What’s a Modem?

• Aug 01, 2008

Medicare still requires analog phone connections for submitting claims. What can providers do?

Modems. Is there anything more emblematic of the business world's first foray into electronic communications? The rapid fire dialing, the pickup, the screeches and hisses — all heralded an era when speed was determined by whether something was faster than sending a fax or filling out a carbonless form. This is hardly today's business climate, where data communications is a mission critical element of any business plan. Today, enterprises as small as bakeries and as large as banking institutions see IT as critical a business function as sales, service or accounting.

Today, those shrieking and squealing modem tones seem far off and hard to place, like a tune you can barely remember. But, if you’re ever feeling nostalgic for the late 1980s/early 1990s, you can take a trip down memory lane by simply billing Medicare electronically.

Welcome to Yesterday
Why? Because CMS insists that electronic billing transactions be submitted via “Olde Tyme” analog modems. Providers must dial into the Medicare system, log on and submit their electronic claim. However, the process is anything but elegant and is fraught with a host of problems, such as continual busy signals, agonizing delays and repeatedly dropped calls, says Mark Blount, vice president of marketing for HME billing and inventory software provider Brightree Inc.

David Siegel, chief operating officer for CPAP and bi-level device provider Nationwide Medical, describes the experience as “absolutely miserable.”
“It was tortuous,” Siegel says. “We’d dial in, get six or seven minutes into the sequence, and the line would drop. So, we’d have to scoop up all the data again, reformat it, resend it, and then the line would drop again. It was so unproductive. We’d spend up to an hour submitting claims.”
CMS’s modem approach is certainly anachronistic in a Web 2.0 world. Edward Kutt, general manager of Diabco Medical Billing Systems, recalls he was working with one provider who honestly didn’t know what a modem was. “He asked me ‘What’s a modem?’” Kutt says. “These days you can’t buy a computer with a modem in it. You have to buy an external modem or have an internal one installed.”

Worse yet, CMS’s recent efforts to streamline and standardize electronic claim filing by requiring providers to submit their electronic claims via its common electronic interchange (CEDI) for processing, which is being run by CMS contractor National Government Services Inc. (NGS), might have actually wound up causing more problems.

“From what I am hearing, 80 times out of 100 they are getting busy signals,” explains Brightree’s Blount, adding that when providers do ultimately get through, their transactions can still get up to 90 percent of the way complete and then drop off, forcing them to endure the entire process again.
The issue of “volume” is the key sticking point for CEDI, according to Blount. In the move to push the CEDI program through, Blount says the volume of electronic submissions and the additional phone lines, modems and other gear that would entail were grossly underestimated.

Another common problem providers submitting claims are experiencing with CEDI are password resets. The only way to address those resets is to call the CEDI help line, which Blount says is overwhelmed with calls; and Blount has heard of providers waiting as long as three hours on hold.

Why would a government agency insist on a time-consuming, outdated, inefficient, unreliable and presumably more expensive method for billing rather than conducting it via the Internet? Security is the justification CMS proffers up, Diabco’s Kutt says. “Medicare doesn’t feel that the Internet is secure enough for claims processing,” he relates.

It’s as though Medicare hasn’t noticed that a multiplicity of important communications involving personal and financial information is being exchanged securely over the Internet on a daily basis, the world over. Moreover, Medicare apparently hasn’t been paying attention to its state-level counterparts, either.
“Many state Medicaid services have Web sites for uploading claims that are far more advanced,” Kutt says, adding that they clearly are much easier to work with than dialing up Medicare.

Electronic Calvary
To help providers deal with CMS’s refusal to go digital, HME software systems makers provide a variety of billing tools to help providers batch process their claims. Instead of dialing into CMS and submitting claims one by one, HME software systems let providers submit their claims in groups, saving time and frustration.

Also, those batches can be customized. For instance, Spencer Kay, president of Fastrack Healthcare Systems Inc., says users of his system can decide how big their batched files are by grouping different billing runs together to maximize the transmissions times. Also, users can decide when to send batches, such as during CEDI’s off hours.

Also, Siegel, of Nationwide Medical, which uses Brightree, says the ability to replicate frequent claims is a big help:?“Now it’s all in the setup. You set up the insurance and the patient account under the insurance, and you basically set it up once in the system. Then every time a patient confirms an account, you submit the claim and it pulls from what you already set up, and you’re good as gold.”

In fact, Brightree is one vendor that is pushing the envelope with CEDI. Blount says the firm is now connecting via FTP to CEDI to submit CMS?claims. And while that envelope continues to be pushed, providers are at the ready, Fastrack’s Kay says his system incorporates all the necessary protocols when CMS can handle electronic billing.

Getting Closer
Problem solved? Let’s just say the industry is getting there. Despite CMS’s best efforts to work like it’s 15 years ago, software vendors are making a valiant effort to bring Medicare billing kicking and screaming into the modern age.

This article originally appeared in the August 2008 issue of HME Business.