Don't be afraid to add, mix, and integrate new software programs into your current operations.

As I reflect back to when I first got into this business in the late 1980s, it seems that software evolution has been slow and never really seemed to keep up with other industries. Although today there are more software products and services than ever, there are still relics from the past that are held tightly.

Today's most efficient DME companies use multiple software applications in concert to bring about the best possible results. In the past, companies tried to use one system—practice management software—to try to run all aspects of the business. DME is a complex business with several large and distinct disciplines to manage. It is not realistic to think that one software can satisfy all these needs. Instead, integrating and optimizing each are critically important.

The practice management software is typically the primary software where the major transactions are handled. This would include order intake, billing, and inventory control. This is your most critical piece of software because it will usually be the system that drives your process flow.

Whether your package is a new state-of-the-art software, or an old DOS-based platform, often the software is underutilized and not managed properly. These mistakes lead to dissatisfaction with the software itself.

The old saying "garbage in garbage out" could not be more fitting. Keep in mind that "data input" starts way before you enter a patient's demographics or delivery ticket. In fact, before "data input" even begins, there must be proper planning to the setup and structure of how you will use the software and its data files. This is called "system optimization and file maintenance."

System optimization is the process of evaluating how you currently do business—outside your software system—and matching it up to the tools and options available within the software. Unfortunately, when most of us implement a software package, we "don't know what we don't know" in that there are so many options and transactions that it is hard to determine if we have established the perfect setup for our needs. Years later, we find ourselves fighting against the system instead of working with it.

At this point, we may be tempted to abandon the mess and start over again with a new software package. Most times this can result in recreating the same disaster all over again. No matter what software you are on and no matter how long you have been on it, you can benefit from an exercise in system optimization.

To start this process, identify a technology-friendly problem solver who knows industry processes. This person will need to receive as much training as possible on the software itself. They also will need to follow everyone's job through the software to see how it is used, and look for ways to streamline those processes. When this "system optimization" person is reviewing the processes, items done manually outside the system, or transactions that are hand-written or corrected, may emerge as huge red flags.

VISIT A SATISFIED CUSTOMER

Lisa Bargmann

It is always a good idea to network with another company that uses your same software. Make a site visit, if they will allow you, to pick up on tips and ideas they have implemented. If you do not have someone internally who is either capable or available to handle such a large project, you may want to consider bringing in consultants or project coordinators that have done this type of activity in the past. They can help jump-start your project, train, and pass off the ongoing duties to your own staff members as well.

System optimization also includes putting together written operating procedures of how you will use your system as daily activities occur. These are short, easy-to-follow, step-by-step instructions for transactions that are common—such as how to handle a change of insurance for a patient or the proper way to handle a pick-up request. These procedures, also known as best practices, will guide your associates to your preferred usage of the system coupled with the actual functions outside the system. This will allow you to achieve consistency and reporting to manage your business efficiently.

FILE MAINTENANCE

Another major component of system optimization is file maintenance. File maintenance dictates how you will set up and maintain the various data files in your system. While it is true that certain files, like customer demographic master files, will be entered and maintained by many of your associates, other files should have tighter controls and limited access. These might be files such as inventory item master files or price table data.

Once you establish best practices of how to use data files, have an expert build and maintain them. Proper file maintenance will allow you to build "smarts" into your system. "Smarts" can allow the system to automatically prompt or populate correct information so that your associates do not have to memorize or refer to manuals for each and every procedure or rule.

If someone needs to white out a claim form, fix modifiers, or manually attach a certain required CMN form template, chances are you have not optimized your item price tables. Establish a primary file maintenance specialist to maintain the integrity of your data files. This person is typically well versed in reimbursement but also is able to understand how the billing functions of the system will affect inventory control. The specialist should have a great understanding of how insurance contracts are written and how to build those rules into the software system.

It is also a good idea to have an inventory file maintenance specialist who will handle certain inventory-related structures of the system. This additional person would work hand in hand with your primary file maintenance specialist. Too many companies allow free rein of the software to many or all of their users, which creates a sloppy, unreliable, and inefficient system. No matter the size of your company, there should always be an approval process for changes to major data files within your system.

FEELING OVERWHELMED?

You might be thinking that this is a lot of work and asking whether it is worthwhile. Although it may seem painful, it is an extremely worthwhile exercise to invest in your software knowledge and implement the best practices surrounding its use. Besides the obvious efficiencies, you may also minimize how many actual separate software applications you need to use since you may have tools you were not even aware of.

If you are thinking of switching primary software, it is important to go through these exercises to ensure a smoother conversion. When you do not understand the data file structures and processes to begin with, it makes a conversion that much more difficult. You want to start off the right way with your new software to assure your data is converted cleanly, accurately, and completely. If not, you risk large amounts of lost revenue and slow down cash flow.

If you can get off on the right foot with written structure and procedures, you will be more successful. Your associates will be anxious enough about such a major switch, so giving them the proper tools and training is vital.

Many of the primary practice management software packages have optional bolt-on features or packages that can help you improve efficiency. Probably the most important one is electronic claim submission. Although most of us have probably been sending our Medicare claims electronically for many years now, we seem to lag behind in submitting to other payors this way. There are many low-cost options available to do this.

For these submissions to work seamlessly, it is important to have those clean master files since there might not be a final opportunity to hand correct a claim before it goes electronic. Once you have it going, you will enjoy faster claim processing times and less risk of keying errors at the insurance company. In fact, you can probably receive your cash 2 to 3 weeks sooner than hard copy claims.

Like most people, you probably want to get paid sooner. If your claim is going to deny, you will find out about it sooner so you can make those corrections and keep the claim moving to a faster resolution. Most software vendors partner with one or more clearinghouses for your claim submission. If there are issues with direct electronic submission through your software, you may want to use a software or service under a separate agreement where the data for claims can be scraped from your system directly into another for submission. Sometimes this is necessary if tools are limited in your primary software. Also on the horizon is the ability to post payments electronically. Again, you are probably doing this with your Medicare payments, but technology is close to being able to post all payments this way—which is a huge efficiency.

DOCUMENT IMAGING

Over the last several years, document imaging software solutions have come on the scene. This is a hugely powerful software application that is revolutionizing our paper-intensive industry. Separate software vendors (other than your primary software application) originally offered these, but as their popularity grew, many vendors offered their own integrated versions.

Document imaging software allows you to have a virtual medical records department. Some even offer process flow management options that can be customized to your needs. This is different from the "forced" process flow of traditional systems. Imaging systems are being used as a work-around to make existing software applications more efficient, compensating for short fallings.

No matter your size, almost any DME will benefit in cost savings and efficiency by going "paperless." Costs have come down, while those of hard goods such as filing cabinets, file folders, and labels continue to grow. Additional storage space is expensive and can encroach on office work space.

When pondering whether you should purchase a stand-alone document imaging system or one offered by your practice management software, consider your goals. Often, stand-alone systems offer more tools and options along with better technology since this is their focus application. Also, most systems are fairly easily integrated with your other software applications and allow for flexibility should you decide to change your primary software down the line.

If you are considering a primary software system conversion, it is best to go paperless first if possible. Going paperless is an easier conversion to complete, and you will realize almost immediate efficiency. Once you do make your primary software conversion, all your records will be at your fingertips, making that conversion go smoother.

Software-based services can easily enhance our current technology. Items such as denial management solutions, patient invoice/statement billing and processing services, online merchant service portals to take credit card and check payments over the phone—all allow providers to focus on what they know best, servicing the patient. These services take time-consuming manual tasks and turn them into quicker cash flow. In particular, most DMEs do not have the money to invest in automation equipment that will quickly process patient invoices and statements.

A process that may take your entire reimbursement department down for 3 or 4 days each month can easily be handled by an outsource company with the right software and hardware. That 3 or 4 days down may cost you tens of thousands of dollars each month in delayed or denied insurance claims. When examining these options, look for companies that understand the DME's requirements of processing statements without needing your manual intervention to appropriately process.

Inventory control continues to be a complex and critical focus of our industry. Although various bar coding and automation software options have been available, this is one area that should see more evolution in coming years. Without the margins of the past and changes in title of ownership rules, effective asset management will be necessary. This is a perfect candidate for a stand-alone software application to be integrated with a primary software application. Technology, such as RFID (radio-frequency identification), that is being used in other industries can revolutionize the DME inventory control arena. This would greatly improve physical inventory, purchasing, and receiving processes.

Lisa Bargmann is president and CEO of Bargmann Management LLC and Homecare Collection Service (HCS), Akron, Ohio. Bargmann specializes in  HME and reimbursement solutions for companies nationwide, including consulting and project services. She can be reached via e-mail: .