You already know that software is essential to increasing business efficiency and lowering costs, but you may not be maximizing the capabilities of your current software.

As the HME industry moves into 2007, providers are looking to operate more efficiently and effectively while assessing their systems and deciding whether to invest in new technology. 

One of those areas is software, an area that affects all aspects of your business. Does your current software fit the growing needs of your company?

One thing to keep in mind: There is no perfect software system. Trying to find the perfect software package is like trying to find the perfect spouse. They just aren’t out there.

The first thing to do when reviewing your current program or when shopping for a new program is to get your expectations in line with the market. There are many good programs, but you have to find the best fit for your company. What works for your company may not work for another.

One reason some companies are unhappy with their current system is that they are not fully aware of or trained on all of their current system’s capabilities. The software may have been purchased years ago and training was given at the time of purchase. Since the initial training, the company has experienced staff turnover. Training was given by an outgoing employee or was a “trial by fire” for the new employee. Providers may blame the system when the system is not at fault. The problem simply could be the lack of system knowledge. 

Prior to making the expenditure on new software, evaluate how your current system is being used and identify any education deficits. You may find that the system has what you need, but your employees just need better training. Contact your software vendor and discuss training options. Additional training may be a fraction of the cost of a new system. Determine the cost of additional quality training versus the cost of not only a new system, but the cost of the “learning curve” of the conversion (claim processing delays).

Another reason providers are unhappy with their system is that they have an old version. Many organizations have not invested in the updates that have become available. Like hardware, computer software can quickly become outdated. Investigate the features that have been added and see if they are what you are looking for.

The Evolution Revolution
It is exciting to see the advances in technology over the past 15 years, and many of the software vendors have spent millions of dollars in research and development to meet the needs of our changing market. Gone are the days of filing all claims via mail. Claims can be processed electronically for not only Medicare, but also Medicaid programs and many commercial payors.

The more claims filed electronically, the more efficient your billing department becomes. Billers can now spend time working on other projects rather than getting claims in envelopes and out the door. If you are not using your current system’s electronic claims filing capabilities to its fullest, then you should research all of the payors that can be filed electronically from your system.  

Investigate which payors you can file electronically directly from your system and which would require a clearing house. If your system has the capability to file claims directly to the payor electronically (without the aid of a clearinghouse), then it should be able to download and post the 835/ERA/ERN files. The ability to download electronic remittance advice (ERA) files will allow for automatic cash posting. Automatic posting capabilities also allow for extra time savings for your cash posters.

Auto-posting is relatively easy; however, remember that some payments may not be applied by the system and will require your cash poster to reconcile the payments and make the appropriate adjustments. Even with this duty, the time savings in the auto-post feature are realized.

Software packages that have the capability to customize reports where users can easily change the filter/select criteria are a plus. The ability to export reports to a database or spreadsheet allows a company to manage their accounts receivable and unbilled/held revenue, and identify inconsistencies in their organization. Check into the custom reporting features from your system. When investigating report customization,  inquire as to whether you can customize the report—or does it require your vendor to make the appropriate change request—and if so, is there a fee associated with the custom report?

Web-Based Systems
Some systems offer Web-based solutions for their software systems. By accessing your system via the Web, you can relieve your company of the IT hassles of maintaining your own system. Web-based solutions offer a secure environment that can withstand disasters, and the systems meet all HIPAA requirements. They also provide a protective firewall, which (through multiple levels of encryption) provides a secure environment. 

If you are determining whether to outsource certain parts or all of your billing functions, an Internet-hosted program allows for an easy transition. Your outsource partner becomes a seamless extension of your staff.

Software is just one way to improve your internal operations. There are also Web-based tools that can assist with denial management and DSO reduction.  Managers can get firm answers as to where denials are originating and use the data to improve internal processes. Billers are able to process denied claims in an organized manner while working denials with the highest dollars outstanding first, therefore processing the most money in the quickest time (as opposed to working through EOBs/ERAs one denied claim at a time based on the order they came into the billing department).

Understanding where denials come from and working them in a systematic manner results in increased cash flow and decreased DSO. The ability of the system to aggregate the data from the ERA saves your staff time and money. Managers can set up the system to assign specific claims to be worked by staff members, allowing for accountability regarding processing those unpaid claims. As you evaluate your company’s efficiencies, look at the processes within your organization. Where do those processes work and where do they fall short? Software and denial management tools are just the beginning. A process and procedure overhaul may be what is needed in addition to investigating the newest in technology. Be leery of the “bells and whistles” that are all show. Sometimes what is needed to operate as a top performer is the basics with power and dependability.   

Sarah Hanna is vice president of ECS Billing & Consulting Inc, Tiffin, Ohio. Along with Lisa Bargmann of Homecare Collection Services, Hanna, will be leading a full-day seminar on Feb 8, 2007, at the Hilton Garden Inn, Dallas. The program will take an in-depth look at the accounts receivable  (AR) process and address private pay (patient-owed) AR. To register for the seminar, contact Sue Bare via e-mail: sbare@bright.net , or via phone: (888) 811-2250. Sarah Hanna can be reached via e-mail: sarahhanna@bright.net.