It is with great and sincere pleasure that I write this statement of service and value on behalf of expEDIum and their excellent program, expEDIum Medical Billing. Deciding to go through a software conversion took a lot of work. Change of this magnitude takes a lot of patience and hard work. We are very thankful that we went with expEDIum.
Billijean S. Hobson, President, MAX Revenue Corp
A Philadelphia-based Ambulance biller with 20 ambulance agencies that process over 4000 professional claims a month. The claims are being sent to PA, WV, NJ Medicaid, Medicare, BCBS, and several commercial payers. They used legacy billing software and have moved to an expEDIum Medical Billing (eMB) solution.
The issues faced with the legacy system included:
- Not having an integrated electronic claims processing and submission.
- A better view of the claim life cycle and a level of automation such as auto-posting.
- Ambulance-specific data screens and lookup.
- Copy/Cloning claims that save data entry.
- Paper billing to contracted facilities.
- Consistent stream of cash flow and a process-driven claims processing.
- Ensuring that compliance issues are addressed effectively and quickly.
- Secondary claim visibility and follow-up.
- Secure client access to the claim system.
- Data analytics/dashboard.
- Consistent denial/rejection/error claims follow-up.
expEDIum migrated this client from their legacy system to an eMB solution along with some data, such as the contracted facilities list. expEDIum eMB effectively addressed the main issues faced by the biller. In addition to the above issues, the solution has a built claim validation and a claim scrubber that ensures only error-free claims are sent to the clearinghouse and the payers. The solution streamlined their billing operation by standardizing the processes, making the claim life cycle more transparent. The biller increased productivity and simplified the billing operation with more automation and less paper handling with respect to bookkeeping, invoices, reports, etc.
The ambulance agencies were able to access their data using secure provider logins and had access to a variety of reports. This installation used Office Ally as their chosen clearinghouse as their payer list had good coverage of relevant payers from Pennsylvania, West Virginia, and New Jersey states. They had also enrolled with all the relevant payers to receive ERAs automatically through the clearinghouse and, in turn, into the eMB system.
Return on Investment (ROI)
- The biller processes over 3200 HCFA claims a month with less than a 2% denial rate compared to the earlier 3% denial rate.
- The overall productivity improved, resulting in better claim visibility, automation, and denial/rejection processing.
- The biller received Electronic ERAs (that are auto posted) for about 89% of the claims sent and the remaining 11% on paper EOBs (that are manually posted). The 89% auto posting saved 100s of hours of data entry savings every month.
- The secondary collection increased from 16% (of the total # of claims) to 21% due to increased visibility.
- Deleted all the double entries for mandated electronic.
- The total work hours were cut in half. The staff can concentrate on other aspects of the business, such as compliance, client training, and marketing.
- expEDIum has allowed the billing agency to spend more time on what they always wanted to do. Still, they needed more time and resources because everything was manual in the legacy system.
- The (biller's) clients getting into their system is a huge time savings on phone call resolution/question time spent by the billing agency.
- The billing agency has also been able to assign account managers, so clients have the same person to work with throughout. Account managers can handle the account from start to finish.
