The HME industry has always been labeled as being behind the times when it comes to IT solutions. Often I hear industry experts say that our industry does not embrace technology as it should. I imagine that is because the majority of us are small businesses, many of us coming from clinical, hands-on training who saw the need for HME in our regions and created the many companies that exist now.

Most of us know that automation and increased efficiencies are a must if we are to survive over the next few years. We need more from our software, whether we improve what we have or replace it to allow us to be more efficient.

I have been in the HME industry for more than 20 years, and I have seen many of the current software packages on the market. Amazingly, I am essentially using the software that I started with some 20 years ago.

Like so many opportunities that hit our doorsteps, software is only what we make of it. Before you decide to scrap what you have, it makes sense to sit back and evaluate. What do you want your software to do? Has your company failed to maximize the software's potential? In other words, we may need to adapt to how the software works, and not expect the software to adapt to what our manual processes are.

I agree that programmers often create products for what they think we do—or need to do—but we may need to ask software companies to adjust to what is real in the marketplace. I know that I have had several conversations on how National Provider Identifier (NPI) numbers are really being used and transmitted, as opposed to what the intent was.

There are three big issues for most companies: 1) Can the software bill and process accounts receivable? 2) Can I create orders and deliver to patients? and 3) Can I track inventory?

The degree to which you want each of these functions can vary. Start with the top five desires for each area and then determine if your current vendor can do those functions. Often we get caught up in adjunct desires and forget the core processes we need. If your current software can do those things (perhaps with some adjustment in your processes), think twice before throwing in the towel. It is expensive to switch, not only from a cash outlay perspective, but from a time and energy one as well. With that being said, does your IT solution need to do everything, or should we be open to multiple vendors?

There are many niche IT solutions that we are lucky to have available. Some of these new players can thank the implementation of HIPAA and ANSI transactions. As much as these standards have wreaked havoc in our lives over the last few years, they have also created opportunity.

My favorite standard due to HIPAA is the 835 electronic remittance notices (ERNs). Before HIPAA, the only standard electronic remittance we were able to receive was from Medicare; now we can obtain ERNS from virtually all of our payors. Our main database applications may not be able to auto-apply the cash, like Medicare, but we can still obtain ERNs from our other big payors and manipulate the data to show denial trends and help us focus.

Most of the larger payors allow you to download your ERNs from their Web site. By obtaining your denial and payment information electronically, you can manipulate it to manage your denials. If you do not have an IT guru in your company, look outside. There are a handful of vendors that you can upload this data to, and they can provide you with real-time reports to help work the denials and manage what you are doing. These solutions are often not part of our main software vendor's applications, and that is OK. This is the most underutilized IT solution in the marketplace.

What else is out there? Claims and more claims. While the ANSI standard for ERNs has been good, the ANSI standard for claims has not been so good. In the good old days of NSF (many of us thought this stood for nearly standard format), we thought it was hard. Well, many of us wish we were back there.

The ANSI claims formats (no good translation for this one) make the NSF look easy. Electronic claims have a new format, but the only standard is the electronic boxes and the number of characters they can hold; what can be required to be in each field locator (NTE segment) can be a world apart from payor to payor. So how do we deal with this one? Clearinghouses!

There are many up and coming players in this arena. I am a fan of Zirmed. This group reaches many payors and allows quick Web site access to fix rejected claims. When our billing systems require us to fix an issue and wait for the next batch of claims to be processed, I can access the Zirmed Web site and, on demand, fix and resubmit my claims. But again, there are options out there, so look beyond what you have traditionally used and what your software vendor may recommend. The goal is to fix on demand and go; get away from uploading and batching requirements wherever you can.

Kim Brummett

MEDICARE ELIGIBILITY

Perhaps the one area that all of us need to focus on is Medicare eligibility, or online verification of insurance coverage. The technical term is 270 and 271 transactions. With the Medicare Advantage Plans-gone-wild strategy that many of us are experiencing, it is more important than ever to know when our patients are changing plans. The home health agency side of home care does this better than DME. Lewis Group has an excellent product for home health agencies that queries the Medicare carrier every night and sends out an Excel spreadsheet daily with the patients who have changed insurance.

The DME industry is not quite there. We have some software vendors that have made the online eligibility checking easier and more user friendly, but imagine a daily report of all of your active rental Medicare patients who now have another carrier (this can be a Medicare Advantage Plan or a hospice). It is time for us to demand this technology from our software vendors; again it does not need to come from your main application, but we need it as an industry.

The bottom line is to really look at what you need your software to do, and focus on the core business processes. It is nice to dream, but the bottom line is we need to enter orders, deliver product, know where product is, and bill and collect. Beyond that, there is opportunity with niche software vendors, so investigate what they have to offer. See if it fits your company and makes you more efficient.

Kim Brummett is vice president of contracting and reimbursement for Advanced Home Care, Greensboro, NC. She can be reached through the HME Today editor via e-mail: .