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

In this case study, we focus on a Georgia-based gastroenterology (GI) clinic with two providers that process over 500 claims per month. 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 particular GI clinic looked for a 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 with a value 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 they 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 iTech team migrated the client's legacy system to eMB. As a result, iTech's eMB has been able to address the main issues faced by billers effectively.

• The solution includes a built-in claim validation and claim scrubber to ensure only error-free claims are sent to clearinghouses and payers.
• The solution can auto-reconcile and post the ERA received from 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 were able to access their data using secure operator logons, and the clinic administrator could access various reports at any time. This installation used Office Ally® as their clearinghouse since their payer list covered a wide range of relevant payers. Additionally, they had enrolled all applicable payers to receive ERAs automatically through the clearinghouse.

• With a denial rate of less than 1%, the clinic processes over 500 claims a month.
• As a result of improved productivity, claim visibility and denial/rejection processing 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 superbill, 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 and saved almost a half-person month of data entry and convenience time per year.

In the above data, we can see 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 that the biller earns $19/hour, we can conclude that the clinic saves over $8,300 per year. Currently, the clinic pays only $3240 per year for the software subscription, which saves them over $23K each year. As of now, iTech is working on the cross-over of primary HCFA to secondary UB04 and vice versa and on the cloning of claims between the two, which will save them additional labor.