Although change has and will always keep HME providers on their toes, today's rapid rate of change revolves not only around new and modified guidelines, but also around the accelerated rate of advancement in technology. Software nearly becomes obsolete before the HME community even has a chance to embrace it. Automation can create an inherent struggle for those who like the control of a manual environment. In fact, some who are forced to do their job in an automated way will maintain manual systems as backup. This type of duplication can negate any efficiency benefit of automation.
Medical Necessity Documentation
A prime example of continuing manual systems is the notorious 1-31 medical documentation file. This file is replete with multiple copies and excess paper. Obviously, when hard-copy attachments are required, guidelines must be followed—but this should generally be an automated function. Adopt e-faxing for sending and receiving all documents, including medical necessity documents and chart notes. Have forms bar coded so they can be received electronically and autopopulated into patients' electronic files. Less time will be wasted getting up and down to walk to the fax machine, and less paper will be generated, distributed, filed, monitored, scanned, re-faxed, etc.
Copay/Self-Pay Collection
Another manual process is the attempt to collect self-pay/private-pay money. As a general rule, HME providers are not proficient at this necessary task, even though this will only become a more pressing issue as deductibles soar and coverage percentages dwindle. Further, the law of diminishing return applies here—the more a receivable ages, the less likely it is to be collected. Having your staff dedicate time to collection tasks, such as calling patients, sending out statements and creating small monthly payment plans, is poor use of their time. At their core, most HME collectors are not set up for private-pay collection responsibilities. By automating the private-pay collections function, you should be able to recover additional monies from private-pay patients and use your resources on third-party payers. This means adding an IVR and/or autopay feature for ongoing rentals. This is done through an automatic bank debit or credit card payment. Additionally, you should have an accessible online bill pay portal for patients to review and pay their bills directly from your website. Finally, having invoices automatically sent in an easy-to-read format should help avoid unnecessary patient calls.
Coverage Requirements
It is nearly impossible for intake staff to know all of the requirements for each payer when it comes to securing proper documentation. Even selecting the correct payer is a challenge with the constant barrage of new managed Medicare and Medicaid plans. To keep track of the varied payer nuances, changes and requirements, many HME providers create a shared spreadsheet for easy accessibility. While this is better than having no other tracking mechanism, it requires staff to stop and search for this information when they are taking an order. To better equip frontline employees, implement a rules engine that stores pertinent payer information based on the product and payer selection. For example, if the order is generated with an E0601 for a particular Blue Cross payer, it should list the number of CPAP rental months covered by the patient's plan prior to converting to purchase, the medical necessity requirements including sleep study and doctor order needs, compliance download musts, resupply limitations and prior/reauthorization intervals. Including this type of automated feature should facilitate the intake process with improved accuracy, help with audit responses and also help prevent denials.
Mobile Delivery
Another common bottleneck in HME companies is at the order confirmation step. This process can sometimes take a week or longer, making it challenging to get claims transmitted. When real delays are encountered, timely filing is at risk. The current benchmark for average delivery-to-confirmation is typically 24 to 48 hours. This is a best practice for companies who are able to retrieve their delivery tickets in a timely manner. To enhance and automate this process, implement mobile delivery devices. A mobile delivery device with an electronic signature for HME providers would ensure real-time delivery and order confirmation. To accomplish this, HME providers must have access to similar mobile delivery devices with the proper security levels. Once implemented, HME providers can all but eliminate interruptions in the confirmation process and enjoy a delivery-to-confirmation lag time of minutes rather than days. Better tracking and control over delivery tickets will follow.
Denial and A/R Management
Once the confirmation process is complete and all of the required documentation is on hand, billing is generated and transmitted. Regardless of your streamlined and automated order-to-billing process, a certain percentage of your claims will not be paid. Consequently, tracking and working denials daily is a must to maintain control over new receivables. Your staff should be able to work from denial reports that are sorted by payer, denial reason code, product/HCPCS codes, staff, etc. Use an automated denial management program to resolve denials and track your efforts. The bonus is that it will also help you train toward prevention of denials. Moreover, you should monitor and evaluate staff on their successes in working the denials both timely and accurately. Once denials are worked, the bulk of the remaining hours in a day should be spent working on A/R. This means that an easy-to-use denial tracking system should be part of the daily process. If your staff is also able to master denial management, they will not run up against timely filing constraints for denials, leaving plenty of time to work on their older A/R. Frankly, working the A/R is what requires the most significant effort. It typically demands focused and uninterrupted time. Regardless of the automation initiatives you employ, be certain you conduct a cost benefit analysis prior to forging ahead. It is understandable that, given the current state of the HME industry, you will only be able to afford a specified number of changes this year. Work with your staff to determine the best automation initiative(s) for your current and future company focus. Although only a few of the countless automation initiatives are listed in this article, it behooves you to search for ways to run your operation more efficiently and innovatively. This will make the difference between successful HME companies and those that lag behind just waiting for better days to come.
