Billing systems get more sophisticate

The term “billing system” is becoming archaic. The technology that once served as automated claims processing for HME providers has evolved into a virtual control center with multi-dimensional capabilities.

Now described with terms such as enterprise resource planning and integrated business management platforms, the billing systems of old have advanced to a point where they can serve all of an HME provider's automation needs, information technology specialists say.

“Providers have been adopting billing systems for the past few years, but systems like ours are for more than just claims processing,” said Scott Higley, vice president of business development for Las Vegas-based ATLAS Enterprise Software. “We have a billing component, but it is important for providers that everything is set up right before going to billing. The focus is not just on getting paid, but staying paid.”

With RAC audits on the rise, prior authorization has become paramount, along with a need for operational consistency, Higley said.

“Providers need a process solution that requires them to do things in a consistent manner,” he said. “Staff needs guidance on how to manage the documents all the way through. Audits are a problem for providers who don't have consistency in processes and procedures.”

Jay Williams, national sales manager of retail pharmacy and HME-West for Spartanburg, S.C.-based QS/1, acknowledges that billing systems have blossomed into full-scale IT operations and says HME providers need to thoroughly investigate their system's capabilities.

“There are some who are not using their HME business management software to its fullest extent,” he said. “Businesses that are having to perform functions outside of their HME business management software need to create a list of those items and inquire with their vendor about how those items can be automated. It may be as simple as having onsite training to better use the software to automate those items they are doing
manually.”

For an HME company to get optimal usage from its information technology, the system needs to create a streamlined workflow, says Phil Deschaine, marketing director for Davison, Mich.-based Universal Software Solutions. 

“A capable billing system will enable providers to produce low-touch claims that are accurate and complete and with a minimum of staff time,” he said. “The software will guide them through an order intake process that collects all the necessary patient and order information with the least amount of intervention by billing staff. We do this by creating a workflow that automatically checks for all the necessary data, creates the necessary documentation and reduces the likelihood of denials or compliance audits.”

Expanding the platform

The information technology available today is “what makes the difference between profitability and failure,” observes Wayne Bailey, director of client services for Bonafide Management Systems in Thousand Oaks, Calif. Today's technology has advanced functionality that can give providers a holistic view of their financial operations, he said.

“They allow providers to instantly check eligibility and claim status across multiple payers for all of their customers, saving thousands of dollars in wasted time spent signing on to each separate payer login,” Bailey said. “Advanced billing systems allow providers to get everything they need in a single place, eliminating costly time investments of tracking down individual details. All data appears on a single screen, enabling intuitive verification and claim submission.”

Additionally, the systems can automatically scrub, track, validate coding, mitigate denials and audit payer payments against payer contracts to ensure clean claims and complete payment, he said.

“These efficiencies cannot be underestimated, and can make a huge impact on a provider's ability to maximize reimbursement,” Bailey said.

Gregg Timmons, CEO of Media, Pa.-based Apacheta, says there are a lot of advantages for providers with one multifunctional platform.

“Having a solution with everything from inventory management to back-office programs to billing software integrated into a single platform not only streamlines overall business efficiencies, it also allows field technicians to automatically send completed proof-of-delivery documents to the billing department as opposed to a stack of physical paperwork,” Timmons said. “An automated system reduces paperwork, eliminates the potential for lost or missing documents and significantly reduces the number of days sales outstanding, improving cash flow while saving providers time, resources and money.”

Another important function, Timmons says, is tracking organizational trends, such as material costs and staff turnover rates.

“If you aren't monitoring your trends and costs, you remain blind to the factors hindering your business,” Timmons said. “Any billing system can easily pull reports showing providers the good, the bad and the ugly of their workflow, allowing them to make necessary improvements to processes.”

Interoperability: Not yet

As accountable care organizations continue to develop and the post-acute care sector gains more prominence under the prospective payment model, HME providers would be well served to become part of the electronic infrastructure that flows across the continuum of care. They just don't have a legitimate entry point yet.

Interoperability is a project that has been under development for more than a decade now and health systems are leading the way on its deployment. Using uniform standards like HL7, providers (ideally) can break through the legacy silos that prevent data from traveling to each care site.

Bailey acknowledges the value of interoperability as a vehicle for sharing electronic health records: “HL7 interface with EHR software systems saves time and resources by eliminating the need for double data entry, but more importantly, the data from an interface is accurate and compliance documents are automatically connected to the referral. This efficiency, driven by connected software systems, is the only way to balance the severe cuts experienced by this industry.”

Yet Williams concedes that full interoperability is still off in the distance for HME.

“Interoperability is highly desired, but not readily available,” he said. “Some HME business management software providers offer one- or two-way interfaces with hospital systems but not with much else. While it will it would greatly improve patient outcomes, the biggest barrier is everyone uses a different system and everyone wants their system to be the standard. Without full cooperation from the hospital EHR providers, interoperability with hospitals, doctors and pharmacies is very difficult.”