A clinic selected expEDIum Medical Billing to automate their complete practice workflow

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Integrated EHR+PMS saved 100s of manual data entry hours for the Gastroenterology Clinic.

....Over the last few years, we have worked with them to seamlessly offer our product and services from single proprietor doctor's offices to small groups and ambulatory surgery centres, with multiple stakeholders…Each challenge we have brought to their attention has been thoroughly researched, and we have collaborated on bringing thoughtful and comprehensive solutions to our clients and end-users….Our billing resources find its ease of use and time saved in handling patient statements…I wholeheartedly recommend working with the expEDIum workshop's fine team to provide seamless integration of billing/practice management into any existing product line.

Carl Thomas, Customer Support/Integration Manager, Infinite Software Solutions Inc. D/B/A MD-Reports

This case study focuses on a Georgia-based gastroenterology (GI) clinic with two providers that process over 500 monthly claims. This clinic is only one of the many installations from this Gastroenterology EMR partner, who submitted over 150K claims last year and recovered over $27M from hundreds of payers. The GI clinic looked for secure cloud-based medical billing software to migrate from legacy software and chose expEDIum Medical Billing. On average, a GI provider makes over $155K per year. Last year, in expEDIum this GI clinic submitted claims of about $3.9M and recovered over $591K from several payers, resulting in an average of $295K per provider.

Prior issues faced by the GI Clinic include:

  • Late payment because of error claims getting submitted to the clearinghouse.
  • The Payer paid their dues but were not posted manually in the system.
  • They overlooked several pending secondary claims.
  • They wanted to remove the paper superbill as it is an extra effort for the clinics.
  • Looked for a solution that supported both Outpatient/Consulting and Ambulatory claims.

The expEDIum team migrated the client's legacy system to eMB. As a result, expEDIum eMB has effectively addressed the main issues billers face.

  • The solution includes a built-in claim validation and scrubber to ensure error-free claims are sent to clearinghouses and payers.
  • The solution can auto-reconcile and post the ERA received from the Payer.
  • With eMB, secondary claims will be identified after auto-posting, Payer-to-Payer COB secondary claims will be automatically created, and secondary payments will be auto-reconciled. As a result, no secondary claims are left unbilled, and those claims become more visible.
  • This solution also has ESB (Electronic Super Bill), which can capture all the charges and create an electronic claim. The biller increased productivity and streamlined the billing operation with more automation and lesser paper handling concerning bookkeeping, invoices, reports, patient statements, etc.
  • expEDIum supports both CMS-1500 and UB04 claims seamlessly. This clinic has submitted over 900 ambulatory claims (UB04) alongside thousands of professional claims (CMS-1500) in the last year.

Providers could access their data using secure operator logons, and the clinic administrator could access various reports anytime. This installation used Office Ally® as its clearinghouse since its payer list covered many relevant payers. Additionally, they had enrolled all applicable payers to receive ERAs automatically through the clearinghouse.

Return on Investment (ROI)
  • With a denial rate of less than 1%, the clinic processes over 500 monthly claims.
  • As a result of improved productivity, claim visibility, and denial/rejection processing, it was also improved.
  • Since using our solution, the secondary collection has gone from 4% (of total charges) to 5%, resulting in an additional $18,000 per year in collections.
  • The clinic uses ESB instead of paper superbills, saving almost a person month of data entry time per year.
  • Instead of going to other Payer or Clearinghouse portals and making eligibility inquiries, they used expEDIum's seamless IEV. They saved almost a half-person month of data entry and convenience time per year.

The above data shows that the clinic saves over 2.5 person-months of data entry per year and generates an additional $18,000 in revenue from the secondary collection. Assuming the biller earns $19/hour, we can conclude that the clinic saves over $8,300 annually. Currently, the clinic pays only $3240 per year for the software subscription, saving them over $23K annually. Currently, expEDIum is working on the cross-over of primary HCFA to secondary UB04 and vice versa and on cloning claims between the two, which will save them additional labour.