Billing software makes great strides

Paper billing is so 1989. HME software vendors have added so much sophistication to their billing software in the past two decades that they contend providers simply have no excuse for continuing to use manual processes.

“Back then, the lower-cost PC systems were a means to replace a pool of typewriters and to assist providers by producing claim forms faster and more accurately,” said Mark Thomson, president of Glenside, Pa.-based Client Services. “Electronic billing was still very new to many providers and system features were very basic. A ton of data was being inputted to these systems but very little was being pulled back out in the way of reporting and business intelligence.”

Not so today, say software vendors. They contend that they have developed advanced functionality that allows users to not only file the cleanest claims possible, but also navigate the confusing regulatory labyrinth.

“Today's HME providers not only have to comply with complex and changing Medicare regulations, but also have to deal with the impact of reimbursement cuts on their businesses,” said Jeff Johnston, co-owner of Columbus, Ohio-based Definitive Homecare Solutions. “Providers are demanding that their billing systems equip them with the tools to automate compliance with Medicare requirements and commercial payer revenue qualifications.”

Historically, HME providers have been perceived to be technology luddites, but they are now actively pursuing automation technology because they realize its benefits, said Esther Apter, CEO of Chestnut Ridge, N.Y.-based MedForce Technologies.

“Moving data between applications is not a new concept, but it has been slow in coming to HME software vendors,” she said. “One of the big changes has been recognizing that not every package can be everything to everyone. Providers utilizing systems that give them the freedom to move data can select multiple systems to handle their specific needs without having to double-key data.”

Enhanced features

Today's systems have many features to increase efficiencies and minimize paper, said Ralph Capasso, senior vice president of billing services for Atlanta-based CareCentric. Along with electronic claims submission, the new generations of software can also provide online insurance verification, electronic CMNs, cash posting for electronic remit notices, and proof of delivery through hand-held devices.

“Inventory control and general ledger applications are two examples,” Capasso said. “Beyond utilization, it is also critical that the providers maintain their systems to the current level of updates with regard to coding, pricing and insurance regulatory changes. Failure to comply with the updates will reduce chances of being paid.”

Because people are constantly changing health plans, HME providers can get stuck sending claims to the old payer. That is why Plainview, N.Y.-based Fastrack Healthcare Systems developed a feature called transaction transfer, designed to automatically track a patient's insurance status.

“We have an automated process that reverses out accounts receivable activity and transfers it to the new carrier, eliminating the multitude of steps that would have been previously required,” said President Spencer Kay.

Other examples include workflow automation that tracks the flow and status of every order; document imaging that eliminates the need to black out the patient name when submitting co-insurance; a manual billing hold for claims in review that can also stop the billing when patient is deceased; a collection module that makes claims resubmission easier; and online eligibility verification to Medicare, Medicaid and commercial insurance carriers.

Linking HME & MDs

One of the more aggravating billing snafus occurs at the physician's office, where paper documents can get lost, misfiled or forgotten altogether. Automation can help solve the “paper gap.” Seth Loonan, director of marketing for Berkeley Heights, N.J.-based Authentidate, says there is an intermediate step providers can use to get them out of 1980s fax mode.

The company's Inscrybe platform configures with workflows for HME, physician clinics and payers using an online platform. With this service, physician referrals can be initiated, patients can be automatically discharged to ancillary care facilities, care plans can be reviewed and patient records can be exchanged online. Additional workflows can be easily configured and deployed on Inscrybe, Loonan said.

“This is a terrific opportunity for HMEs and physicians to advance their relationship,” he said. “It helps them get out of the paper business.”