Tammy Zelenko

As the HME industry prepares for competitive bidding, providers are seeking ways to reduce costs without cutting quality or service. For Tammy Zelenko, president and CEO of AdvaCare Home Services, a respiratory and sleep equipment provider headquartered in Bridgeville, Pa, efficiency means investing in software that targets specific HME concerns, such as billing, documentation, and even employee training. With ready access to patient and billing information on the server, Zelenko’s staff can concentrate their resources on customers, rather than spending precious minutes hunting down files. “We’re able to put that time and energy into important things like patient care and follow-up,” Zelenko says. “And with the money that we’re going to save long-term, we can reinvest in the company and in equipment and technology, so there are a lot of benefits.”

CUTTING COSTS

Over the past year, Zelenko has invested in several software programs to improve her operations, including a document-scanning program, which allows employees in all three Pennsylvania locations (Bridgeville, Philadelphia, and Beaver) immediate access to the latest versions of all patient files and relevant documents. This means that any staff member can handle a patient’s questions, or instantaneously provide referral sources with requested documentation.

Sales and marketing staff can even update account files immediately after in-person sales calls, thanks to smartphones that interface directly with office software. Smartphones also allow Zelenko to keep abreast of operations via e-mail when she is away. “When I’m not in the office, I’m able to respond to anything, which is probably one of the best things I did for myself,” Zelenko says.

Zelenko also bought training and testing software to give her staff a better understanding of payors’ needs and regulatory agency requirements. In light of ever-changing criteria, Zelenko believes strongly in giving employees the tools and resources they need to do their jobs. “I think that is probably the most important role that I have, and obviously software is a big part of that,” she says.

AdvaCare Home Services also uses software for referral management. To mirror the company’s service appointment and delivery system, Zelenko purchased referral-tracking software that organizes referrals based on zip code, allowing staff to coordinate regular visits with referrals in the same area. Delivery vehicles also are equipped with GPS (global positioning system) devices for better efficiency on the road. “We’re being as efficient as we can, especially with the costs of gasoline,” she says.

These savings are vital to providers entering the competitive bidding arena. “If your costs are higher, then your bids are going to have to be higher,” Zelenko says. “So, ultimately, I’m going to be able to bid maybe $5 or $10 less on a product because I’m saving that on the front end and on the back end by being more efficient.”

TAKING THE PLUNGE

Investing in a new software system can be daunting for providers who worry about high costs, ongoing maintenance, and a potentially steep learning curve. But with the right combination of research, support, and customization, the long-term benefits often outweigh the initial barriers.

When choosing a software system, carefully consider features that will be most helpful to your business. Roberta Domos, RRT, owner and president of Domos HME Consulting Group, Redmond, Wash, says that before purchasing, providers should make time for extensive software demos. This means setting up real-world scenarios, printing reports, and exploring features in depth. To get a clear picture of the company’s needs, members from every department, especially those who will be using the software regularly, should be involved in choosing the software package. “Avoid trying to make the decision with just one or two people at the top tier of the company,” Domos says.

It is also important to consult with other providers who use similar systems. For example, in addition to trade shows, Zelenko learned about software choices through her membership in a buying group (the Van G. Miller [VGM] Group, Waterloo, Iowa). “They’re very supportive about working with their providers to make them more efficient,” Zelenko says.

At a minimum, Domos says providers should be able to track their documentation, prior authorizations, and serial numbers, as well as be able to print that documentation from their systems. The size of your business often determines the specific features that you need. As businesses grow, Domos recommends bar-coding features, which help manage inventory and delivery confirmations, and document scanning and imaging software, which can improve staff productivity. Today’s software also can provide statistical data on electronic remittance notices, which helps target problems in the billing process and provides the necessary data for mandatory accreditation.

WEB-BASED OR NON-WEB-BASED

When weighing Web-based versus non-Web-based software, Domos says the main difference is cost, because there are quality products in both categories. Web-based systems are leased, rather than purchased outright, which means a monthly fee that can be costly over a long time period. On the other hand, some purchased software requires multiple licenses for multiple employees—so it is important to understand the costs up front, including fees for setup and ongoing support.

In some cases, a $500 monthly fee for a Web-based software program may be more appropriate than purchasing an $8,000 system outright. “If cash flow is an issue when you’re first starting up, it’s not a bad idea to go with an online company,” Domos says.

For providers interested in document-scanning software, Domos advises looking for programs that integrate well with existing software and that include an auto-filing feature, which places scanned forms in the correct files automatically. She also recommends investing in a high-end scanner to ensure speed and accuracy. While document-scanning software will not completely eliminate paper from your business, it does give you the option to store must-save documents off-site, while still giving you access to the electronic versions in house.

Domos warns that document-scanning software will not necessarily save time on the filing end (as scanned documents will need quality assurance), but having centralized, organized records will save time in the long term. “The real improvement is in the collections effort, no more lost files, and people being able to access a document immediately,” Domos says.

Zelenko agrees. Her document-scanning software features drop-down boxes with forms designed to improve communication with patients. For example, staff respiratory therapists can complete follow-up forms or answer any outstanding questions on file during a telephone call with a patient. “It allows you to use your resources in the most efficient way that you can,” she says.

Researching your needs and options is vital to maximizing your software purchase. Domos says that, unfortunately, providers do not always take full advantage of the software features available to them. “It’s important to have an efficient, logical process from the time of intake to collections,” Domos says. “So, you don’t want to bypass your software for that. Your software can help you manage those processes.”

For example, providers can use software to streamline billing and reimbursement processes and improve cash flow. Zelenko takes advantage of electronic funds transfer and also downloads all denials electronically to turn them around more quickly. Domos advises using software to electronically file with as many payors as possible, and she also suggests seeking out integrated insurance-verification features.

Before switching over to a new system, Domos recommends cleaning up accounts receivable issues, backing up files before transferring the data, and establishing a staff training plan that ideally includes on-site demos from the vendor. Providers also should consider which tables in their current databases will be converted and which should be built from scratch. “A good plan can go a long way to reducing the time it takes for staff to get confident with the new software,” Domos says.

Once the software is in place, keep exploring new features and improvements. “You can buy anything,” Zelenko says, “but if you’re not going to be committed to that product and to your staff, it’s not going to work for you.”

PROVIDING SUPPORT

After installing software, a comprehensive training program is required to get employees up to speed. Usually, this combines on-site training from the vendor and ongoing in-house sessions. When AdvaCare Home Services integrated the MedFORCE document-scanning software in December 2005, every department underwent separate online training, because each uses the system differently. After each department completed the online portion, all employees received hands-on training and a live demo, and each department met to discuss questions and ideas for improvement. Employees continue to be trained on new features as they are integrated.

The key to successful software integration is managing your employees’ expectations. “It’s not going to take care of everything,” Zelenko says, “but it certainly will make you more efficient if you use it and use it well.” To reinforce the training and encourage employees to explore other software capabilities, the AdvaCare Home Services “Geek of the Day” award recognizes an employee for time-saving ideas related to software or even just for mastering a different feature, such as scanning and sending out a set of documents for the first time.

In addition to maintaining employee skill levels, providers must maintain and update the software itself. When purchasing software, it is important to thoroughly understand the vendor’s service fees and support policy. Zelenko advises providers to seek out vendors who are known for accessibility, fast response times, and openness to improvements. “You definitely need someone on that other end, especially when you’re starting with a new product, and it can’t [cost] $100 an hour,” Zelenko says. “You need to be able to work with a company that is able to offer support, and that is open to enhancing their product based on your needs.”

Zelenko’s team works closely with MedFORCE to suggest improvements to the software, such as developing the drop-down forms mentioned previously. “You need to make the software work for you,” Zelenko says. “You’re responsible for saying, ‘These are the things I need.’”

Both Domos and Zelenko stress the need for a point person in your company to handle software updates, troubleshoot with the vendor, and maintain communication about other software-related issues with the rest of the staff. “All too often, nobody has that responsibility in a business, and so it just doesn’t get the attention that it needs,” Domos says.

For more information and articles on software, visit the free online archives section. Additional articles by software expert Roberta Domos can be found in February 2007, March 2006, October 2005, and June 2005.

Domos adds that this does not mean hiring for a new position—a management staffer can likely take on this responsibility. One of Zelenko’s employees, whom she affectionately refers to as her “geek,” joined the company’s reimbursement department, but quickly showed an aptitude for software management. “We recently changed her position to add on that piece of being responsible for the software integration and support, and she’s just wonderful,” Zelenko says.

Zelenko describes the software learning curve as “a constant” and stresses the need to continually refine its use within the company. With so many possibilities available, Zelenko believes that the only limitation is the user’s imagination. “It’s how much do you want to commit to learning the software, teaching your employees, and giving them what they need to use that particular software to its fullest benefit,” she says.

Ann H. Carlson is a contributing writer for  HME Today.