Automation allows real-time data dives

Friday, April 26, 2013

No longer should automated claims processing and administrative systems be seen as things that are “nice to have.” With financial difficulties from Medicare competitive bidding and RAC audits, using information technology to account for every dollar and asset has become a “must have,” software specialists say.

With claims and A/R serving as the fiscal lifeblood of every HME company, technology experts agree that it is imperative for providers to make a concerted effort toward using electronic means for all transactions while working toward total elimination of wasteful manual processes. Otherwise, they contend, floor-level reimbursement rates, rejected claims, workflow redundancies and asset mismanagement will take a toll on the business.

“Today’s systems are a lot smarter,” says Spencer Kay, president of Plainview, N.Y.-based Fastrack Healthcare Systems. “Our system knows the claims requirements for all carriers and bases its logic according to each carrier. Claims with errors are held so they can be corrected before they go out. That ensures no bad claims are sent.”

System logic also works on the order side so that the company is not shipping equipment to patients who aren’t covered, Kay said. The system lets the field reps capture the COD amounts at the point of delivery, while the accounts receivable collection function allows for payments to be broken out by payer, high-ticket items past due and other criteria, Kay said.

“It is real-time inventory control, so whenever they order, they can see what is on order and committed to patients in all locations. It is truly an enterprise-wide system,” he said.

Grab those dollars

Wayne Bailey, director of marketing and sales for Thousand Oaks, Calif.-based Bonafide Management Systems, says automation serves a vital purpose at the critical intake phase by checking patient eligibility and calculating co-pay and deductible amounts. 

“HME providers really need to pay more attention to this,” he said. “When I first came into the industry in 2004, I asked about how deductibles were collected and many companies said they didn’t. That is 20 percentage points right off the top.”

Deploying the right technology will help shift the HME mindset on collections so that providers collect every cent that is due to them, Bailey says.

“Checking eligibility and deductibles should be automatic,” he said. “This happens simultaneously at intake. If you don’t do this, you are giving the product away.”

State of automation

While Medicare’s requirements for hard documents might require the home medical equipment industry to remain “a paper intensive business” for the foreseeable future, a transformation is taking place in healthcare as initiatives such as electronic health records and health information exchanges gain momentum, says Esther Apter, CEO of MedForce Technologies in Chestnut Ridge, N.Y.

Apter recommends that HME providers take a close look at their information technology capabilities and determine how they can better utilize automation in their businesses.

“Some will say if they have automated generation of tickets or delivery, they believe they’re fully automated, but that is only one aspect,” she said. “Many have automated one function, but do not have full automation.”

Deploying a fully electronic system offers insight about just how fragmented the HME environment is and how improving efficiencies positively impacts finances, Apter said.

“Automation is about coming into the office each morning and everything you need to do is on your computer—that is how you prioritize, assign and escalate,” she said. “If you don’t have a process management program in place, how do you know what to do? If an audit letter is just sitting on someone’s desk, it may not be addressed for days.”

Measure up

Real-time data compiled into sensible metrics is critical to managing a business properly, says Chris Watson, chief marketing officer for Atlanta-based Brightree.

“Managers and owners all need to see the data from the same source to ensure they are all interpreting the same information,” said Watson. “A business owner does not need to wait for information—they can see it and drill into it in real time. Reports, dashboards, scorecards, are all valuable ways to measure business performance.”

It’s also important to know how to interpret the data, she said. 

“Business owners should have a software partner that understands the data and can help the owner interpret it properly to make better decisions,” said Watson. “This includes benchmarking against industry averages to understand how you compare against other providers.”