What’s Your Problem?

Every provider has glitches or mistakes they routinely make in their operations. It is a part of having humans involved in the process. But each time a mistake, glitch or problem is encountered, we give up profit to fix it. However, we don’t have to keep making the mistake.

To reduce the number of “fixes,” we must first recognize that we have a problem. Sometimes the problem is not noticed. A problem is not overlooked because we don’t want to fix it, but because of the tools and the process we are using. So, we might assume the problem is just another cost of doing business.

There are four problems that I frequently see when working with providers that are not always recognized as problems. They are:

1. Those responsible for completing the intake form, verifying coverage and getting authorizations are setting up the situation that the company must deal with in order to get paid. When we fail to collect and consider critical information, we drive denials higher and cause payment delays. I have found that it costs in the range of $6 to $9 to work a denial. If we are to be paid efficiently, we must set up a situation that facilitates fast and certain payment. One way to do that draws from other industries that collect critical information by phone. They develop scripts for their staffs to use. The scripts are on the computer screens with the data collection tools. For HME companies, the data collection tool is the billing system screens. By showing a script on one side of the screen and the billing system on the other, providers are finding they can be more accurate and consistent in collecting critical information. So the solution is to develop and use telephone scripts for the collection of critical information.
2. Just because we are prompted to collect an address and telephone number for our patient/customer, and we do it correctly every time, doesn’t mean that we will be able to contact them when we need to. This is one of those situations where it is easy to overlook the problem and assume any difficulty in contacting a customer is just the cost of doing business. Prevent this from happening by investing a few seconds to collect alternate contact information. Find a place in the billing system and include in the script questions that prompt for cell phone, work and additional caregiver telephone numbers. It may also be worthwhile to ask for e-mail addresses.
3. Once an order has been processed, many small provider customer service teams print the delivery tickets and pile the day’s delivery tickets in a specified bin or folder. At the end of the day, the stack is handed over to the delivery team. The walk from customer service to the warehouse and back costs about $2. A much more efficient way to get delivery tickets to the delivery team is to print them on a printer in the warehouse as soon as the order is approved. Printers are very inexpensive and will pay for themselves quickly by saving the time that someone uses to walk from the customer service area to the warehouse. Additionally, the delivery team will have longer to plan for the next day’s work.
4. Providers often purchase three or more brands of wheelchairs billed as a K0001. The feature sets are essentially the same, but the additional stock items are justified by the preferences of referral sources and sometimes by manufacturer discounts. The cost of having the additional stock items is driven by creating additional purchase orders, processing more receiving reports, disbursing more payments, counting more inventory items, consuming more capital, consuming more space and creating more opportunity for error. These costs can easily top $40 per extra order.

The solution is to develop a formulary of equipment. The formulary is a list of equipment brands and models by HCPCS that are the standard for the company. Medicare’s competitive bidding program is likely to add additional value to the use of formularies. It is fair to note that custom rehab equipment is more challenging to fit into a formulary, but even there the basics can be covered.

Solving problems like these and others that can be found when we look for them are key to maintaining profitability in this environment of declining reimbursements.

Wallace Weeks is founder and president of Weeks Group Inc., a Melbourne, Fla.-based strategy consulting firm. He can be reached at 321/752-4514 or by e-mail at [email protected].