eSimplify: Infusing Efficiency in Medical Billing Practice

Pradeep Kalmat, Founder & CEO

After managing large clients in the Business Process Outsourcing (BPO) arena, and gathering vast experience in IT, Pradeep Kalmat took the decision to start his own entrepreneurial venture in medical billing. While attending conferences, it was an astonishing revelation for Kalmat to find numerous private physicians inundated with the administrative burdens of medical practices. With hours of time spent on documenting patient visits, mandated by private insurers and other payers, physicians have less time to attend their patients. Concurrently, CMS regulations have shifted toward a value-based model making practitioners in primary care, being rated based on quality care instead of the number of patients attended.

Kalmat started exploring the possibility of developing an inherent mechanism or data to market his billing services to private physicians. Confronting these tribulations with a comprehensive portfolio of cutting-edge analytical solutions for physicians, billing agencies, and hospitals, Kalmat went on to launch eSimplify Solutions.

Our solution helps revenue management consultants and companies in healthcare provide optimum patient care and also foster growth in their practice

Being the only analytical data solution based on aggregated claims information, it simplifies the time-intensive business processes of the healthcare industry through technological innovations. “Our solution helps revenue management consultants and companies in healthcare provide optimum patient care and also foster growth in their practice,” says Kalmat, founder and CEO of eSimplify Solutions. “Physicians get the advantage of getting insights into their processes, take any precaution related to potential audits, and prevent significant penalties from CMS in future.”

eSimplify Solutions has designed a unique subscription-based, Practice Revenue Analytics product that streamlines the business processes. Physicians can view the total number of patients they attended and review the historical billing data from Medicare through the dashboards in the application. The dashboard also shows demographics that list the average age of each patient, the number of females compared to males, and the mean score of that patient population.
The physician can also get detailed statistics on the condition of the patients such as the total number of patients suffering from asthma, high cholesterol, and so on.

Medicare, RAC auditors, and commercial payers track down billing habits and compare that to the national averages to control fraud and abuse. eSimplify’s application encompasses audit risk monitoring where physicians can monitor audit risks through charts and perform internal billing audits and manage the cost of healthcare.

Revenue analysis is another key feature eSimplify provides in their product that aids practitioners track their duties timely. To substantiate with an example, for a Provider treating 500 of his patients on the dashboard, the ones with diabetes need their blood sugar levels to be monitored every quarter. If those diabetic patients are not managed properly, it can possibly lead to emergency and hospital room visits. CMS through MACRA and MIPS in an effort to manage the overall cost of Healthcare, reacts strongly in such a situation, which leads to a drop in MIPS ratings of the particular physician.

With subscribers growing daily, eSimplify is sprinting in full steam to serve more customers. The organization is also looking for investments to expand its infrastructure and introduce enhanced solutions by incorporating newer technologies that will stand the test of time. Since the industry lacks a single common system for every solution, eSimplify aims to integrate their product with every single EMR in the market and make practitioners grow organically.