It is essential that HME organizations find ways to expedite the billing process. Some matters are beyond our control—unreasonable audit requests, for example—but the areas where you can maintain control should be constantly evaluated and reexamined for cost-cutting opportunities. A few specific issues that arise repeatedly are in the areas of order distribution, third party matters and specific findings detected while performing internal audits.
Intake Order Distribution
Many HME providers chose to implement more efficient processes to handle an intake/referral through to completion/delivery. Not all employees completely adopt that new system. For example, a printed copy of an e-fax order might be hand-delivered to the CSR/intake representative. Once the CSR enters the order into the system, it is set aside for scanning back into the software. In an efficient process, the order should be easy to allocate to the appropriate party— electronically—no physical paperwork necessary. Retrain your staff to work within the system as much as possible, and prevent them from leaving their desks unnecessarily. This can help reduce office chatter, thereby increasing productivity.
Third-Party Payer Network Issues
Many HME providers feel forced to accept patients—given the continuing saga of Medicare and competitive bidding—but have not established a protocol for how to handle these cases. When a third-party payer sends a check to the patient, you are required to collect from the patient months down the line—typically after the money is already spent.Rather than acquiescing, work to obtain payment—or at least a portion of the payment—up front.
If the product you dispense is not readily available through the in-network provider and/or the in-network provider is not local, work with the payer to obtain a waiver. Meet to resolve the issue and request to be the in-network provider for specific products. Be warned that despite your hard efforts and payer’s agreement to make an out-of-network waiver/exception, the patient might still be paid on occasion. You must constantly revisit these issues with the payer and always have the patient sign a document that obligates them to pay in the event their insurance will not.
Automation
All HME providers can use automation initiatives to prevent additional inefficiencies. Make a list of all of the possible automation solutions available that might enhance productivity. Then perform a cost-benefit analysis of each one. Further, issue a priority level to each initiative and begin the research for the most cost-effective initiative.
Measure this against the need for more staff if you choose not to implement this solution. Consider how much growth you can realize, without adding staff, once you add the automated feature/initiative. For example, with document imaging, you may not initially save money because you will need a file clerk to facilitate the scanning. As you grow and add more documents, you will not need to incorporate more resources if you have a smooth process in place.
Internal Auditing
To maximize your staff, confirm that they work efficiently and to their potential by establishing goals and measures. Routinely grade and monitor staff, and make sure to audit random functions within the operation to ensure their continued effectiveness. Pull 5 to 10 cases and evaluate them.
Issues discovered in this type of audit range from non-compliance to manual systems. Some providers keep an abundance of hand-written paper delivery tickets. They decide that it is easier to write out tickets by hand and have others enter the information later. With this inefficiency removed, the staff will realize a tremendous amount of increased productivity and control. By randomly selecting a few patients to audit each month, you can learn about issues and savings that you would not find otherwise.
By addressing intakes, third-party payer challenges, using automation as a means to increase efficiency, and auditing files, you will find ways to increase efficiency and remain compliant. When margins are shrinking, you have to make an effort to obtain cash quickly and improve productivity and accuracy.
