The Future of HME Software and you

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?