Project Planning

Plan Overview

Description of the Technology Project Plan

I am currently employed as Insurance Coordinator for the Whitsett Vision Group (WVG). Whitsett Vision Group is comprised of three doctors, including Jeffrey C. Whitsett, MD, ophthalmologist, Cybele Woon, MD, neuro-ophthtalmologist, and Jorge Garrett, OD therapeutic optometrist. Our primary purpose is to enhance our patients' vision by providing custom vision care. We currently have a large quantity of patients with many different insurance plans ranging from Medicare, Medicaid, Blue Cross Blue Shield, Aetna, United Health Care, etc. As a fast-paced, growing practice, it is our responsibility to meet the needs of our patients by providing quality service at an affordable rate. The project I have selected to undergo will be to implement the EDI Insight software to our current system.

EDI Insight is deemed as the physician network solution. Practice Insight, LLC, are the inventors of this software and have been leaders in the healthcare industry, migrating from mainframes to micros, paper claims to developing a claims clearinghouse and from UNIX to Microsoft and Linux based products (Practice Insight Website, 2005). This software allows your practice to dramatically improve productivity with secure real-time claims management solutions from EDI Insight. EDI Insight is ASP based with little up front cost to the practice (Practice Insight Website, 2005). This is the ideal software for every physician's office that files medical claims with insurance companies. EDI Insight is offered to us by Medical Office Systems.

EDI Insight would be ideal for Whitsett Vision Group, as well as any other physician's office because it provides total claims management, claims follow-up; rules based claim management, and electronic statements and letters. This software provides total claims management by scrubbing claims for clean submission, real time or batch claim status with messaging and real time or batch eligibility. Scrubbing claims means checking the ICD-9 and CPT codes to ensure proper usage to avoid denials. Real time or batch claim status with messaging means that providers are able to send their claims off and the insurance company receives them instantaneously. The providers are able to view real time status from the insurance companies after they have processed the claim. The insurance company then sends a message stating how much they have paid on the claim or why they are denying payment on the claim. This is much faster than waiting thirty days to receive an EOB (explanation of benefits) from the insurance company or a check.

Our mission is to enhance every person's vision by providing excellent customer service and care to each patient. In order to accomplish our goal, we must have patients to care for. Most of our patients have insurance. As a provider of vision care, it is in our best interest to correct as many of our patient's vision needs as possible. In order to do this, each patient must have the means to pay for their care, which in most cases is having insurance that we accept. For most of our patients, insurance is key since it is the most common form of payment that we receive from them. With the EDI Insight implementation, we will be able to verify benefits online and efficiently.

To begin my project, I will research EDI Insight's information and present it to my Office Administrator. I will present the facts about the software, the cost, what the benefits and risks are and compare it to our current system. This software should sell itself. By having rules based claim management software; there will be a reduction in the amount of rejected claims. This gives the provider more power and flexibility. Electronic statements and letters can also be sent through this software. This software enables the provider to add a message online to a statement they will receive, automatically generates patient due letters the day the claim balance is due from the patient and produces and sends informative patient statements (Practice Insight Website, 2005).

The cost for this EDI Software is as follows:

1.) Initial Software= $750.00 includes training by Medical Office Systems

2.) Unlimited claims submission electronically = $100.00 per month * 12 months = $1,200 total per year

3.) $.60 for every paper claim (Cannot be sent electronically), averaging 100 paper claims per month = $60.00 * 12 months = $720.00 total per year

4.) IT Support and Installation of Software = $150.00 per hour = 3 hours per month = 3 hours * 12 months = 36 hours = $5400.00 per year

5.) Unexpected events and delays = $600.00 per year

6.) Grand Total = $8,670.00, Budget will be $ 10,000.00

To undergo this project we will need a budget of $10,000.00. A rule to abide by to manage your project correctly is to develop a project plan, by defining goals and objectives, specifying tasks or how goals will be achieved, what resources are needed, delegating the right people for each task and associating budgets and timelines for completion (McNamara, 2005). This is crucial because if you fail to spend the time on this initially, it will cost you far more in the future. By keeping these practices in mind, most projects can be lead to success. The timeline to complete this project will be 5 months. This will include initial installation, training, follow-up and actual usage of the software.

Also, it is imperative that I follow this five month schedule and evaluate the project's performance at specific