Billing: merely a piece of the electronic pie

Tuesday, May 31, 2005

With all the integration capabilities of today's automation technology, it seems anachronistic to continue using the term "billing systems" when referring to the electronic options available for modernizing HME office functions. Sure, billing is a key component in the provider's revenue flow, but it isn't an island and shouldn't be segregated when shopping for an IT solution, software vendors say.
"HME providers aren't in the billing business -- they are in the business of delivering products and services," said Spencer Kay, president of Fastrack Healthcare Systems in Plainview, NY. "Ultimately it's not about billing at all, though it's the end result of what we all do. Providers need to think [about automation] in terms of managing the delivery process."
To be sure, providers are overly focused on billing at the expense of other critical business areas, agreed Wayne Bailey, director of marketing and sales for Thousand Oaks, Calif.-based Bonafide.
"They need to look more closely at the relationship of billing and inventory control," he said. "We see it as a complete picture. Inventory helps with billing -- it cuts down denials because everything is accurate to start with. Your billing is only as good as your inventory."
So if billing is the sum of the parts, which parts should fit with it? Besides inventory management, it should interface with all other back office functions, such as accounts receivable, patient health information and certificates of medical necessity, vendors say. The operating system platform should be versatile enough to provide connectivity for all these elements, they contend, otherwise each department will operate in its own parochial domain.
By most accounts, providers are finally recognizing the potential of IT systems to help them wring out excess costs from their operations and are seeking a higher degree of sophistication when inquiring about new systems. The dire financial future brought on by the Medicare Modernization Act has motivated providers to look at how automation can boost revenues by streamlining their business processes.
Shedding paper
Seen as the low hanging fruit for cutting waste, automation proponents say paper documents absorb dollars like a sponge. Now, despite the security blanket-attachment most providers have had to paper, they are overcoming their fears and instituting paperless offices.
Mac McConkey, director of sales for Duluth, Ga.-based Brightree Software, commends the industry on taking the brave step forward.
"Companies now understand how much time, labor and effort is spent on managing paper," he said. "An estimated 40% to 75% of work inside the office is handling paper in some way, shape or form. Providers have come to the realization that the savings will justify the cost. I would say that over the next 18 months to two years, we'll see most companies implement some type of document imaging system."
McConkey's associate Diana McAuliffe issued a firm caveat regarding document imaging systems to providers contemplating the paperless concept.
"What they need to consider is the practicality of linking scanned documents into the system so they are easy to retrieve," said McAuliffe, director of customer services. "You want a system that intuitively attaches the document to the patient chart. Scanning is easy - it's the retrieval and loading that is just starting to be addressed."
Raising the bar (coding)
Back on the issue of how billing and inventory management are inexorably linked, software vendors say providers are a bit more skittish about adopting bar code scanning systems. While the benefits of bar coding are being acknowledged, the issues of cost, implementation and formatting reportedly have providers continuing to balk.
"The reality is that while the technology has been around for a long time, it varies from company to company who makes use of it," McConkey said. "Everyone says they want to scan their inventory, but when it gets down to the nuts and bolts of it, it's an arduous process administratively and not that many are taking advantage of it for this reason."
Unifying the divergent formats into a single HME standard would probably jump start provider interest in the concept, but the industry also has its eyes toward the future with radio frequency identification (RFID), said Duane Ridenour, HME industry analyst with Spartanburg, SC-based QS/1 Data Systems.
"We're a good five years out, but RFID will be the standard," he said. "Wal-Mart is already requiring its suppliers to use it. It's the best way to enhance inventory control -- a pallet is brought in, scanned and the inventory is automatically updated. How can it get any better than that?"
HME providers have clung to the proprietary platforms of their old legacy systems longer than just about any other business and only recently have they faced the decision of what to use next. In Spencer Kay's view, there is really only one choice.
"They have to buy a Windows-based system -- nothing else will give them the productivity gains they need," he said. "I can't imagine anyone choosing a DOS or Unix platform now."
Michael Quinn, vice president of Atlanta-based CareCentric, is a staunch advocate of the Microsoft.Net platform, a variation of Windows.
"Microsoft.Net takes Windows a step beyond," he said. "Microsoft is investing heavily in this environment because it embodies features of Windows XP and 2003 and offers a suite of development capabilities. Go to the Microsoft Web site and you'll see that the majority of their future development activity is on the Microsoft.Net platform. We're hooking our wagon to that technology because it provides a higher level of functionality."
Finding functionality
While "billing systems" may be an antiquated phrase and only a piece of the automation puzzle, providers still consider it the primary feature and look for the highest degree of functionality possible, vendors say.
When it comes to billing, that means having a system with a series of safeguards that ensure electronic claims are as clean as possible before they are submitted to payers, Kay said.
"They want a system that provides checks and balances so that only billable orders go out and that they are only shipping products that they know are accurate," he said.
McAuliffe added that the best billing programs "push" information to the user instead of requiring it to be "pulled" out. Otherwise, the company will have to repeatedly check every step of the process for errors.
"The system should put each bill through an audit process and not let it go unless it's clean," she said. "Once it's confirmed, you don't have to worry about it."


Category: Billing systems

Key trends:

- Billing systems no longer have to be stand-alone programs. They can be integrated with administrative, operational and clinical functions.
- In 18 to 24 months, most providers should be paperless.
- Windows and its new variant Microsoft.Net are considered to be universal platforms.
- As the HME industry considers adopting a uniform bar coding standard, RFID systems are four or five years away.
- Most providers want a degree of functionality that audits claims before they are sent, ensuring they are clean.