Outside forces such as competitive bidding and a flood of audits make it imperative that HME/DME providers embrace business technology and software tools to boost efficiency and maximize profits. However, the industry still lags behind many others on the technology front.
In fact, as a whole the health care market’s investment in technology—around 3 percent of revenue—tends to be low compared to the average among other industries—between 6 and 7 percent—says Spencer Kay, president and CEO of Fastrack Health Care Systems, a technology supplier to the HME/DME industry. “As a result, more health care providers are inefficient and will have difficulty competing and surviving as reimbursement rates continue to decline.”
Kay points to Federal Express and UPS as examples of companies that dominate their field because of investments in technology—an example more HME companies should follow. The use of advanced technology is imperative in today’s world, he contends. Among the key advanced technologies available for HME/DME providers he lists mobile computing, an Internet portal and e-commerce storefront, bar coding for warehouse and delivery automation, document storage, IVR (interactive voice response) automated patient contact systems, integration with third-party applications and optimized routing of delivery vehicles.
Automation is an important tool as providers adjust their business to the new realities of competitive bidding, lower reimbursements, frequent audits and regulatory change, agrees Chris Watson, chief marketing officer of technology supplier Brightree. “Now is not the time to back away from investing in technology,” she says. “Every provider, from a national company to a smaller, specialized provider, needs to take a look at how technology innovations can improve efficiencies, help them generate new revenue and maximize compliance.”
However, automation is not a cure-all, and sometimes implementing a software system can uncover underlying problems in a business, according to Kent Barnes, director of marketing for technology supplier Team DME!. “A lot of HME/DME providers implement software expecting it to solve all their problems,” he says. “It has been said that technology is a lot like medicine; it has side effects that only show up after you have purchased and taken the medicine.”
Maximizing Software Benefits
Providers also aren’t maximizing the benefits of the software they have already purchased, experts note. “Most HME businesses use less than half of the features found in their HME software,” says Jay Williams, national sales director–western region for QS/1 Data Systems, who was sales manager for SystemOne—the company’s product for the HME industry—for more than 10 years. “They need to budget money each year for additional training on their software so they can learn how to use more features, which can help them operate their businesses more efficiently. This could help them reduce staff, bill claims more quickly, get paid faster by both carriers and patients, which increases cash flow, and control inventory more tightly so they can have just the right amount of inventory on hand.”
Not training newly hired staff on a system leads to mistakes and underutilization of the system, says Kay. “Providers need to invest more in software training both for new employees and as a refresher for existing staff, since a good software vendor is constantly adding new functionality to the software.”
Chris Watson of Brightree agrees that many providers use only a fraction of the capabilities of their software platform; instead they should be using “its full potential.” For example, Watson points to the value of custom report capabilities for users. “We advise providers to not only use their dashboard capabilities regularly, but also to become experts at creating and analyzing custom reports from their systems,” she says. “Reporting and analysis should drive decisions, and getting the right business intelligence should be a critical part of every provider’s core business processes.”
Brightree provides business management and software solutions to 2,500 customers and 40,000 users in the HME market. The company’s core platform is an integrated, Internet-based business management platform built on Microsoft.Net technology, enabling providers to maximize cash flow and increase profitability through process automation, business insight and ease of use.
This spring Brightree announced a document management solution that goes beyond document imaging to incorporate critical documents and data into business processes. The document management solution, available this summer, will enable providers to capture, manage, share and secure documentation to leverage patient, payer and product data from the Brightree platform. This data can then be used to create intelligent workflows, guide users and automate processes.
Benefits of an Integrated Solution
“Use as few software systems as possible to run and manage your business,” advises David Schaer, president of Computers Unlimited, which provides integrated software solutions, cloud computing and support services to the HME/DME industry. “A single integrated solution may not offer as many bells and whistles as some systems focused on only a portion of the provider’s business, but in the long run a single integrated solution leads to streamlined and efficient business processes and provides a unified view of the business performance and profitability.”
The company’s flagship TIMS (total information management system) software delivers an all-in-one software solution for providers, eliminating the hassle and costs of managing multiple systems for initial patient intake, claims processing, document management, complete asset control, financial management and business intelligence. In addition to providing an end-to-end integration of core business processes, TIMS allows the analysis of 100 percent of data using business intelligence tools from Microsoft and third-party vendors. Software customization meets the unique business requirements of larger HME providers.
TIMS developments in the last year include a new Patient Intake System, which guides the end user through the entire process while validating and qualifying the patient before delivery of a product or service. The system makes it paperless, simple and intuitive to minimize claim denials by proactively qualifying patients.
Expanding the Technology Mix
Jay Williams of QS/1 sees opportunities for providers to use more technologies such as e-prescribing, document imaging and GPS routing and tracking. They should use IVR software to handle patient resupply requests, remind patients that it is time for more supplies, check to make sure patients are still using their rental equipment and perform accreditation-required new patient satisfaction surveys. Providers should also embrace having their delivery drivers capture signatures electronically and accept credit card payments in the field for patient co-pays.
QS/1 has more than 8,000 HME and pharmacy customers, and serves 30 percent of the independent retail pharmacy market. SystemOne offered the first fully functional IVR system and has a touch-screen point-of-sale (POS) system that is both PCI DSS (Payment Card Industry Data Security Standard) for storing credit cards and IIAS-certified to accept FSA/HSA credit cards. QS/1 also offers an integrated pharmacy, POS and HME software solution for pharmacies.
With competitive bidding pressuring HME businesses to operate more efficiently, QS/1 has focused on accounts receivable and inventory control, the two biggest areas where money is tied up besides employee salaries and benefits. In the accounts receivable area, QS/1 has strengthened its interface with AR Allegiance, a business partner specializing in billing and collecting patient balances. In the inventory area QS/1 has added the ability to drop ship patient orders directly from suppliers, which relieves the provider of the burdens of stocking, shipping and delivering the product.
Broaden the Focus
Spencer Kay of Fastrack sees providers focusing on implementing billing and cash posting aspects of software without paying enough attention to automating the entire financial, operational and clinical aspects of the business. “Improving productivity and reducing operating costs in regards to the warehouse dispatching and delivery operation, customer service, clinical services, etc., can go a long way toward ensuring the profitability and competitive advantage of the business.”
Fastrack Healthcare Systems offers integrated solutions for HME and respiratory providers, infusion pharmacies and home health care agencies in both Web-hosted and on-premises models. Each service or product line is available standalone or combined for a fully integrated system that offers electronic patient records with one common database, financials and customizable reporting. The system encompasses financial, operational and clinical aspects of a provider’s business, and the modular design allows providers to add functionality as business needs change.
In the last year the company has introduced Fastrack MDI, a service that uses a master death index database updated weekly to determine if patients in the provider’s system are deceased. The feature is aimed at solving the problems providers face when they are not notified, such as inappropriate billing for rental equipment or losses from equipment that was not retrieved in a timely manner and was discarded by the family.
Set Expectations High
“You cannot simply implement a new technology or software and expect it to work on its own,” warns Kent Barnes of TeamDME!. “It is very important to set the expectations of what you are trying to accomplish with new software or technology, set goals, plan the process for achieving the goals and review constantly, and hold people accountable through follow-up and checkpoints.”
TeamDME! is a fully integrated billing and business management package that handles both front- and back-office processes. The software covers intake and online eligibility, denial tracking, smart collections, serialized inventory maintenance, fixed asset tracking, a payer-specific rules engine, document imaging, expense tracking and company profitability.
A new feature is geared toward Medicare competitive bidding. The system tracks all the Metropolitan Statistical Area zip codes and alerts the provider when they are entering patients that live in a competitive bid area. “We also track the bid categories they have won or are choosing to grandfather and pulling the correct allowable amount,” says Barnes.
“It is critical for DME providers to think outside of any previously-defined box,” says Ed Bauer, national sales manager for Noble House, another technology provider. “Expanding may mean developing business opportunities that might not have been considered in the past, such as increasing current sales levels, retail sales, dealing with additional private insurances and expanding into new categories of equipment and supplies.” DME software can be leveraged to provide well-defined, accurate billing and collections, thus minimizing operating costs while providing the vision necessary for company expansion.
Established in 1989, Noble House developed and markets Noble*Direct comprehensive billing and claims management software, focusing on methods to streamline providers’ procedures and reduce operating costs. Features include electronic claims, automatic creation of recurring claims and cap-rentals, complete inventory control, automatic generation and tracking of required documents and online patient eligibility. Other features include document imaging, National Provider Identifier (NPI) registry and Medicare Provider Enrollment, Chain and Ownership System (PECOS) lookups, competitive bidding tools, patient scheduling and a QuickBooks interface. A new feature allows providers to manage the burden of ongoing Medicare audits. Previously scanned completed patient documents may be easily selected to be part of an audit and then electronically transmitted to Medicare.
Bauer urges “due diligence” in choosing DME billing software. He recommends comparing systems to determine features and functions necessary for current operations as well as planned growth. “Software developers provide many features that may be superfluous to the needs of the provider and may therefore confuse billing operations,” he says. “Program ease of use allows for quick and painless conversion, simple cross-training of employees and a tighter, more-accurate billing and collections process.”
The paperwork and informational flow required to properly service DME patients is integrated into Noble*Direct and is necessary as defined by CMS and commercial insurers.
Conclusion
Savvy business owners benefit from embracing leading-edge technologies in many ways, according to Gregg Timmons, president and CEO of MedAct Software. “HME/DMEs can leverage integrated business management software to enhance productivity, improve patient outcomes and most importantly, strengthen the bottom line. Synchronizing revenue cycle management, supply chain management and financial management is key to doing more with less, and with higher accuracy. To complement the needs of each company software should deliver flexibility in workflow automation focused on enhancing the uniqueness of each HME provider, with the option of various deployment models, including cloud-based subscription, online hosting, and onsite deployment, tuned to each HME’s investment strategy.
“With margins down and volumes up, the goal is to achieve tangible business value to boost profitability and cash flow,” Timmons says, “rather than buying technology just because of the bells and whistles.”
Sidebars:
Ensure Payment with E-Prescribing
The HME/DME industry has been slow to adopt e-prescribing, even though it has significant benefits for providers. The problem is that many physicians consider e-prescribing for DME as additional workload, reflecting a deeper problem, which is that some physicians aren’t providing the necessary documentation and support information to ensure Medicare coverage. “If they were, e-prescribing would be a tremendous time savings,” says Mickey Letson, CEO of Dream Software, supplier of a DME e-prescribing system. DME providers, increasingly at risk of an audit that will track whether the documentation is in place, often struggle—and spend a lot of time and money—to get documentation from the doctor after the fact. “The average DME spends between 30 and 40 dollars per order just trying to get the documentation.”
When a doctor writes a prescription for DME equipment, the provider must react quickly to fulfill the order, often because the patient is being discharged from the hospital. If the proper documentation isn’t provided along with the prescription, the provider is stuck trying to compile the information, and doesn’t get paid by Medicare unless and until he does. If the provider demands the information up front, the doctor could find a provider who is “easier to do business with.”
Dream Software’s Web-based e-prescribing system automates collection of all information the provider needs from the physician and ensures that support material is provided upfront, in effect ensuring that the provider will be paid before he delivers the equipment. The software is updated to keep up with changing Medicare requirements. Letson says a physician staff member can complete the needed documentation and have the physician sign it in less than three minutes—about the time it takes to complete a prescription by hand and fax it.
DMEs pay Dream Software a monthly service fee and a transaction fee and receive any DME referrals from Medicare, Medicaid or insurance. Recent updates to the system include the ability to upload documentation from an electronic medical records (EMR) system. The system will soon add in-process eligibility checks to confirm insurance eligibility in real-time during the prescribing process.
Letson says doctors may be more accepting of the e-prescribing model related to private insurance, which covers enough patients that a doctor can’t just walk away. “Private insurers aren’t afraid of the physician the same way that Medicare is. They have a lot of authority and no problem mandating systems that can benefit them. They are gravitating to this process because it lowers the administrative burden on them and provides a virtual audit on every order that comes through the system,” says Letson.
Many doctors’ offices are upgrading to electronic medical records (EMR), and there is some resistance to embracing yet another software program. However, the e-prescribing functions of EMR software are geared toward prescription drugs and don’t provide the detailed written orders and documentation required by the DME market. “EMR systems do not make any allowance for the requirements to prescribe DME,” says Letson.
Ironically, doctors’ offices that have embraced e-prescribing of DME tend to become very loyal to the system, and to the DME who introduced them to it. Letson urges providers to “look into the future and where you will be as a result of competitive bidding. Your biggest overhead is intake, billing and documentation, and streamlining with an e-prescribing system can automate the process.”
Web-Based Training Helps Create Audit Trail
Many experts predict technology will continue to migrate toward Web-based systems, also known as SaaS (software as a service) and cloud-based software. “As the industry progresses you will see more support for the Web-based service model, which we have been doing for 10 years,” says Jon Jasperson, president of DMETrain.
DMETrain is an Internet-based supplier of training to all sizes of DME providers, from three employees to 1,500 employees or more. In its tenth year in the industry, DMETrain has about 1,000 customer companies representing about 20,000 employees. Training includes more than 400 online courses covering business ethics and fraud, how to set up equipment and billing, in addition to fulfilling mandatory training requirements and continuing education recertification requirements for AARC, BOC, ABC, and RESNA, etc. Pricing is based on a flat fee per employee, from $133 for a new user at a small company down to $50 or less per employee for larger companies, for which they can take as many courses as they want. Web-based training helps to lower continuing education costs and avoid the expense of sending employees off-site to be trained.
“For the next year we are looking to simplify how data is reported to users,” says Jasperson. “There is an overwhelming amount of data about training, and we want to make the data going back to users more concise and focused on noncompliance with government regulations and accreditation requirements.”
One thing driving the training business is audits, and DMETrain offers a number of courses related to documentation of billing.
In addition to the content provided by DMETrain, many customers are creating their own content and educational tools and integrating them into the system to make them easily accessible to employees. “Providers are taking a more-proactive stance about education,” says Jasperson. “We rarely lose customers, which is a direct result of saving these folks money. When they train on our system they get a very solid audit trail of what training was taken and when it was taken, which helps to meet accreditation requirements.”
