Billing systems get more sophisticate

Wednesday, April 20, 2016

The vanguard of progress in healthcare is within the information technology segment, which is leading the industry forward on all fronts—clinical, administrative, operational and financial. In fact, automation specialists contend that providers can now control all of these functions from a single platform.

For the HME industry, claims processing and billing systems are the lifeblood of the business, and while having the ability to assess, produce and file clean claims is paramount, those using older models should consider upgrading to achieve the highest functionality possible, says Rob Boeye, executive vice president of Home Medical Equipment for Lawrenceville, Ga.-based Brightree.

“Today’s technology enables providers to manage all aspects of their business from a singular platform,” he said. “Beyond billing, providers may store documents, file claims, review business analytics and utilize new revenue generation tools like patient resupply. There’s tremendous opportunity for the provider, and the responsibility lies on both the technology partner and the provider to have a strong dialogue around priorities and goals, and how the technology can best serve them.”

One profound advantage of having multiple functions on a single platform is that it enables more comprehensive workflow, which extends to all areas of the business, says Paul O’Toole, vice president and general manager of Home Care Solutions for Oak Brook, Ill.-based Mediware Information Systems.

Among the functions now available through a single system, he said, are document imaging, accounts receivable management, wireless procurement and inventory, mobile dispatching and delivery, and integration with other vendors to capture critical clinical documentation and eligibility and claim status inquiries.

“Leading software applications also offer workflow tools that empower HME providers to proactively gauge competency from the earliest stages of the process of caring for and qualifying their patients,” O’Toole said. “With these tools, staff can make adjustments as needed in the process, identifying bottlenecks early on and addressing them immediately. This allows the company to accelerate satisfaction rates with both referral sources and patients. Workflow tools also typically help to monitor billing cycles and productivity, which can fuel-inject your cash flow and put the brakes on extended days outstanding levels.”

Yet a vast array of new capabilities available aren’t worthwhile if providers don’t know how to use them, notes David Schaer, president of Billings, Mont.-based Computers Unlimited.

 “Systems will always continue to incorporate new features and capabilities—however, ongoing training and ‘awareness’ on how to utilize existing capabilities becomes extremely important,” he said. “We use webinars and blogs to build awareness of new system capabilities and hold annual Users Group conferences to educate our user base on how to take full advantage of existing functionality.”  

The interoperability issue

When the Office of the National Coordinator for Health Information Technology was founded in 2004, the agency wanted the entire healthcare industry to be interoperable by 2014. While that still hasn’t happened, progress has been made and HME providers need to ascertain how their systems fit within continuum, Boeye said.

“Payers are trying to improve patient outcomes and reduce readmissions through the sharing of information and HME providers need to be able to share information bi-directionally with other referral sources and physicians across the healthcare continuum,” he said. “By taking advantage of electronic information sharing, HME providers become relevant in the discussion of a patient’s outcome, improving relationships with referral sources. The ability to share data becomes a differentiator. If referral sources find it easy to work with an HME provider and share information, they won’t need to go with anyone else.”

Over the past decade since the interoperability initiative began, the healthcare industry has undergone a subsequent evolution influenced by the Affordable Care Act in 2009, as well as the advent of cloud computing and wireless mobile devices. Moreover, there are proponents for replacing the original HL7 standard with more modern formats. These developments not only interrupted the timeline for bringing electronic health records and interoperability to fruition, they have influenced its course, says Ken Accardi, CEO of Boston-based Ankota.

“While the concept of sharing health data has been at the heart of the Affordable Care Act from the outset, in the short term things got worse instead of better,” he said. “With the mandate for hospitals and doctors to achieve ‘meaningful use,’ the early game plan was to implement a single system. Although the healthcare industry has taken a temporary step backward, resulting in less interoperability, the computer world in general has made great leaps forward, and the future should be bright.”