Among the most critical issues facing DME providers is reimbursement. Timely reimbursement of clean claims can mean the difference between profitability and bankruptcy. Adding to this need for timeliness is the government requirement that Medicare claims be filed electronically. Both these realities necessitate the need for billing software that can efficiently and quickly allow providers to file accurate, clean claims.

But not all billing software is created equal. This means that providers must carefully consider what they need in a particular software program before they purchase it, and this may mean considering more than price and system compatibility. Today’s savvy providers are just as often looking at the software programs’ service contracts, ease of use, and flexibility. And like the software systems themselves, the needs and experiences of the providers differ in their quest for the perfect software.

Entering the Computer Age
One of the primary reasons many providers originally entered the billing computer age had to do with Medicare requirements that mandated that all providers file claims electronically. In addition, there were some practical benefits to adding billing software. For one thing, it helped speed up payments.

Jack Hogan, vice president of Health Complex, Watertown, Conn, has known how crucial the quick turnaround time of electronic filing is to staying in business since 1991. That is when his company’s pharmacy business first purchased a billing software package.

“[Billing] was just too slow,” he says. “Medicare came out with an electronic package, and instead of being paid in 60 to 90 days, it would pay you in 17 days. It was for fiscal reasons that we decided that we needed a computer software package to bill electronically.”

But government regulations and business efficiency are only a small part of the need for billing software. There is also the question of control. “I knew that billing was critical,” says Vicki D. Jones, founder of Women’s Health Boutique franchise, a Longview, Tex-based women’s home health products provider. “In 1995, I sold my DME business, and up until that time, my DME company had done all the billing for Women’s Health Boutique. At that point, I hired an [outside company] to do my billing from 1995 to 1997. In 1997, I wanted a software package that could actually do everything in-house instead of sending it out. I just wanted to be in control.”

Walker Davis, president of Health Products Plus, a Cordele, Ga-based DME provider, wanted to make it more convenient to do business. One of his primary requirements was the ability to access the software system at whatever location he was in so he could stay in touch with the day-to-day operations of his business.

However, deciding that a billing system is needed may be only the beginning of implementing the software. As motivations for purchasing billing software differ from provider to provider, so do the criteria. Though cost was a factor for some providers, such as Davis, it is often less of a driving force than other issues. What mattered more to Davis was the system’s capabilities. He wanted better inventory control and the ability to connect all of his company’s locations in real time.

For Hogan, there were some budget constraints as well, but more important was whether the software fit his company’s needs. “In 1991, our needs were to stay progressive and stay on top of the home care industry in order to be growing and viable; a software package was the answer,” he says.

Another critical selection factor was what type of customer support the software vendor offered. “If you don’t have support, you die,” says Robert Brown, owner of Andrew Brown Home Healthcare in Scranton, Pa. “Software support is crucial in that they are able to change the software in response to Medicare regulations.”

A high level of service was what sold Hogan on his current vendor. “They listen,” he says. “We frequently provide them with suggestions that will help to improve our business, and I must say that they implement it. It might not be as timely as we would like, but they bring it to the programmers and they institute most of those changes. They wanted the feedback. That was something they sold us on. It is important to us to be able to call and talk to someone in customer support.”

Jones worked with her vendor to improve its software to include a better point of sale feature. “Women’s Health Boutique is a franchise system, and, at the time, I was looking for software that could be used throughout my franchise system,” she says. “So I needed some flexibility, and because we do retail sales as well as health care billing sales, it was important to me that point of sale be user friendly and an integrated part of the software.”

Because the vendor was willing to work with Jones to create a point of sale feature and continues to support the software, Jones has stayed with that vendor and the software has become an integral part of her business.

“There were things I wanted to track: the results of marketing, referrals from physician groups, I wanted to be able to do mailings,” she says. “Those were things that the software did and continues to do now.”

Other criteria that these providers considered were the size of their companies’ user bases and the software companies’ abilities to react to changes in Medicare rules. But there was one criterion that turned out to be even more crucial than responsiveness to change and accessibility. No matter the system, the provider and their staff had to want to use it.

User Friendly is Key
Staff buy-in is an important factor to consider when purchasing billing software. Without it, the thousands of dollars spent on the cost and installation of the software might be wasted.

“The software can do lots of things, but it is only as good as the information that is put into the system,” Jones says. “When people are going to look at a software billing program, they need to be very cognizant of what their front end is doing. I think every single employee needs to be brought in on the [purchasing] decision.”

In the constantly changing landscape of the electronic world, there is one inescapable fact facing providers who are using billing software—without it, they could not function.

“We couldn’t be in this business without a computer,” Hogan says. “We do a lot with our computer software, we do marketing, we do inventory control, we don’t just do billing. That is our lifeline.”

But once a provider has bought a system and integrated it into his or her business, that does not mean that the provider is done. As with any other product, there are new and improved software models being introduced constantly. Hogan is always on the lookout for new software and has a key principle for providers choosing business software. “Anybody who is looking at a software package, my advice to them would be not to be so frugal, not to be so penny-wise and pound-foolish in choosing a system,” he says. “Buy something that is updated often and will grow with your business.”

C.A. Wolski is associate editor of Dealer/ Provider.