Providers High on E-Prescribing Systems

ATLANTA — Before the advent of e-prescribing at Boardman Medical Supply, Boardman, Ohio, it was a constant struggle to obtain and track the needed information to support an order for HME equipment from a referral source. The company received fax orders, orders over the phone, verbal orders from hospitals, and there was a whole department dedicated to tracking and processing the CMNs and other documents critical to getting paid for doctor-ordered equipment. Boardman has seven locations and 176 employees, and patients are a mix of approximately 40 percent Medicare, 30 percent private insurance and 30 percent Medicaid.

Following up on paperwork involved a hodgepodge of spreadsheets and tickler files, and there were duplicated efforts and errors in the information. It all had a negative effect on DSO, which was in the neighborhood of 45 to 60 days at the time. “It’s just a monster that gets out of control quickly and really affects your cash flow,” Kelly Franko, Boardman Medical Supply’s vice president of sales, told attendees at a Nov. 16 Medtrade session on e-prescribing.

Since Boardman implemented an e-prescribing system from Jaysec Technologies six years ago, DSO has decreased to around 20 to 25 days, and the software has imposed structure and dependability to previously chaotic processes, said Franko. The department dedicated to CMN processing has shrunk from eight people to three, which translates into $150,000 a year in savings (assuming five full-time employees making $30,000 per year).

The software automates the necessary paperwork, incorporating forms for Medicare, for various states’ Medicaid requirements and for private insurance. Physicians using the software are prompted to provide complete information with a list of questions; they can also provide supporting documentation as PDF files. The doctor’s signature is securely encrypted into the system, is password-protected and meets Medicare guidelines for electronic signatures.

Positive results from e-prescribing are also evident at Griffin Medical Services, Calhoun, Ga., which began using an e-prescribing system from Dream Software about a year ago. “We try to get all the supporting information before we bill, but that’s hard to do,” owner Ben Griffin told attendees. “Chasing paperwork is the least fun thing we do, and it’s the easiest thing people will put off to the side or not do as well, or they get lazy. It’s hard to keep up with it.” Since transitioning to e-prescribing, Griffin says he has cut DSO in half. His company has 16 employees and has the software in place for a dozen or so doctors in the immediate area and is planning to implement another 12 in outlying areas.

Mickey Letson, CEO of Dream, said the goal is to standardize issues related to required documentation and qualification so that all HME providers are collecting the same information and that the information fulfills Medicare requirements. Using the software is simple, said Letson: “If you can read, you can use it.”

Although many electronic medical records (EMR) programs include e-prescribing capabilities, they do not provide the necessary documentation to ensure HME providers will get paid, Letson said. “There is no technology built in to ensure compilation of documentation,” he said. “In Medicare, the qualification for medical equipment has to be done at the physician before it gets to you. These systems help that physician with the process and ensure you are not dispensing equipment that you won’t be paid for.” The Dream system prompts doctors to provide the necessary information in their notes by providing a series of questions, and also captures the notes.

Boardman’s Franko told fellow providers that it requires a lot of effort to encourage referral services to participate in e-prescribing, but it’s worth it. “It takes a lot of marketing to get it off the ground,” she said. “It is something you have to grow one doc at a time and keep following up.” Her company’s approach is to provide CMNs electronically even for faxed orders to help emphasize the ease of using the system.

“If you’re going to do this, you have to take ownership of it,” agreed Griffin Medical Services’ Griffin. “You might have one doctor who is just out of school and played video games while he did his homework, and he jumps right on it and wants to do it. Another guy still wants to fax, so you let him fax and come back to him later. You are going to have a hybrid of things going on. You have to go into it with a marathon approach.” He suggests focusing on nurses and office managers who actually do the paperwork, and encouraging them to get into the habit of clicking on the e-prescribing icon at the end of the day. “Doctors love the concept, but they do very little processing,” Griffin said.

He added that, internally, his employees got more excited about the system as they saw its value develop. “They know I’m not going to hire anybody else, and we need to get them more efficient at what they do.

“You have to take it seriously yourself,” Griffin said. “Don’t get discouraged, and this time next year, it will be old news.”