Providers are continuing to look for ways to improve their business operations without impacting their budgets. A common goal is to increase productivity and streamline processes that positively impact the bottom line. The place to start is with what you already have: software.

Software can provide so much more if it is used to its potential, and not reaching that potential is one of the prime reasons customers change software. Don't worry about the number of customers that a vendor converted or sold, but know how many customers the vendor has lost. Of what value is it to change vendors when you are not ready to make the necessary internal changes for success?

The flow of information within your organization may change based on efficiencies built in to your software. For example, Medicare eligibility can be performed within seconds. Are you going to have the customer service staff take all the information and pass it to the eligibility department while the patient waits? It takes just a few seconds, and the patient is not kept waiting. This example is a bit over the top, but the underlying principle is constant. If the change is appropriate, implement it wholeheartedly.

INTAKE IMPROVEMENTS

The first place where software should positively impact your efficiency is in the customer service or intake department. It is here that processes are often set aside to "take care of the customer." Your internal processes should support your efforts to take care of the customer, not create an obstacle. Our front-line staff members need to have the tools necessary to complete their responsibilities in a timely manner, and without hoops to jump through. Most organizations I work with have two processes: one that is written, and one that is used. New employees are told about the written one and trained on the actual process.

Here is a two-part exercise to drive this point home. Create a flowchart for the process of information within your organization. Then, do the same for each department. Which process does the flowchart reflect? Your written process, flowchart, and actual process should be identical.

The next area within customer service/intake where you should realize improvements in efficiency is the order entry process. Intelligently designed software will have a recognizable and industry-based flow to it. This is more than simply entering the patient's name followed by address and phone number. Rather, it is an overarching progression that leads the user logically through the entire order entry process. The end result is that the user is able to communicate to the patient what their out-of-pocket costs are expected to be.

Since order entry is where billing truly begins, it is wise to acquire necessary information available to customer service. When a patient is standing in front of you, copy their insurance card(s) and ask a couple of prepared questions. These questions should be designed to obtain additional information based on the product prescribed. Does the scrip indicate testing 3x/day, and the patient thinks they need to test only once per day? If family members are present, include their information in the patient's record. Requiring next of kin data is equally important to insurance information. Each one of these items is helpful to intake and to the billing staff.

DOCUMENTATION HANDLING

The responsibility for CMNs and scrips is often relegated to the billing staff. (CMNs are defined in this article in a generic sense, not the specific CMS CMNs.) I am suggesting we turn this upside down. As orders are being entered, customer service reps are smart enough to know if the CMN meets dispensing criteria. If the document is insufficient, they can instantly generate the appropriate form.

Using a faxserver, e-mail, or software on an individual's PC, the CMN can be sent to the physician immediately. This method does not suggest the order will be released for billing. The emphasis is on efficiency. Intake staff already has the order on the screen. Billing is freed up to perform billing functions.

For CMN follow-up, your sales staff can use their people skills and perform this task. They can use the opportunity to collect a completed CMN for a marketing call. In medical sales, it is the last person to see the physician who usually receives the referral. Schedule CMN retrieval between sales calls, and put your face in front of the referral more often.

Advance notification of documentation requiring renewal will further enhance your productivity. A well-designed system has the ability to identify and print these documents. Whether a prior authorization is reaching its expiration date, or a CPAP follow-up is necessary, you need to be aware of these looming dates. Sending the appropriate documentation well in advance of the next billing date will reduce your claims being held due to an expired CMN.

INVENTORY MANAGEMENT

Inventory management is a vital component for boosting your efficiency, and must include more than simply knowing where your equipment is. A complete inventory management system covers the entire range from placing the order, receiving the product, delivering it to the patient, and maintenance scheduling.

Products are purchased from vendors using electronic purchase orders. It is akin to electronic claims submission. With electronic purchase orders, there is no effort on your part to send the PO once it is approved. Your vendor(s) receive the PO, process the order, and ship it. The products are received and, using the packing list, compared to the PO. Differences between the two documents are resolved and the supplies are added to stock.

Another component of good management of inventory includes your rental equipment. These items will most likely have a manufacturer's serial number. Since manufacturer serial numbers are usually lengthy, writing them down increases the probability of transposing numbers. As a result, providers will add their own internal number or asset tag to an item. These asset tags are also applied to rental items that do not have a serial number. Many systems allow you to track a serial number and save a secondary number. Inventory management requires the capability of tracking both of these numbers, not just the manufacturer's serial number.

Tracking extends to history for a specific product. How much revenue has been received for this bed? What expenses have been incurred keeping it in service? Has there been a recurring problem with this bed? How do the revenue and expenses compare with those for similar equipment? These questions can be answered with a well-thought-out software system.

Are you still keeping a paper log? This is a common area where providers have not embraced an electronic solution. For whatever reason, they feel the continuation of a paper log is the most efficient. Their experience tells them that no computer-based solution exists. In reality, there are solutions that will handle lot number tracking. Whether it is a simple Windows program for less than $100, or part of a complete software solution, take advantage of the speed of the computer and ditch the paper log.

ELECTRONIC DATA INTERCHANGE

Most are familiar with electronic data interchange (EDI) and, for the most part, are sending our claims electronically. Providers are also receiving their remits this same way. EDI allows providers to post their payments automatically, eliminating the time-consuming manual task, at least for Medicare payments. There is so much more that can be accomplished with EDI than sending and receiving Medicare claims and payments.

Duane Ridenour

A clearinghouse will allow you to send claims to thousands of carriers electronically. Create one file and send it to the clearinghouse. Whomever you choose should also be able to create electronic remittance files if the carriers do not do so themselves. Using this file, you can auto-post those payments just as you do with Medicare. Manual check posting is limited to patient payments and those special payors such as hospice or wholesale accounts.

Checking a patient's insurance coverage at time of order is beneficial, particularly if the patient is in your showroom. Do you perform a check again before shipping the next month's or quarter's supply order? Your software can identify those orders coming up for resupply. These patients may have a good scrip on file, but has their insurance changed since the last time you spoke with them? Some clearinghouses have the ability to handle 270/271 transactions. If yours does, use that info to update your system and stop orders where the insurance coverage or eligibility has changed. And with smaller margins, how many products can you send out to noneligible patients?

Duane Ridenour has provided training and consulting services throughout the United States. He is vice chair for the NSCAC executive committee and serves on DME MAC Advisory Committees. Ridenour can be reached via e-mail: .