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Knowing that the Medicare Modernization Act will continue to impact the Home Medical Equipment Industry (HME) industry, most providers are closely scrutinizing their businesses. While some are already implementing strategic plans, others are waiting to see what happens. Quite frankly, those who plan ahead will be better prepared to cope, regardless of the changes. In other words, even if there is no real certainty about competitive bidding and how it will impact your business, it is time to look introspectively at your business for ways to improve operations. Specifically, remain focused on matters such as proper order intake, training, clean claim submission and automation.

PROPER ORDER INTAKE

How well does your staff perform under pressure and high scrutiny? The order intake employee today is responsible for being a negotiator, a Medicare and insurance expert, a detective, a politician, a social worker and a sales person. Further, they must be able to multi-task and think on their feet. Not a small feat, order intake is truly what makes or breaks the order. In fact, if the order is not right, why continue the rest of the operational process?

TRAINING

Training is where you can make the difference. Give your staff the benefit of ample training and do not work under desperation. Allow them time to make mistakes but have them shadow your knowledgeable staff until they are able to try it on their own. Have the trainer observe the trainee until they are both comfortable that no real serious mishaps will occur. Finally, provide resources such as Medicare manuals and additional websites and web-based training. With proper tools, the intake department should be able to make an educated decision about an order.

ENSURING CLEAN CLAIM SUBMISSION

Another way to improve operational efficiency is to ensure that the claims you submit are accurate. Clean claim submission is determined during the intake process. As mentioned before, are you making educated decisions about the financial viability of an order during intake? Equally important is to gather the medical necessity information up front and make sure the equipment is authorized (for non-Medicare patients). Further, if the item requires a CMN, make sure you are using the most current form. Many companies fail to update their forms when Medicare changes. Because Medicare makes changes available through their list-serve (whereby they actually email YOU of any changes), there is really no excuse for not adhering to the changes. By peering internally into your standard operating practices and staying current with Medicare requirements, you should be able to generate cleaner claims with minimal effort.

OPERATIONAL EFFICIENCY

As you consider the additional costs associated with employing the necessary procedures to undertake enhanced scrutiny and compliance, you may feel frustrated as Medicare continues to make allowable reductions. However, if you are looking for ways to cut costs in other areas, conduct an impromptu visit around your company in search of every manual function. You will likely find hand-written logs that duplicate the data found in your software. The good news is that if you automate these functions, you will free staff to perform more important tasks.

AUTOMATION

While simple manual and duplicate functions seem easy to eliminate, also look into automating other functions. This includes document imaging of your important forms in a patient file. Such forms include intake, medical necessity/authorization, delivery tickets, invoices/statements, remittance notices and more. Inventory scanning and on-line purchasing will also save time.

Internet eligibility and benefits checks go hand in hand with electronic claim submissions to the vast majority of your third party payer sources. Invaluable for your company, you should either be submitting commercial insurance claims electronically already or preparing for it.

Although there are many unknown variables with respect to the MMA and its impact on HME providers, one thing is certain: change. Are you ready? Prepare by examining operations for proper intake, adequate training, clean claim submission, and increased automation. Ways to create additional efficiencies should be found. The result should be a well planned and successfully executed strategic plan.