Glenda Hill MBA 775 499 5499 Glenda hillgotelecare

Glenda Hill, MBA (775) 499 -5499 Glenda. hill@gotelecare. com Home Healthcare Medical Billing 41 Madison Avenue, 25 th Floor, New York, NY 10010

Overview Key Facts Awards, Affiliations & Certifications § Sun Knowledge is our closely affiliated company under the same ownership. § ISO 27001: 2005 and ISO 9001: 2008 certified company § ‘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 process knowledge § Structured training, feedback and coaching § HIPAA-HITECH compliant § Offices located in USA & India • New York City, USA – Situated in Manhattan (facility inbuilt with all redundancies – power, infrastructure and others) • Kolkata, India – Situated in the IT Hub (facility inbuilt with all redundancies – power, infrastructure and others) 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved § 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 14 th 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 1 st August 2013 in Singapore 2

HOME HEALTHCARE ADVANTAGES & BENEFITS • Significant decrease in operational expenses • With over 5 years of successful provider billing and collection experience, Sun Knowledge/Go. Telecare provides professional consulting to best allocate resources to increase profit margins. • Outsourcing your billing operations allows clients to focus on brand marketing, patient recruiting and delivering the highest quality of patient care. • We guarantee > 50% operational savings effective immediately. • For Example: New York Home Health Care Equipment reported to Sun Knowledge a $2. 1 million operational savings in Y 1* • Heightened collections and increased Account Receivables • Daily notifications of check history and payment floor status • Cyclical Data Reporting • Data reporting interval can be customized to meet the needs of the customer. • Demonstrated experience handling DME claims • Medicare, Medicaid, and Commercial Plans Fee for Service and Capitated Plans • Remove the stress of interpreting confusing Medicare eligibility for patients. 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 3

GOTELECARE SERVICE PORTFOLIO Administrative Services Clinical Services § Enrollment Processing & Member Fulfillment § Claims Administration § Coding & Medical Billing § Credentialing § Premium billing and collections Contact Center § Utilization Management § Medication Therapy Management § Hospital Re-admission Management § Therapeutic Interchange § Provider Support § Member Retention Program § Clinical Help Desk § Formulary Management Analytics IT Services § Claims /Drug Utilization Analysis § Telemedicine Services § PDE Analysis § Application Development § RAF Analysis § Data Modeling & Data Warehousing § Payment Reconciliation § Technical Support § Technical Documentation We provide services to Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 4

HOME HEALTHCARE BILLING 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 5

MEDICAL CODING & BILLING SERVICES Service Offerings • Medical Coding • Place of Service Based Coding – Inpatient, Outpatient Coding • Provider Specialty Based Coding– E/M, Cardiology, Orthopedics, Physical Medicine etc. • Medical Billing • Provider EDI enrollment • Patient Demographics entry • Charge entry • Claim submission – Electronic and Paper • Payment entry • Denial posting • Payment reconciliation Go. Telecare can handle medical coding & billing processes - promptly, perfectly and professionally using Emdeon or other billing systems preferred by the client. 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 6

MEDICAL CODING - PROCESS Medical Coding Process Flow Downloading Allocation Encrypted reports are downloaded from SFTP site Reports are allocated to coders according to specialty Quality Check Coding Quality checked for LCDs, updates and client specs. Analysis of reports, allocation of ICD and Service codes Uploading Analysis of reports, allocation of ICD and CPT codes Feedbacks & Updates Client reports back with feedbacks and updates 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 7

MEDICAL CODING – KEY FACTS • Our coders deliver error free charge sheets within agreed TAT provided by the client • We monitor, analyze, and improve coding documentation to avoid denials and guarantee reimbursements • We carefully determine the codes according to the clinical information provided by the Healthcare Provider/Professionals and report back according to the information provided • Our coders have undergone extensive medical coding training and are well aware of updated coding guidelines Our Specialties • Emergency Room • Inpatient Hospitalization • DME • Pathology • Critical Care • Radiology • Ambulatory Surgery Center • EKG • Pulmonary • Cardiology • ENT • Orthopedic Surgery • Anesthesia • Family Practice • Internal Medicine 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 8

MEDICAL BILLING – KEY FACTS § Review encounter (SOAP) notes and select appropriate CPT/HCPCS and ICD codes § Claims generation and review of edits § EDI claims submission through clearing house with TAT of 24 – 48 hours § Claims rejection review and resubmission § Payment and denial management § Accounts receivables analysis and follow-up § Quality check is conducted at all stages § HIPAA compliance (Complete Data and Document Security) 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 9

MEDICAL BILLING - PAYMENT/DENIAL POSTING Payment Entry Process-Flowchart Select Patient Account Select Encounter Payment Denial Post Payment Write-off Transfer Balance If not found Refer Client Specifies Denial Code Hold Transfer Balance § Receipt of ERA/EOB from payer triggers the payment/denial management process § Payment posting is important with respect to payment reconciliation § Effective and timely follow-up increase the reimbursement rate of the claims 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 10

CODING AND BILLING SYSTEM Sun Knowledge/Go. Telecare uses Emdeon system for coding and billing services that covers complete billing cycle: ü Appointment scheduling ü Encounter (SOAP) notes review ü Superbill generation and coding ü Claims edit checking and correction ü EDI claims submission through clearing house ü Rejection management ü ERA/EOB posting and reconciliation ü Automatic secondary payer billing ü Denial Management ü Patient statement generation and mailing 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 11

BILLING FOR DURABLE MEDICAL EQUIPMENT Durable medical equipment (DME) is any equipment that provides therapeutic benefits to a member because of certain medical conditions and/or illnesses that can withstand repeated use, is primarily and customarily used to serve a medical purpose, and is appropriate for use in the home. Example: § Ambulatory equipment: rollator, cane, crutch § Chairs: Geriatric chair, wedge cushions, Wheel chairs etc. § Breast pump § CPAP & Bi. PAP machines & supplies § Continuous Passive Motion machine § Perenteral & enteral feeding equipment & products § Hospital bed: Semi electric, fully electric, Side rails, gel overlay mattress etc. § Blood pressure, Glucose monitoring devices § Orthotics: Splint, brace , inserts etc. § Oxygen devices: Concentrator & supplies § Respiratory equipment: Nebulizer compressor, Suction machines etc. 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 12

DME COVERAGE & BILLING DME coverage may be subject to a copay or coinsurance. Authorization is required for various DME and this varies from payer to payer. This is considered a part of the member’s DME benefits provisions. For DME to be covered the general billing requirements are: § A prescription from the ordering physician dated prior to delivery date § Certain items must be rented prior to being converted to purchase and therefore must be billed as rentals § Consideration of limitations based on time period within which the item can be covered if supplied earlier. E. g. CPAP machines cannot be ordered more than once every 5 years while most CPAP supplies are available every 3 months § Appropriate modifiers must be billed with DME § Letter of medical necessity and additional documentation may be required for some DME, e. g. orthotics, beds & mattresses, Bi. PAP machines etc. Coverage for such equipment is subject to medical review. § Coverage of DME is also subject to qualifying diagnosis, E. g. CPAP machines – Obstructive Sleep Apnea § Maintenance, repair, or replacement and supplies may be eligible for separate reimbursement under a contracted maintenance fee with a DME supplier acceptable by the payer. 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 13

DME BILLING CYCLE The billing cycle for DME 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) § 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 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 14

ADVANTAGES OF SUN KNOWLEDGE/GOTELECARE § § § Very Little Risk § Go. Telecare is experienced in handling complex contracts/claims § Go. Telecare is experienced working with various claims & billing systems § Quick and efficient resource for special projects when needed e. g. member retention program, etc. § Quick and efficient temporary resource when needed e. g. inventory back up, annual enrollment period, etc. Significant Upside Potential § Go. Telecare has a good understanding of US Health Care industry. We work both for the payers and providers. § Extremely competitive rates, greater productivity, improved accuracy of claims, increased provider satisfaction, reduction in overtime cost Reduced Admin Cost § Leverage partial outsourcing to increase and/or create operational expansion opportunities Proven process performance § Claims Processing: Accuracy > 98%; TAT: 5 - 10 days § Efficient coding & billing process – special focus on rejection and denial management § Contact Center: Abandonment Rate < 2%, ASA within 30 Seconds for 90% of calls, High CSAT § Clear Communication And Quick Response Time At All Times § End user data privacy and protection through implementation of industry standard like ISO 27001: 2005 & HIPAA 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (646) 661 -7853 | E-mail: rh@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 15

CUSTOMER TESTIMONIALS & ADDITIONAL INFORMATION "My firm has evaluated an outsourcing transaction with Sun Knowledge. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry“ Chairman, President and Chief Executive Officer New York based Health Plan “Our company is very pleased with the administrative, and business analytical solutions which Sun Knowledge delivers to our company from a quality & cost perspective. They have been a true partner in bringing industry expertise, and innovative solutions to the table. Their ability to grow with our evolving needs for higher end services such as clinical services is a significant differentiator among healthcare business process outsourcing firms. ” Executive Vice President of Operations Leading MSO For Additional Information, Please Contact Glenda Hill, MBA Franchise Owner, Washington, Oregon, Idaho, Northern Nevada, and Arizona Go. Telecare Phone: 775 -499 -5499 Cell: 503 -860 -7377 E-mail: glendahill@gotelecare. com 41 Madison Avenue, 25 th Floor, New York, NY 10010 Phone: (775) 499 -5499 | E-mail: Glenda. hill@gotelecare. com © Go. Telecare 2016 -17| All Rights Reserved 16