Change: Are You Ready?

• By Dave Cormack
• Feb 01, 2009

SaaS helps you handle industry shifts.

On the dawn of the Obama administration’s inauguration which sports Tom Daschle as Secretary of Health and Human Services, the future of competitive bidding remains unclear. Couple that with oxygen caps and reimbursement cuts and there is no doubt that 2009 promises to be a year of tremendous change in our industry. Sometimes change can be good, and sometimes not. Your view likely depends on your ability to embrace it.

Several industry experts with whom I have spoken are predicting that reimbursement cuts and oxygen caps will cause 15 to 20 percent of providers to go out of business in the next two years. That’s staggering, and should be a wake-up call for those who are ill-equipped to adapt to the changes predicated by this new climate.

Opposing Outlooks

At last October’s Medtrade show, the impact of these changes was very evident. A common thread among many presentations, conversations, and other show chatter centered around the need to streamline efficiencies, reduce administrative costs and increase productivity so that providers could survive the impending change. Providers seemed to fall into two distinct groups, and each group had a polar opposite attitude about the future.

On one hand, providers using Internet-hosted (also called Software as a Service, or “SaaS”) solutions spoke of the future with optimism, ready to embrace upcoming changes. It was awesome to hear how SaaS offerings were delivering efficient workflows and helping streamline providers to become more profitable. They seemed very prepared for the market changes. In fact, many were “excited” and confident that they’ll pick up market share in 2009 as poorly equipped competitors fall by the wayside.

On the other hand, providers employing multiple applications and tedious processes seemed paralyzed with fear about what lies ahead. And most of them seemed to have lost confidence in their current software’s ability to help increase their efficiency in order to offset the changes. One underlying fear is “how can I reduce my costs while simultaneously increasing my productivity?”

The fact is that providers who are saddled with outdated software are in a bad place. In order to have a prosperous new year, they must find ways to optimize their workflows, increase their efficiency, and become more profitable quickly. If they keep everything the same (including their software), they will never be able to cope with the impending barrage of caps, cuts, bidding, and whatever other challenges lie ahead.

Virtual Insanity

I am reminded of a familiar Einstein quote when I try to empathize with challenges facing providers who are unwilling to replace their outdated legacy software and manual processes. The quote goes: “The definition of insanity is doing the same thing over and over again and expecting different results.” Think about this and ask yourself if it applies to the way your business is currently run. Can you really expect to offset the impact of the changes we all face by staying with the status quo?

The time is now for providers to automate and streamline as many manual processes as possible, including modernizing their software. Providers must eliminate common pitfalls for errors and slow-downs, such as re-keying of data, performing time-consuming duplicate steps, and faxing CMNs. Providers should seek a fully-integrated solution to get the most bang for their buck.

For example, let’s look at how SaaS solutions can revolutionize the handling of rejections and denials.
1.    Bill accurately the first time. Gone are the days of manually updating billing information so that claims are filed accurately. With a SaaS solution, this process is automatically executed for providers who receive automatic updates on Medicare price tables each quarter as well as diagnostic and procedure codes. SaaS solutions also check for errors and flag any problem claims before they are sent.
2.    Automate to work smarter. Now providers can file claims electronically with the additional functionality of receiving payment and rejection information for all major payers. This invaluable information is automatically received and posted into the system. Information on claims that require correction is immediately flagged. This information, along with the reason for the rejection, is automatically posted as an alert to the biller’s message center to prompt a timely resolution.
3.    Identify trends to improve processes. SaaS solutions automatically capture and build a database of comprehensive rejection and denial information which can be analyzed by the provider to uncover trends such as payer-specific or product-specific rejections/denials. By identifying where issues are repeatedly occurring, providers can improve front-end processes to avoid future problems.

Calculate the time you’ll save by never having to key in payment, rejection or denial details. If SaaS solutions can do this for remittance management, imagine the impact they can have on the rest of your business.

In summary, there are several key areas that you should consider in order to embrace the changes of the new market and ease your anxiety about the forthcoming changes. You should look for a software solution that addresses all of your needs with one simple turnkey solution. Team up with an SaaS solution and transform your business with more efficient and streamlined processes. Become a part of the new evolution of HME/DME processing and payments with lower administration costs, automatic payment postings, price table updates and inventory management.

As we begin 2009, now is the time to evaluate your business and determine if the upcoming changes will be a good thing or a bad thing for you. Are you optimistic about your future? Or are you afraid, and doing nothing to prepare for success?
Is your business prepared to be 9.5 percent more efficient this year? If not, I encourage you to consider moving to a more efficient and streamlined solution so that you can survive … and prosper.

This article originally appeared in the February 2009 issue of HME Business.