Look for 'agility' in billing systems

Friday, April 24, 2015

Because billing is the lifeblood of the HME business, having an automated system that enables prompt claims payment and supports other key financial functions is of paramount importance. Within the landscape of billing system vendors, there are myriad options for system design, but it is up to each provider to determine which one would work best for the company’s specific operation.

“All too often we hear of providers learning from the billing software companies themselves what the most important features are,” said Esther Apter, CEO of Suffern, N.Y.-based MedForce Technologies. “We strongly believe providers should come to the table with a check list of their needs and priorities and make sure whatever software products they purchase can live up to expectations. The best customers are informed and empowered customers.”

One of the biggest misnomers for HME providers is to look to their billing software “to be everything to everyone,” Apter said. “What they hope will be a panacea can end up leaving much to be desired in one area or another.”

For example, she pointed out that one billing software might be great at managing transmissions and cash posting but not as good at analyzing accounts receivables and providing a true priority-based process to follow up on claims. Another billing software might be strong on inventory but have overly complex billing management, she said.

“A best-of-breed approach can help providers ensure their organization’s specific strategic priorities are addressed,” Apter said. “They should assess their needs and select the best fit for each and tie them all together—the best inventory management, the best A/R analysis, the best document management, and the best process management.“

The automated billing environment has grown more complex in the past three or four years and is light years beyond a decade ago, observed Dave Cormack, president and CEO of Lawrenceville, Ga.-based Brightree.

“Technology needs were once considered simply a billing system, maybe with some inventory management,” he said. “Now the need is to encompass the entire enterprise with integrated and automated technology solutions. Today, with reduced reimbursement rates and additional regulations, providers must streamline and automate every aspect of their business.”

Enhanced functionality

As the result of technology advancements over the past four years, Brightree has greatly expanded its product portfolio for customers, Cormack said. Specifically, he said the company’s cloud-based platform gives providers a wider breadth of functionality, including intelligent document management, automated patient resupply and compliance, electronic claims processing and remittance, and integrated electronic purchasing with major suppliers and distributors.

“Providers should make sure they are implementing the right technology with a modern, flexible software platform that can easily adapt to evolving standards and changing needs,” Cormack said. “Older generation technology does not provide the agility an HME provider requires to survive an ever-changing healthcare environment.”

Keeping up with regulatory and billing  format changes has been a focus for software vendors and new offerings should have all the current updates, said David Schaer, president of Billings, Mont.-based Computers Unlimited.

“We work with the necessary regulatory bodies to ensure that our software platform is compliant and up to date with all regulations,” he said. “ICD-10 coding is a perfect example where we have incorporated functionality to process the new codes with the flip of a switch. We have also provided customers with an easy-to-use cross-walk functionality and various reports to identify exactly what actions need to be taken to ensure their cash flow will not be impacted.”

Third-party option

With plentiful billing systems technologies available, HME providers can pick and choose which automated system will work best for them. Even so, the issue of getting paid isn’t always about the “latest and greatest” in products, says Ward Cook, president and CEO of Tampa, Fla.-based Allegro Medical Billing.

“Some programs work better than others, but in all cases, the key component is the person doing the billing,” he says. “If that person knows the proper codes, modifiers and local coverage determinations along with keeping up with all the changes every couple of months, the company can survive. But my contention has always been that a billing company that doesn’t get paid unless the provider gets paid will usually do a better job than an in-house biller who gets paid every other week regardless.”

Therefore, HME providers can enjoy certain advantages to outsourcing the billing function to a third party, Cook says, because the company has extensive experience in the unique dynamics of HME and is diligent in tracking down each claim.

“The reality is that it is very hard to find a biller that understands DME,” he said. “It is one of the trickiest forms of medical billing out there, and if the biller doesn’t work the denials on a timely basis, then money will be lost forever.”