Billing systems: Go beyond claims processing

HME providers that are using their new-generation billing systems strictly for claims processing are barely scratching the surface of what this modern equipment can do, software vendors say. With multi-functionality for clinical, administrative and financial operations, the automated billing system has come a long way, observes Spencer Kay, president of Plainview, N.Y.-based Fastrack Healthcare Systems.

"Early on, billing and cash posting seemed to dominate the functionality of HME software," he said. "Today some vendors offer what is referred to as an 'enterprise' system in that it truly helps manage the entire operation of the business from patient intake right through to the delivery of the product or service in the patient's home. A good enterprise system features advanced technology that plays a key role in improving productivity, enhancing patient satisfaction and reducing operating costs, while eliminating the need for multiple software products to run the business."

Esther Apter, CEO of Chestnut Ridge, N.Y.,-based MedForce Technologies agrees that having an advanced billing system is an ideal pivot point for automating the entire HME provider operation.

"Many of our early adopters are growing in spite of the tough times and I believe it is directly related to their ability to invest in good technology," she said. "This gives them the ability to be as efficient and lean as possible, thereby giving them the resources to focus on growth."

To be sure, billing systems have gotten more sophisticated, says Steve Post, director of marketing at Davison, Mich.-based Universal Software Solutions, but he cautions that "just as buying a new wrench won't guarantee you can fix your car, buying a software system that can produce more reports doesn't guarantee the provider will understand how to take action with that new information."

System evolution

Byron Maynard, president and CEO of Sacramento, Calif.-based Pacware Software Development contends that "just being able to bill is no longer good enough" and that HME providers need compliance, accreditation management, inventory control, document imaging, data analysis, GPS tracking, retail management and reorder management.

"They need to have all these features or grow into them on a steady basis to compete in the more fractured and complicated healthcare environment that is coming toward us," he said. "The basics are no longer good enough to compete in today's HME world."

Driven by input from its 1,300 provider customers, Lawrenceville, Ga.-based Brightree has expanded its original billing automation system to a comprehensive business management platform, says chief marketing officer Chris Watson. To illustrate the platform's evolution, Watson uses a cell phone analogy.

"In the beginning there was the handset cell phone, used specifically for making a phone call on the go," she said. "Now, millions of smart phones are sold each year and hundreds of thousands of applications are available on these systems. These multi-purpose 'phones' are now an integral part of our lives and are often used for everything from e-mail and navigation  to movie show times and restaurant selections. That's because we are able to improve efficiencies in our lives and the experiences we encounter with the data that resides on these smart phones."

Automation advantage

John Williams, senior vice president for marketing and IT services at Atlanta-based CareCentric, points out that with electronic claims submission, electronic cash application and electronic documents, HME providers can more easily identify and correct billing and compliance errors. Moreover, by partnering with software vendors, HME companies can more easily conduct self-audits as part of their own compliance program, he said.

"Additionally, the use of these electronic and automated systems reduces labor time and costs," Williams said. "Even the automation of work flows can increase accuracy and efficiency, which result in increased cash flow and higher levels of compliance with regulatory requirements."

Two billing system functions that HME providers should be using are business analytics and reporting, says Tim Barone, partner for business development at Cuyahoga Falls, Ohio-based ACU-Serve.

"As reimbursement cuts continue, it is critical for every HME provider to monitor cash flow, write-offs and revenue," he said. "Many of the systems have made it easier to trend out this data so that a provider can immediately determine why cash flow is down and, even better, forecast what their cash will be in upcoming weeks and months."

If a void does exist in modern billing systems, it is in the area of compliance and rules management, notes Brent Mattox, president of Greer, S.C.-based Reimbursement Services.

"Users are still expected to have an intricate knowledge of billing rules for many different payers and are required to remember hundreds of small details as they perform their work," he said. "This knowledge base could be incorporated into a rules-based system which could guide users through their billing tasks and prevent most common billing errors from occurring in the first place."

The EHR factor

As the healthcare industry moves toward electronic health record (EHR) adoption in 2013, HME providers who get themselves situated with billing automation tools now will be in an advantageous position when the deadline arrives, said Lorraine Lodigiani, director of marketing and business development for McKinney, Texas-based MedAct Software.

"EHRs will make working with physicians and other referral sources much easier," she said. "Going forward, the HME market will be smaller and leaner with a younger, more tech-savvy workforce. Being more comfortable with technology such as on-demand automation and mobile devices will give providers the ability to improve patient safety and quality of care while simultaneously improving the bottom line."