If your revenues are being squeezed due to pricing and reimbursement reductions, there is only one place to look if you want to protect your bottom line: expenses.

Owners and managers in the home health care industry are always trying to manage expenses by doing more with fewer people. However, while payroll is a big part of every company’s expense structure, simply cutting staff is an oversimplified solution to an underlying problem: inefficiency.

One common source of inefficiency is paper pushing, but very few owners or managers really examine how many of their staff are primarily pushing paper and not contributing to either revenue growth or expense management. Well, now is the time to take a hard look at the paper processes in your business and eliminate them as part of an overall expense management strategy.

Getting Started
Talk of a paperless office usually results in skepticism because no one, including me, believes a time will come when paper documents will be completely eliminated from everyday business. However, while we may never get rid of all paper, that does not mean that the implementation of a document imaging and retention system will not make a huge impact on the amount of paper pushing that goes on in your business.

There are three basic components to initiating a document imaging and retention plan.

Component 1: Software
This is the guts of an imaging system and the component that allows all types of documents, including an entire patient file, to be imaged, labeled, and categorized into sections. For example, sections within a patient file could include laboratory test results, certificates of medical necessity (CMNs), delivery and pickup documentation, assignments of benefits (AOBs), etc. The software is also essential to easy and rapid retrieval of key pieces of information and to enable the entire patient file to be imaged and accessible to employees of the company.

Software can be licensed from a software provider, which then collects maintenance payments, or it can be rented via an Internet-based software provider, which then collects a monthly subscription fee.

Component 2: Hardware
This includes a scanner for converting paper documents to images; a server, or storage system, for retaining images; and a burner for copying images to CDs for backup.

Scanners range from simple “flatbed” units to multifunction machines that can fax, photocopy, scan, and network printers. Once the images are created with the scanner, they have to be placed somewhere to be retrieved and stored. Many companies use a large capacity server for this purpose. Finally, a CD burner allows providers to archive and store images for later retrieval or restoration in the event of a disaster.

Component 3: Placement
To really make imaging work, scanners need to be located in those portions of your business that generate the paper to begin with. Consider installing imaging hardware where your customer service/clinical staff can use it regularly. You may want another scanner located in your billing department so that documents created there can be imaged and added to a patient file.

Also, once documents are imaged, make sure they are accessible to your staff.

What Can Be Imaged?
One of the most paper-intensive processes in every HME or infusion business is the patient file. This record-keeping burden only grows with time, meaning these files can become quite large and difficult to navigate. Also, many departments—including customer service, clinical, management, and billing—may need access to the same patient records. This often results in multiple versions of the same patient file.

Imaging eliminates that problem by creating a single version of all the documents in a patient file that customer service representatives, billers, and clinicians can access.

Other paper monsters that can be eliminated with imaging are your accounts payable and vendor records, your managed care or payor contracts, and your explanation of benefits (EOB) documents and remittances. Look at it from a reimbursement perspective. The billing staff needs access to payor contracts to make sure claims were paid at the contract rate and billed with the correct rules. In addition, billing staff constantly need copies of EOBs and remittances to bill secondary insurance companies. Rather than making many copies of EOBs, billers can simply access the image of the EOB needed and send that image to a laser printer.

A common myth is that documents such as original CMNs cannot be imaged. Everything can be imaged, and the imaged documents are what you would work with every day. Documents that must be kept in their original paper form for audit purposes can be archived after they are imaged and retained on paper.

Document Retention: The Other Benefit
HME and infusion companies spend a lot of time worrying about postpayment audit nightmares related to lost or misfiled records. However, it is time-consuming—if not nearly impossible—to try to ensure that all of a company’s paper files are 100% complete and orderly, especially with companies in the HME industry being bought and sold and branch offices and billing centers being opened and then closed.

While document imaging is only as good as the paper process that takes place prior to imaging, once documents are imaged and stored properly on a server, they are retained much more securely than a paper file that can be lost or misfiled.

Considering the negative consequences associated with lost documents during a postpayment audit, imaging and retention are an excellent “insurance policy.”

Imaging Old and New
Assuming that you already have quite a bit of paper in your office, you will need to start your transition to paperless document storage by pursuing two concurrent paths. The first is to develop a plan to prepare and image the paper documents you already have. The second is to come up with a method for imaging new documents as they are created.

Let me warn you that this is an enormous undertaking. However, once you have converted to a comprehensive document imaging and retention system, you will not know how you ever got along without it.

Some specific “To Do” list items include:

• Create an “index” for each category of documents you want to image and retain. You will need to develop a consensus within your company regarding how patient files and other data will be organized and what will go into each section of an imaged file. Just like you do not want a paper folder with all kinds of loose documents thrown in there, you do not want a digital file to have images all in one section.

• Determine how to label the documents based on your index. This often will result in the use of bar codes so that the software knows where to place documents automatically.

• Prepare the paper patient files for scanning. This could include adding bar codes, removing staples and paper clips, and organizing documents.

This is really the short list, but it provides a good idea of the preparation necessary to implement a successful imaging plan.

Just a Dream or Reality?
I wish I could pinpoint the savings of a document imaging plan. It is very difficult and time-consuming to ascertain all the discreet costs that are incurred maintaining a paper-based process. But every owner and manager in our industry will be able to identify with the time and frustration associated with the typical paper documentation process. Just imagine if that process was eliminated and documentation was easily accessible to staff without mailing or faxing paper back and forth.

Think about the paper, office supplies, postage, copy machine maintenance, and filing cabinets you would eliminate by implementing a comprehensive imaging solution in your business. Projecting forward, imagine having fewer staff pushing paper and more pursuing revenue growth and collections.

Best of all, as document imaging has grown technologically, prices are becoming more affordable. In many instances the monthly cost of a document imaging system is no more than the salary of a well-paid administrative employee. Now is the time to seriously consider modernizing your internal, paper-based process.

Lisa Thomas-Payne is the founder of Medical Reimbursement Systems Inc, Albuquerque, NM. Contact her online at www.lisathomaspayne.com.