Garbage in, garbage out: Bill right from the get-go

Friday, March 23, 2012

In any chain of events, the first link is generally the most important. If something goes wrong there, it can impact every other step in the process. This is particularly true with HME providers, which rely on intake coordinators to get a complicated billing process initiated properly. Starting off on the wrong foot wastes time and money, and opens the provider up to denials and, even worse, a potential audit.

How can a provider ensure intake coordinators are doing the best possible job? First, make sure intake coordinators receive instructions and tools to improve their efficiency and accuracy. Second, go digital. Too many providers rely on worn books and tattered printouts as reference points to align items such as diagnostic codes with HCPCS codes. Since paper-based reference materials are not integrated into the billing system, these become hard to use and difficult to keep up.

Coding and documentation

An important component of proper intake is having a keen understanding of the relationship between ICD-9 codes, HCPCS codes and how these are to be applied based on LCD and NCD guidelines. These codes guide product selection and are critical to the proper submission of a claim. When the wrong code is assigned, the claim is denied. Beyond that, applying the wrong HCPCS code also can become costly when a provider has to recover and replace a product that was incorrectly assigned. Add those costs to already-reduced competitive bid reimbursements, and a provider's cash flow can quickly be squeezed. This can be compounded if an error is unknowingly reproduced on multiple occasions.

In addition to coding, intake coordinators also are responsible for gathering the necessary documentation to file the claim, including verifying eligibility and providing back-up documents such as a certificate of medical necessity. Failure to include the correct documentation also can result in a claim denial. And the risk only goes up from there--once a provider is determined to have too many denials, an audit can be initiated.

Proper execution

Trained intake coordinators using business management software can help solve this problem and mitigate the risk by fully automating the intake process. A comprehensive software package with end-to-end coverage ensures that LCDs and NCDs are tied directly to inventory items and provides reference information alongside each product to easily interpret the diagnosis. In addition, through constant, web-based updating, a software provider can automatically keep intake coordinators up-to-date on the latest code or policy changes.

Other critical steps at intake are eligibility verification and making certain all documentation required for a claim is attached to each order. There must be processes in place to reduce the level of human error by hard coding a document checklist into the intake process; intuitive software can fill the void.

Leveraging technology

To streamline the billing process while maintaining strict quality control standards at intake, business management software can be beneficial. It's important to avoid implementing technology for the sake of having technology. It's critical to understand whether or not the software being considered will save time and money while enhancing productivity and workflow.

In the end, it's really about the beginning of the process that requires the greatest focus and attention. The old adage of "garbage in, garbage out" applies to the HME billing intake process just as it would with any other industry that relies on quality control of data management. By implementing better training for intake personnel and integrating the right technology, efficiency and productivity can be improved while decreasing errors and audit exposure. hme

Gregg Timmons is president and CEO of MedAct Software, which provides medical billing and inventory management software solutions for the HME/DMEPOS industry. For more information, visit: