You could end up using a new software system for years to come, so it is essential you know the right questions to ask during the selection process.

Choosing a billing software package should not be taken lightly. It is easy to be wowed by glamorous screen shots of what a product is featured to do. It is a software company's job to tout their best features. But as a decision maker for your company, it is important to determine the best fit for your specific needs. As a national consultant, I am frequently asked what product a company should use. While I really like a select few products, I cannot say that there is a one-size-fits-all answer for every business.

My best advice is to make a spreadsheet with a few standard questions to separate the wheat from the chaff. First determine which features are "must haves," and then identify several "like to have" features. Pick a handful of vendors to "interview." Sign up for demos and ask the same questions of each vendor. Here are a few considerations.

Price: What is the baseline cost for the software? What is the cost to add additional components? What finance options are available? Is this product an outright purchase or is it a month-to-month contract? How many users are included in the base price? What are the fees for additional users? Are there additional charges for branch locations/lines of business?

Keep in mind that you will use this application every day for the next several years. While there are "free" and "low cost" software packages, these lower-end programs will perform only basic functions. Try not to make a decision based on price alone—you get what you pay for. Often the efficiencies of a well-designed system will save you money over time.

Conversion Costs: What are the costs to import the data from your existing software to the new program? What data will be brought over—old accounts receivable? Rentals only? How long will the conversion process take?

Support: How much is the monthly maintenance fee (if any)? What does that include? How quickly are questions answered? How often do customers have to leave a message and await a return call? What percentage of calls is answered live via phone? How many calls are returned the next business day? Is there instant Web support available?

Training: How long will it take to get staff trained on the program? Is it intuitive to do basic functions such as post payments, load patient data, and build charges? Will you have to send all new staff to ongoing, special training sessions? Is training included in the base price, or do you have to pay separately? Will it be offered on-site or online?

Networking and Remote Access: Does the program support multiple access avenues? Can you offer access to off-site employees? How is security maintained for remote access? What infrastructure and hardware will be required to offer the program in a network environment?

Experience: How long has the vendor been in the billing industry? How long have they focused on DME? How did the program get started and what is the background of the company? I prefer companies that started in the DME industry as opposed to those that may have expertise in physician billing or other areas that are non-DME related.

This industry has a lot of unique billing requirements, and the level of experience in this field makes a difference. Also, if HME is not their main focus, you may not get the responsiveness that you would expect for your money. On the contrary, if HME is their focus, you will see continual software updates and integrated technology updates designed to make the product an increasingly more useful tool.

Product Line: What product line is their specialty? What features are enabled to help you track reoccurring supply orders, mail order products, prosthetic and orthotic products, infusion products, nutrition orders, monthly rentals, capped rentals, and other specialty products? Make sure the software is experienced with your product categories. Each product has its own billing issues, so make sure that you are not being used to test whether the system can handle your product line.

Andrea Stark

Reporting: How robust is the reporting package? Can you customize and run your own reports? Is all data pictured numerically, or will the program create helpful graphs to visualize some data? Pick a few specific standard reports that you would like to have the vendor run so that you get an idea of the type of data contained in a report. If you need to add a column of data, how difficult is it to manipulate the report?

Updates: How do you get updates and how are they installed? Is it automated? How often are updates scheduled? How do they notify customers that an update is available? (This is very important to the technologically impaired—keep it simple, keep it automated!)

Format: Is the program Windows or DOS based? Windows is definitely the preferred platform for its ease of use, and its compatibility with other programs.

Exporting Data: Will the program export data to other Windows programs like Excel or QuickBooks or other General Ledger-type programs? (This can be a handy feature for working accounts receivable projects and for keeping up to date with accounting requirements).

Accounts Receivable: How easy is it to track what has been billed and what is on hold? Can you update and print collection notes on each account? Are collection notes printed in any reports? Can you identify if a claim has been worked within a specific time frame? Are there any denial management features installed or separately available? Can you track denial rates by product or payment rates by product?

Reminder System: Is there a system in place to schedule reminders or follow up with a patient or account regarding outstanding balances, denials, or reoccurring supply orders?

ICD-9/HCPCS/Allowables Updates: Are these updates automated? Is this a manual process every quarter? Every year? Can you have multiple fee schedules for various payors and contracts?

Communicating/Faxing: Can you use the program to fax orders, prior authorizations, and CMNs directly to referral sources/payors? Will the program track how long a document has been waiting for return?

Inventory: Is there an inventory module? How does it function? How do you maintain it once you get everything loaded to the system? Does it require special equipment or additional products? How do items get moved into or out of inventory? How susceptible is it to human error?

Shipping Interface: When sending products through a delivery service like UPS or FedEX, can the software capture tracking numbers and maintain them in the system?

Electronic EOBs: Can it import and post payments electronically without manual entry (HIPAA-compliant 835 transactions)? Can it print patient-specific EOBs for secondary billing purposes? Posting electronically will save time and reduce posting errors. It also will ensure that secondary claims are billed quicker.

Real-Time Eligibility: Does the product offer real-time eligibility verification (HIPAA-compliant 2701/271 transactions)? This is a relatively new technology that allows you to verify patient eligibility and deductible information, and identify primary payors and HMOs, home health episodes, correct addresses, and much more prior to billing a claim. It is fast and easy.

Claim Status Inquiry: Is the software capable of sending batched claim status inquiries (HIPAA-compliant 276/277 transactions) to give you quick access to information on whether claims have completed processing?

Security: What security features are in place? Can every user perform the same functions, or can access be limited? Do passwords automatically expire to prompt users to change their passwords? (Although not the most convenient of policies, required password resets enable a much more secure environment.) Is there an audit trail to track what individuals do? What security provisions are in place to ensure that data is secure when using Web and remote access? Can you restrict the hours when employees have access to the system?

Point of Sale: Are retail sales supported? Can you process credit cards through the system?

Backup of data: Are backups automated, or a manual process? How do you ensure the best protection from loss of data? Is this done on-site or off-site?

PDA Applications: Does the program integrate with PDAs and/or cell phones to allow remote access to the system, electronic patient signatures, mapping/GPS, or similar functionality?

To get started, I also recommend you do a search for "837 approved vendors" on your respective DME MACs Web site. Each of the MACs maintains a list of approved software vendors. This listing documents only that the vendor has submitted compliantly formatted claims for processing. However, it will give you an idea of all the vendors you can choose from.

Second, consider word-of-mouth recommendations from people who are using various systems. Ask what they like and dislike about their systems, but do not rely on the fact that they did a comprehensive search. Check out the vendors' Web sites. Visit with them at Medtrade, and schedule an online/in-house demo to view the top five products on your shortened list. At the end of this process, you will have a great new product that will allow you to accomplish new feats, and you'll feel confident you made the right decision for your business.

Andrea Stark is a Medicare consultant and reimbursement specialist for medical equipment suppliers and pharmacies. She founded her consulting company, MiraVista LLC, in 2003 after years of experience working for the Region C DMERC, and now provides consulting and education services throughout the country. In 2005, Stark started a billing service for DME providers and uses that experience to provide her clients with additional insight on billing and reimbursement-related issues. She can be reached via e-mail: .