Given the complicated nature of running a home medical equipment
business, it's hard to imagine a time when we didn't use computers.
How did we do it? With a lot of employees to complete all those
processes manually.
Now, with more regulations to comply with than at any time in
the past, decreased reimbursement rates and an aging population
that has most providers busier than ever, it is virtually
impossible to manage a growing, profitable HME business without the
aid of competent computer software. HME software systems are, in
large part, responsible for helping providers keep pace with
changes to the industry imposed by insurance payers.
In just 20 short years, we have seen basic billing processes
move from typewritten certificates of medical necessity and claim
submission forms to basic text-based computer systems and now to
software that sports attractive graphic user interfaces.
In the past, HME software was simply seen as a vehicle for
submitting a claim to insurance payers. But with mandatory
accreditation and competitive bidding on the horizon for thousands
of home care companies, this industry's software system vendors
will have to step up to the plate once again and develop advanced
features to assist providers in meeting all of these new
requirements.
Critical Choice
It's not a stretch to say that a provider's choice of HME
systems software may be the single most important decision that is
made over the life of the business.
Running a home care company involves much more than simply
getting an insurance claim out the door. There is inventory to
manage, sales and marketing efforts to assess, cash flow to
preserve and quality of care issues to monitor. As you evaluate
your company's software choices, you should look for systems that
can help you and your managers run the entire business and collect
and report the data you will need to be successful.
Cash flow is king in the HME business. A competent software
system should provide tools to manage a “just-in-time”
inventory process that includes a basic purchase order system,
allows you to set minimum and maximum levels of stock and generates
reports that tell you how much stock should be ordered on a routine
basis. Bar-coding systems should be available that reduce the time
required to confirm deliveries and move claims through to the
documentation, then the billing process.
In addition, you should look for a system that will help to
determine gross margins for individual products and product
categories. As a result, you will have a good head start when it
comes to submitting a winning bid to Medicare.
Automation of processes can reduce the cost of doing business, a
necessity when insurance payers seem to be constantly seeking to
reduce their own costs. There are dozens of ways a capable software
system can help providers in this regard.
Reliable fee schedule and ICD-9 code updates from the vendor,
documentation tracking reports, flexible accounts receivable
reporting and the ability to add document imaging that can be
retrieved from the customer record are all features that HME owners
should expect from today's software systems.
Features such as the ability to fax CMNs and detailed written
orders directly to the physician's office from the system;
coordinate with online insurance eligibility tools; print single
patient EOBs from remittance notices; and automatically populate
appeal or redetermination forms for denied claims should become
standard capabilities of industry software systems.
Competitive Bidding and Accreditation
During the initial round of Medicare competitive bidding, many
providers have struggled to wrest the data required to complete a
bid from their software systems. With competitive bidding slated to
hit 70 additional MSAs in the near future, it will become
imperative that software vendors add features to assist in
calculating historical revenue data by product and product category
(with the ability to restrict those same revenue reports by payer
and geographic territory).
Software that offers reports set up to provide the specific
information Medicare demands from bidders will save business owners
from the grim task of building spreadsheets with piecemeal data
painfully extracted from their software.
Traditionally, HME software systems have focused on the
reimbursement aspects of the business. But with mandatory
accreditation also looming, software vendors should begin to add
features that make the accreditation process less time-
consuming.
Most of the HME software available today capably tracks rental
inventory location and oxygen lot number deliveries, both of which
are requirements for accreditation. Some systems also allow users
to record a preventive maintenance history for rental items as
well, another mandate of all CMS-approved accrediting bodies.
Vendors that are in touch with current requirements should add
features such as patient follow-up scheduling reports and basic
patient, home assessment and plan-of-care documentation forms that
meet accreditation standards.
Collection and reporting of specific performance improvement
data mandated by CMS' provider quality standards and individual
accrediting bodies also could be much less cumbersome if certain
features were included in HME software systems. For example,
software that reads electronic remittance notices and offers denial
trend analysis will become a must-have feature for all
providers.
In addition, ask if your vendor is considering adding a basic
customer satisfaction form that can be printed when patient
statements are generated, and tools to collect, aggregate and
report those overall results. Lastly, software systems that can
document customer complaints, track when the required written
response was sent and aggregate this data for trend analysis will
also prove useful as you seek to meet the new quality
standards.
Training and Support
If there is an Achilles' heel in the HME software industry, it
is in the area of training and support.
But as new features are added, user training has never been more
critical. Many providers already have very capable software but do
not understand how to use it to maximize its assistance in meeting
the myriad requirements that seem to increase on a monthly
basis.
Implementation of a new software system, particularly when
migrating from one system to another, can be a complicated process.
More often than not, training is focused on the implementation
phase — and not enough on using the features that make the
new system superior.
Vendors that offer a comprehensive training process will meet
their customer's needs better in the long run, and head off the
gripes and frustration that some providers experience when they
don't understand all those fancy features that led them to choose
the software in the first place.
If your vendor offers complete, up-to-date and accurate
documentation of the system's features in the form of manuals or
computer-based training modules, you will be a much happier
customer.
Providers have a responsibility here as well. It is imperative
to spend the time and money required to train a wide array of
employees to use the software to its fullest potential. Too often,
we hear that when an HME company's “software guru”
leaves for another job opportunity, the institutional knowledge of
the software system leaves with him.
Given the nature of software and computer hardware, problems
will inevitably occur, even with the best HME software system. So
remember that your vendor must remain mindful that software that is
not working correctly can have an immediate negative effect on your
cash flow.
In a niche software industry, it is unreasonable to expect
technical support to be as readily available to you as it might be
for software products that are sold to millions of people. The
revenue generated by the HME software industry simply cannot
support that.
However, in order to justify the monthly support fees typically
charged, your vendors should endeavor to respond to all requests
for technical support within one business day, then continue to
follow-up on your problems in a timely manner until they are
completely resolved.
As an HME provider, you understand that excellent customer
service is expected of you by your patients and referral sources
— and you should expect nothing less than that from your
software vendor.
Indeed, much has changed for the HME industry, and software
vendors have been critical to meeting those changes. As the
industry continues to evolve, software vendors will prove even more
critical partners in a provider's success. Those that offer a
timely response to the ever-increasing challenges will stand out
among the countless choices that providers currently have
available.
Roberta Domos, RRT, is the owner and president of Domos HME
Consulting Group, a national HME consulting firm based in Redmond,
Wash. She may be contacted by phone at 425/882-2035 or through her
Web sites at www.hmeconsulting.com or www.hmeaccreditation.com.
Questions to ask vendors when evaluating HME systems
software
General
- How is the product licensed-by location, by user, etc.?
- What are the product support fees, and what services do they
include? - What is the turnaround time for answering technical support
calls? - What product add-ons are available (bar code, document imaging,
point of sale, GPS-based delivery routing/mapping, etc.)? What is
the cost to add those features? - Are there any features of the software that are designed to
assist with Medicare competitive bidding? - What features are designed to assist in meeting the
Medicare-mandated provider accreditation requirement? - What methods of training and implementation support are
available? Is training included in the price? - What types of reports are available to track sales and
marketing efforts? - How customizable are the software's reporting features? Is the
software compatible with any external report-writer products? - Is there an executive report or dashboard feature that provides
a real-time snapshot of critical management information? If so,
what information does it include?
Competitive Bidding
- Can the software generate reports that reveal revenue by
product category? - Can revenue reports be restricted by payer and geographic
location? - Can the software calculate gross profit margin on individual
products and product categories? - Can the software report units sold/ rented by product and by
product category? - Can those reports be restricted by payer and geographic
location?
Reimbursement
- Are Medicare fee schedule, modifier and ICD-9 updates provided
as they occur? - Do physician order forms generated by the system include
medical necessity justifications appropriate to the product ordered
according to Medicare criteria? If not, can they be customized or
edited by the provider? - Does the software offer descending balance accounts receivable
aging reports? Can the aged days time frames be adjusted by the
user? - What reports are available to track CMNs, detailed written
orders and prior authorization documentation requests? - Are user-defined adjustment and write-off reason codes
available? - Can the system fax CMNs and physician orders directly from the
software? - What payers can be billed electronically from within the
software? Is batch cash posting available? - Can the software automatically populate Medicare
redetermination/appeal forms from electronic remittance
notices? - Can single-patient EOBs be printed from electronic remittance
notices? Does the software offer denial trend analysis?
Accreditation
- Does the software track serial numbers and oxygen lot
numbers? - Does the software offer reports to track when preventive
maintenance is due on rental products? Can preventive maintenance
history be documented within the system? - Does the software offer reports that list when patient visit
follow-ups are due within user-configurable time frames? - Does the software assist in collecting and aggregating
performance improvement data, such as customer satisfaction
questionnaires, complaint log trends and complaint resolution and
follow-up? - Can customized forms be set up that will populate with patient
demographic data to assist in documenting accreditation
requirements such as a patient/home assessment and plan of
care?
