGainPreserving Healthcare Profits Healthcare vs. other Industries • Retail Industry • Find your favorite store, clothes and sizes • Purchase online, and track shipping to your doorstep • Understands customer needs and trends • Airline Industry • Find destinations, schedules, type of airline that flies • Purchase tickets online - select seat, food etc. • Check status via internet, phone or text – notifies schedule changes • Receive promotions based on customer preference and history • Healthcare Industry • Minimum or if any web presence • Most cannot schedule appointments online – no notification on delays • Minimum knowledge and tracking of information about patient habits • No infrastructure to share information – loads of paperwork • Medicare takes 6 months to issue or change a new provider number • First IBM PC is launched in 1981 • More than 80 percent of ambulatory surgery centers do not use electronic health records, survey indicates.Healthcare IT News (4/7, Pizzi) reported, "82 percent of ASCs (ambulatory surgery centers) do not use an electronic health record," according to a survey conducted by Renaissance Research. The survey of 175 ASC administrators found “ • that 85 percent...use paper perioperative notes, and • 74 percent use dictation and transcription for the generation of physician procedure notes." The survey also found that "49 percent of administrators had concerns that revenue could be lost in the IT implementation process." MediGain Confidential

4. MediGainPreserving Healthcare Profits Why Utilize Technology in the ASC Technology One of the key building blocks of an ASC: • Technology • Processes • Resources Can provide the following benefits: • Increase revenue • Decrease costs • Improve efficiencies • Decrease errors • Improve visibility to operations • Use it as a strategic advantage over competition • Meet government and regional mandates • Meet consumer expectations Resources Processes ASC MediGain Confidential

5. MediGainPreserving Healthcare Profits MediGainPreserving Healthcare Profits Typical ASC Structure Front Office Back Office Clinical >80% of Revenue From Insurance < 20% of Revenue From Cash Patient Care Customer Service Transcription Coding Billing Collections Follow up Medical Records Scheduling Insurance Verification Patient Info Electronic Claim Processing Paper Claims and Statements Patient Forms Reporting Analytics Business Intelligence Diagnosis Procedures Dictation Inventory Management MediGain Confidential

6. MediGainPreserving Healthcare Profits MediGainPreserving Healthcare Profits Potential Revenue Losses in an ASC ASC’s Have Already Done Work and is Owed 100% Revenue Lost by Typical Facility Patient Registration/ Eligibility Verification Lack of proper front office processes and systems impact reimbursements -5% Fee Schedules/ Charge Master Charges need to be updated and compared with national averages -4% Poor transcription and inaccurate coding can lead to denials and lost rev. -10% Transcription/Coding Almost 3% of claims are lost by insurers after positive receipt by clearing house -3% Claim Submission Secondary Insurance & Patient Portions Many do not send or follow up on secondary and paper statements -3% Inaccurate posting can result in inaccurate statements, follow up, and collections -5% Payment Posting/Follow up Loss of 20% to 30% of the money you have already worked for! Potentially Lost Revenue 20% - 30% MediGain Confidential

7. MediGainPreserving Healthcare Profits What Processes Do You Automate? Manual Process Solutions • Scheduling • Ins Verification • Patient Confirmation • Chart Preparation • Dictn./Transcription • editing • Signature • Distribution • Document mgmt • Medical • Reports • Forms • Coding Web integration to PM System Scheduling and clearing house integration PM Sys and Telephone/Email integration Electronic Forms and Document Mgnt Sys Integrated Transcription and PM System Online editing capability Electronic signature system Web, fax and Email distribution EMR and Electronic Forms with Bar-coding Scanned or electronic health record Scanned or electronic health record Scanned and indexed EMR/Coding Engine X x X >82% >26% X X X >82% X X X X Pre-surgery Post Surgery Claim Prep. MediGain Confidential

8. MediGainPreserving Healthcare Profits What Processes Do You Automate? Manual Process Solutions • Charge Entry • Claim Scrubbing • Claim Submission • Claim Acknw. • Payment Receipt • EOB/PMT Posting • Denial Mgmt. • Reporting • Prescription/Labs • Materials mgt. • Patient info. • Marketing X X X X X X X X X X X X Integrate Registration and EMR Integrated coding engine and edits Clearinghouse integration with PM System Clearinghouse integration with PM System Bank lockbox with web based doc. view ERA with integration to PM System Denial tracking, automated appeals Data capture and business analytics Prescription and Lab integration with PM system Integration of PM Sys. and Clearinghouse Web portal with Integration - Med Rec &PMS Data capture through PM System/Web/Tel Post Surgery - Claim Proc. Post Surgery -Other MediGain Confidential

9. MediGainPreserving Healthcare Profits Asses Current ASC Situation • Technology • Age and efficiency of current systems • Tasks that are done manually but can be be automated • Staff • Knowledge of IT staff, and time allocated for technology planning • Management • How the organization implements and integrates technology related decisions • Financial • Budget and availability of funds for technology implementation, support and maintenance • Conduct needs assessment by functions • Front office – Scheduling, patient access • Clinical – Materials management, lab/pharmacy integration • Back office - Billing, Collections, Patient data gathering and distribution MediGain Confidential

10. MediGainPreserving Healthcare Profits Items to Consider When Investing in Technology • List benefits and calculate ROI • Staff time that will be saved per month x $/hr • Increase in revenue per month i.e. reduction in claim denial • Set IT roadmap and priority based on highest ROI and budget • Selecting vendors • Ability to customize, web based • Customer service, and customer feedback • Other key IT considerations • Capability to integrate to other systems and other facilities i.e. physicians, hospitals via HL7 • Web enabled access for ease of management and maintenance • Data exporting, mining and reporting capabilities • Phased deployment • Phase the deployment to ensure all stakeholders become familiar with new systems – MD’s, staff, patients • Set project plan and realistic timelines MediGain Confidential

11. MediGainPreserving Healthcare Profits Digital Forms Transcription Web Surgery Coding Phone Billing/ Collections Posting Insurance Reporting Analytics Patient Medical Record Inventory Management Bank Referring MD MediGainPreserving Healthcare Profits Ideal ASC Workflow MediGain Confidential

12. MediGainPreserving Healthcare Profits MediGainPreserving Healthcare Profits Example of Opportunity Assuming an average ASC Current revenue generated = $5,000,000/yr Conservative estimate of improvement = 10%-15% Total revenue increase/yr = $500,000 to $750,000 Total revenue increase/mo = $41,666 to $62,500 Note: This does not include any cost savings due to increase in efficiencies. MediGain Confidential

13. MediGainPreserving Healthcare Profits Where do you want your ASC to be? ASC Technology Maturity Model Level 2 Level 3 Level 1 Level 4 Some Scanned records Min. automation of processes Some delays in billing Some electronic claims Ave. collections Poor cash-flow Minimal reporting New but disparate systems Overworked staff Reactive management IT is an afterthought Standalone EMR Some Automated processes Smooth workflow Min delays in billing Consistent collections and cash-flow Basic reporting Some integration of systems Adequate staff levels Some proactive management Embracing IT Paper records Manual entry Manual processes Paper claims Delays in billing Poor collections Poor cash-flow No reporting Obsolete systems Overworked staff Reactive management Afraid of IT EMR accessible to patient/ext. entities Automated processes Optimized workflow Automated billing and coding Optimized cash flow Dashboards & Buss. Intel Fully Integrated systems Optimized staffing Leader in industry Proactive management Using IT as its advantage MediGain Confidential

14. MediGainPreserving Healthcare Profits Questions and Answers MediGain Confidential