Observation Deck

3 Keys to Billing Headache Relief

A three-part formula leveraging technology can give providers more control.

• By Rob Boeye
• Jan 01, 2019

The HME industry is constantly changing, which means the billing process continues to become increasingly complex. Five or ten years ago, providers may have filed everything manually or written out claims by hand, but those days are long gone. To be a viable provider in today’s climate, HMEs need to take advantage of the latest software designed to improve billing from the referral and intake processes all the way through collections.

Let’s face it: a lot of the billing process is simply out of providers’ control, and it’s easy to feel overwhelmed by the amount of minutiae and follow up required. Even with the prodding and constant calling, there’s only so much that can be done.

While it’s a never-ending headache for some providers, others have found a way to relieve the pain of the process. The solution lies with innovations for HME that save HMEs time and money, and increase efficiency and accuracy.

To find billing relief, providers must focus on three key ingredients: automating referrals for cleaner claims, using data for business-critical decisions, and minimizing personnel costs through outsourcing.

Get Clean Claims From The Start

HME providers are up against the clock to get claims out as fast as possible, and need an automated solution to help reduce the inherent burdens within the claims process. They also need a solution that enables them to electronically post submissions to payers — yielding better cash flow.

As referral sources adopt electronic means for sending orders and documentation, providers need to get engaged and participate. Referral sources want visibility in post-acute care, and they want to take the burden involved in ordering and supporting HMEs off of their plates. HMEs who don’t move forward will be left behind by referral sources who see the advantages of modern technology and workflows, such as e-prescription.

E-prescription offers a modern way to automate the front end of a provider’s business. The benefits of this technology include operational efficiency, reimbursement acceleration, alignment with referral sources and better treatment for patients. Referral sources send an accurate and understandable order to HME organizations in an electronic format, which removes significant time and cost out of every order that gets processed. By automating follow-up steps involving documentation, authorization and recertification of patients, providers can spend their time growing the business instead of chasing referral sources for paper and documentation.

And, by getting the right information with an order, providers can file claims faster. This greatly impacts the financial metrics from working capital to days sales outstanding (DSO). E-prescription moves the right information and forms to the right place at the right time — and ensures providers get paid on time. By connecting electronically, HMEs no longer feel like they’re filling orders. Instead, they are a true extension of their referral sources’ care, easing the workflow burden, accelerating care to patients, taking paperwork off referrals’ desks and helping them succeed in a value-based reimbursement world.

Turn Data Into Actionable Insights

Another way to achieve financial success and relieve billing challenges is by employing advanced analytics to gain visibility into the business and drive growth. Because HME providers must be more efficient and nimble than ever before amid today’s reimbursement cuts, data is one critical piece of the puzzle that lets HMEs compete effectively. In some cases, analytics might even identify problems that providers didn’t know existed.

For example, if there’s a sizeable amount of accounts receivable, the best solution may not be to add staff to follow up on the accounts receivable (AR) and work the denials. Instead, the root cause might be that the sales order confirmation team is confirming orders without the proper QA requirement. In simple terms, it doesn’t make sense to bandage a knee if the elbow is what’s bleeding. Data tells providers where, and how, to stop the bleed.

With tools like intuitive dashboards, fixed reports and real-time interactive worklists, providers can effectively measure where the money is by both payer and timeframe and actively collect all receivables. This type of technology helps providers keep pace with insights and actionable information for real-world outcomes.

Data is the one thing today’s HME providers can’t do without because the ability to analyze things like revenue cycle management data gives them all the insight they need to make business-critical decisions. Providers that aren’t already using data to better manage their business are setting themselves up for some big challenges in today’s marketplace.

Tap Experts for Greater Efficiencies

We all know medical billing is a demanding and challenging task. Collecting payments is costly and frustrating for many providers — of all sizes. Providers have a unique set of circumstances that require an efficient way to capture patient payments and create a seamless billing experience. Nowadays, the sheer complexity of billing is overwhelming for many providers.

That’s why many HME providers need the added strength of outsourced billing to offset the intense workload fluctuations and to lower billing costs. With a revenue cycle management service, providers can experience consistent and predictable cash flow, cleaner claims processing, reliable follow-up on A/R aging and faster patient payments, while being able to control the impact of staffing challenges.

By partnering with a professional revenue cycle billing company, providers are able to reallocate staff to higher-value activities and patient care. Their time is freed up to focus on things like developing new product lines and growing referral sources. Providers can’t be efficient at providing excellent patient care if they are bogged down by the financial side of the practice, so outsourcing may be especially advantageous for smaller organizations that might not have a large office staff.

With today’s modern technology, providers have the three main ingredients for fast-acting relief from billing headaches: ePrescribe, advanced analytics and outsourced billing. Providers can increase cash flow, get cash in the door quicker, lower DSO and improve reimbursement rates through higher claims quality and audit readiness.

Providers can turn their revenue cycle data into actionable insights like reducing A/R. They can electronically file and verify claims, reduce denials, automate internal processes and, most importantly, ensure they get paid.

By focusing on the above innovation areas, providers can benefit their business exponentially and avoid the pain caused by billing. So, even though billing can be a real sore spot, this three-ingredient formula is sure to provide fast relief.

This article originally appeared in the Jan/Feb 2019 issue of HME Business.