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   Online electronic claim submittal EDI portal
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4eGuru released
Online EDI claim clearinghouse portal software, flow, claim forms' format & protocol are compliant with State of California Medi-cal (CMS1500)/PCHDP(PM160) form

The use of Electronic Medical Records has undergone a significant transformation in the past 20 years from various individual corporate developments using the PC Operating System in first generation computers to new interfaces, faster communications and advanced WEB-based software.  The advent of the Internet and advanced 3G and 4G technology makes older devices such as the FAX machine obsolete in most cases as digital signatures graphics and imagery methods have been introduced and computer memory sizes and mass storage devices have expanded.  These developments offer modern Physicians invaluable benefits to their practice not only in the introduction of new devices significant improvements to the productivity of their offices.

Starting with the basic Electronic Health Record and advanced input technology an Electronic Health Record becomes developed at a newborn’s early age and as a standardized HL7 computer file, will be able to live with individuals for their lifetime. 

Medical specialties are progressing in their development and addition of related imaging techniques, drug usage and prescription records matching the development of new treatment techniques. Yet, despite the advancements made, some elements in the practice have not improved, namely billing, since there has been a wide disparity in formats for submission of claims statements to insurance companies, federal, state and local offices for efficient compensation to physician individual and group practices. 

This problem has also been addressed by 4eGuru Inc. with the integration of the claims billing process with the Electronic Health record system with a new software module called CHDPGATEWAY” enabling direct statement preparation and electronic transmission to government offices immediately following visits with unnecessary clerical tasks which now consume the time and resources of the physician, nurse practitioner, assistants, and clerical staff, improving the productivity of all and allowing more patients to be treated while providing much more effective reimbursement.

The financial benefits far outweigh the cost of installing and utilizing CHDPGATEWAY”. Its ease of use has been proven through many man-months of use in targeted physician installations. Training and support during the transition from the manual clerical methods now in use is provided by 4eGuru to ensure complete operational facility by physicians and staff before the system goes fully operational. Additional support and troubleshooting of is provided by local staff, not some remote e-mail address.

 

4eGuru Inc.’s “CHDPGATEWAY” online submission flow and module are compliant with California State Department of Health Care Services Medi-Cal standard. It supports online batch claim submission (CHDP-Green form or PM160) and prepares paper print claim submission forms if required, without going through any third party or claim clearinghouse.

A cost-benefit estimate has been prepared below in moving to 4eGuru’s Electronic Health Record and using the CHDPGATEWAY” automatic online claim submittal method.

CHDP Paper Claim vs. Online Web Submission Claim Cost Comparison:

The present CHDP paper claim form completed by manual entry and mail submission is not the optimum method to submit physician visit payment claims compared to electronic paper-less technology.  As shown below, economic benefits can be quickly and easily realized by converting a paper-based medical insurance payment claim or billing to a fully integrated, paperless record system as provided by 4eGuru with the CHDPGATEWAY” claim module, with a breakeven period of about 6 months. Further as a result of the ARRA stimulus program which provides a reimbursement incentive for conversion to electronic technology the cost of conversion results in an additional financial payoff for a four year time period.

How much is Physician time worth?

What if you could save an hour or two per day? If you currently submit CHDP paper forms manually, your office is wasting a valuable resource “Time”,  whose use when optimized, can generate cost savings, enhanced revenues and more efficient office operations.

 

For a typical Physician or Multi-physician Practice cases, billing paper flows follow the procedure in the diagram above; not only does the individual physician have to take the time to write the notes for a biller or and/or their assistant, but the Practice has to forward the visit data in paper summary form to the Billing Office which generates a paper form, copies, packages and mails the billing information to the state in the case of Medi-Cal or to an insurance company. In these cases, labor time savings would occur if data electronically entered an qualified by the Doctor directly could bypass the unnecessary steps of manual entry by the Assistant and then forwarding pre-claim paperwork to generate the claim forms in proper format forwarding the data to the Billing Office and onward.  Manual handling of all the data induces errors, requires filing copies, stuffing envelopes mailing and recording the transactions for follow-up as required.  The analysis below demonstrates how an Electronic Health Record combined electronic forms handling creates major financials reward and many intangible benefits to the practice.


Time and Money Saving Steps - For CHDP Claims:

A.Physician and Provider side:

Doctor and Assistants Activities

A #1. Practice Statistics –Biller/Assistant:

Paper data provided to office biller

Preparation time and Activity

Data collection preparation period

Document Management after submittal

Average time taken by a biller to prepare and fill out paper CHDP form

Collecting patient data

10 minutes

10 minutes

Estimated Average time saved by electronic preparation & submission of CHDP form

Direct computer entry and submittal of Screening/Billing data  by Physician/Assistant

5 minutes

5 minutes

Average Biller entries per day

12

12

Total minutes saved per day

12 visits x 5 minutes

60 (1 hr)

60 (1 hr)

Total hours saved over 12 months

5 hours/wk x 48 wks

240 hour

Total weeks of work saved per year

(240 hrs / 40 hrs/wk)

6 weeks

6 weeks

Total Time Savings

480 hrs(12 weeks)


A #2. Total Biller Cost Savings per year

Biller /Assistant

Hours Saved

Minimum Cost @ $15/h

Total weeks of worked saved per year

480 hrs

$7200.00

Total Savings per biller  per year

 

$7,200.00

 

A #3. Practice Statistics – Doctor: needs to complete required diagnostic information data for each visit   for each CHDP claim

Average time taken by a doctor  to record  visit data on paper form

 

5 minutes

Average estimated time saved by using 4eGuru medical template

 

2 minutes

Average Doctor appointments per day

 

25

Total Minutes Saved per Day

(12 visits x 2.5 minutes)

30 min (say 1/2 hours)

Total estimated time worked in 12 month period

(5 days/wk x 48 wks)

240 days

Total estimated hours saved per year

(240 days x 1/2 hour/day)

120 hour

 

A #4. Savings from reduced Doctor Labor:

Doctor

Rate

@ $60/hr

Total labor saved per year

120 hrs

$7200.00

 

 

 

Total Savings per Doctor per year

 

$7,200.00


A #5. Additional Savings from reduced materials cost: (Paper, Cartridges, Envelopes, Mail)

Total forms submittal

Estimated savings

Annual Savings

Paper, Cartridges, Envelopes, Mail

($1.70 per form x  3000 )

$5,100.00

Total Savings per Doctor per year

  

$5,100.00



A #6a. Maintenance Savings from reduced filing, storing, retrieving, accessing, paper forms for review, and follow-up etc.

Estimated cost of filing, storing, accessing, retrieving - maintenance of paper forms          ~ ½ hour per year @ $15.00/hr

~($8.00/form/year)

$8.00 (est.)

Estimated maintenance of an electronic form

~($1-2/form/year)

$2 (est.)

Annual savings per form

($8 - $2)

$6

Assumed active forms per Doctor

One form per visit or 12/day x 240 day

 Estimated 3,000 visits per year

Estimated Savings per Doctor per form per year

3,000 forms x $6

$18,000.00



A #6b. Savings after Benefits paid in Explanation of Benefits (EOB) Posting Phase from retrieving, accessing, paper forms for review, and follow-up etc.

Estimated cost of filing, storing, accessing, retrieving - maintenance of paper forms          ~ ½ hour per year @ $15.00/hr

~($8.00/form/year)

$8.00 (est.)

Estimated maintenance of an electronic form -10 min

~($1-2/form/year)

$2 (est.)

Annual savings per form

($8 - $2)

$6

Assumed active forms per Doctor

One form per visit or 12/day x 240 da

 Estimated 3,000 visits per year

Estimated Savings per Doctor per form per year

3,000 forms x $6

$18,000.00

 

 A #7. Summary of First Year Estimated Savings by using 4eGuru Digital EHR Records and 4eBill CHDP/CM1500 Forms Submittal Methodology

From Item #2

Annual Savings from Reduced Biller/Assistants Cost

$7,200.00

From Item #4

Savings from Reduced Doctor labor Per Year

$7,200.00

From Item #5

Savings from reduced Materials costs

$5,100.00

From Item #6a

Savings from reduced manual forms maintenance

$18,000.00

From Item #6b

Savings from reduced manual forms maintenance in Explanation of Benefits  Phase

$18,000.00

First Year Summary

Total Savings per Year

$55,500.00


A #8. Cost of Implementation

First Year Investment Costs

Estimated Expense

First Year HW Costs, two computers and printers, modems interconnects , etc

-$5,000

One time  CHDP billing and Pediatric EMR SW Costs with HL7Capability

-$12,000

Annual Network, HW and Software Maintenance

-$6,000

Initial Training for New Updates and New Staff

-$1,500

Total First Year Cost Estimate

$24,500


A #9.  Individual Physician Savings over a Four year period:

Year

Investment

Annual Savings

Financial return

Year 1 :  Hardware Software         &Training
Maintenance
Total

$18,500.00

$6,000.00
$24,500.00

FROM ABOVE

$55,500.00

 

$31,000

Year 2:

$6,000.00

$55,500.00

$49,500

*Years 3,4 Estimated total over 2-year period

$12,000.00

$100,000 Est

$88,000

4 YEAR CUMULATIVE RETURN

 

 

$168,500


A#10.  Additional financial benefits:


Annual & Accelerated Hardware Depreciation

3-year Depreciable Investment on hardware

ARRA Government Credit

Four year program provide large incentive for acquisition of 4eGiuru systems

Reduced payment times due to speed of electronic submit

Estimate – one day for submittal

Reduced Errors and re-submittals due to error checking and integration with Patient Record information

Intangible


A#11. Four Year Summary in a Group Practice of 10 Physicians not including Cost Group Discounts           

Year

Investment

Annual Savings

Financial return

Year 1:Hardware Software & Training
Maintenance

Total

 

$185,000.00

$60,000.00
$245,000.00

See #9 ABOVE

 

$555,000

 

 

$310,000

Year 2:

$60,000.00

$555,000

$495,000

*Years 3,4 Est. Total over 2-year period

$120,000.00

$800,000

$400,000

4 YEAR CUMULATIVE RETURN

 

 

$1,205,000

Note: In third and fourth years there may be software and hardware upgrades so
operational savings are conservatively reduced.


The “CHDPGATEWAY” software suite is a fully integrated and robust solution tying together the patient information and clinical examination and procedure room to the practice management aspects of the medical office which include the reporting, insurance billing, payment receipt and patient reporting.The software operates as a Web-based and Client-Server application, which runs on all computer platforms including Windows- XP, Vista or Windows 7 servers, Linux. Mac OS X, and on all Internet Web-browsers. These include Internet Explorer/Firefox, Mozilla, Safari, and on all devices such as desktops, laptops, tablet computers, iPhones, and other PDA devices. User can maintain full administrative management control to maintain patient data privacy over all applications by restricting access only to appropriate authorized and authenticated levels.

 

CHDPGATEWAY” Medical software product improves office work efficiency, lowering office costs, makes patient record storage and retrieval flow more easily and with less error, enabling the entire office to become virtually paperless.

Just and start submitting your CHDP claims today!

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