Billing system trends

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Monday, June 30, 2003

The electronic billing landscape is slowly changing, with more providers adopting Windows-based platforms, software vendors altering their products to accommodate consumer demand and Web-based applications becoming more available. At the same time, more providers are co-opting their billing load to third-party firms in order to concentrate on other parts of the business.

Yet while more HME providers embrace new billing options, they are hesitant to try anything too new. As a result, companies increasingly adopt Windows-based formats, but still have reservations about using Web-based billing programs, software vendors say.

Provider demand for Microsoft Windows is resonating with several billing system vendors, though some wonder about the necessity of it and whether it’s even the most appropriate format for billing data entry. This skepticism is enabling the ongoing usage of older platforms, such as UNIX, VNS, AIX and DOS.

“Providers fall into two camps on that issue,” said Mark Kulik, senior vice president of sales and marketing for Atlanta-based CareCentric. “One camp believes that if they go with a billing package, it has to be Windows - but if you press them about the reason why, they can’t give an explanation other than ‘Everyone else is doing it.’ The second camp doesn’t care what platform it is as long as it does what they want it to do.”

Kulik breaks out provider platform rationale this way: Those who want Windows are making a decision based on emotion and place a high priority on system presentation; those who don’t care are more pragmatic and are focused more on productivity, he said.

Although the Windows camp is growing, there are still a significant number of pragmatists out there, said Mike Barish, president of AnCor Healthcare Consulting, Coral Springs, Fla.

“Many of the larger systems are on the AIX platform and the users are content to stay with it because Windows is more labor intensive,” he said. “For someone whose job is data entry, it’s more productive to hit the return key rather than use a mouse to point and click.”

The old platforms’ conduciveness to data entry is what splits preferences within provider organizations, notes Bruce Bothis, president of Parker, Colo.-based Centralized Billing and Intake.

“Managers prefer Windows, data entry prefers DOS,” he said. “Windows is great for looking at reports, while with DOS you can buzz through the screens faster.”

Professional biller Beth Newkirk agrees with that assessment.

“I won’t switch to Windows if I can help it,” said the president of Newkirk Medical Billing, Avondale, Ariz. “Windows is time consuming and when you’re a biller you need to be fast. Time is money and DOS is speed.”

Worker preferences aside, the reality is that “95% of the systems out there are Windows,” Bothis said.

Webaphobia

Greg Taylor, vice president of business development for Duluth, Ga.-based Fidelis Software sees a “bright” future in Web-based billing systems. The company’s Brightree application is only available on the Internet and Taylor says it’s just a matter of time before “real time” claims filing becomes the norm in the industry.

“The [Stamford, Conn.-based information technology consulting firm] Gartner Group projects that insurance companies will become real time payers by 2007,” Taylor said. “We as an industry, no matter whether we use the Web, DOS or Windows, will move away from batch-oriented transactions to real time transactions. As a technology supplier, we feel that it is up to us to raise the bar.”

State legislatures may also hasten the practice of real time claims filing, Taylor said, in an attempt to save money on Medicaid claims processing.

“Real time transactions will save Medicaid from paying for duplicate services,” he said. “Because batch claims are after-the-fact, Medicaid frequently doesn’t know if it has already paid for a claim. This system also benefits providers because they will know upfront whether they will be paid for services.”

Plainview, N.Y.-based Fastrack Healthcare Systems also offers a Web-based billing program, which President Spencer Kay says has trade-offs compared to private systems.

“Going over the Web requires less upfront capital, but you’re making monthly payments that can come out to be more money in the long run,” he said. “There are practical considerations, though - we manage the Web-based system from our end, loading updates transparently.”

In addition, Bently Goodwin, CEO of Memphis-based RemitData, says the global aspect of the Internet gives providers a valuable dimension to their billing systems.

“You can securely access your data from anywhere in the world that has an Internet connection,” he said. “That’s a powerful capability.”

Still, there are signs that providers are mistrustful of Web-based applications designed for claims processing.

As Duane Ridenour, HME industry analyst for QS/1 Data Systems in Spartanburg, S.C., relates: “I haven’t had any customers ask for software that will host somewhere else. They are entrepreneurs and want control. They want the data with them and no matter how secure or reliable the Web is, they still have issues with it. Maybe it’s still at the forefront, but I don’t see any interest in it at all right now.”

Estimates of how many HME clients are using Web-based billing applications range from about 20% of Fastrack’s customers to 0%-5%, cited by several sources.

Billing biz booms

Apparently, more HME companies are tired of the whole billing hassle and are farming the job out to professional third-party firms.

Beth Newkirk says her company has seen “tremendous growth” in recent months.

“New clients have told us they want to focus more on patient care than billing,” she said. “Between HIPAA regulations and staffing problems, the need for our service has become huge.”

Nancy Burma, president of Alternative Billing Solutions in Jamestown, N.D., is sharing a similar experience.

“I’ve been in the billing business for 10 years and our clients have primarily been small start-up companies with no computers,” she said.

“Now we’re getting inquiries from companies I never imagined - some with revenues in excess of $10 million are calling to outsource. Managed care has become much more difficult and they just don’t want to deal with it anymore.” HME
Key billing trends

HME software vendors report the following trends occurring among their clients:

- More companies are demanding Microsoft Windows operating systems.

- Some HME firms are gravitating toward Web-based billing programs, but the majority is reluctant to put data on a shared platform.

- Interest in e-CMN filing is growing, but providers are largely uncommitted.

- More companies are turning to third-party billers in order to focus on other business concerns.

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