Software Solutions: Going Paperless with Document Imaging

Not long ago if you needed to send a document you would ask "Do you have a fax?" or "Do you have e-mail?" Now you assume that the people you work with are technologically savvy enough to have a fax and e-mail to enhance communications. For most businesses, the way they do business is so integrated with their paper process that they cannot envision changing: Why fix what is not broken?

Well, it is broken. Any system or process that does not provide you with optimal efficiencies should be reviewed and fixed. Handling paper today is like entering your billing on a ledger and totaling the columns with a calculator, rather than a computer system. Fixing the paper process will provide you with efficiencies that enable you to focus on growing and enhancing the way you do business.

Reimbursement cuts are a way of life in the DME / HME business, as are regulation changes that cause increased paperwork. Every time an announcement hits the wire regarding another cut or another change to the paperwork needed to get claims paid, DME suppliers need to scramble to figure out how to stay profitable in spite of the shrinking margins and increased costs. Technology is available to improve operations, help you stay efficient and grow your business without adding personnel and expenses. Companies maximizing and leveraging technology will be able to stay competitive without sacrificing customer service or their ability to maximize collections.

Document imaging/paperless office technology is the newest buzz word in the DME/HME business and is one of the most powerful options available to add into any organization. Converting from traditional paper and filing cabinets to an electronic imaging system will eliminate wasted man hours spent filing, refiling, retrieving, copying and searching for paper documents. This wasted resource can be put to better use. Employees will be more productive and be able to collect more money when their time is spent on actual work rather than chasing paper documents. Even though most of the customer data resides on a computer, 85 to 90 percent of appeals will require the actual file be pulled and reviewed either to confirm information in the computer or to retrieve a document e.g. CMN that must be attached to the appeal.

So what is actually wrong with paper documents? Here are some statistics from studies done about document imaging by organizations such as the Department of Labor, University of Massachusetts, Medical Records Department and Coopers and Lybrant.

Professionals spend about 60 percent of their time handling paper. According to published survey results, large organizations lose one document every 12 seconds; 3 percent of all documents are incorrectly filed causing the need to spend extensive time searching for the document; 7.5 percent of documents are lost forever. The average executive spends three hours per week hunting for mislabeled, misfiled or lost documents. In the DME/home care business, billing and collection staff spend an average of 20 to 30 minutes per hour retrieving, copying, or searching for documents needed to process claims. Per Department of Labor research, filing a document cost 25 to 30 cents per document. An average document is copied 19 times. Explanations of Medicare Benefits (EOMBs) with multiple patient names on them have to be copied multiple times. Someone has to take the time to black out the other patient names on those EOMBs when sending them out for billing purposes. The University of Massachusetts conducted a study of documents stored in their medical center. They found that 11 percent of documents were missing or misfiled. This is slightly higher than the Coopers and Lybrand audit that showed that 10.5 percent of documents were missing or misfiled in the audit they conducted.

Filing documents requires the filing clerk to sort the documents, pull the file and put the documents in the file. Every time you need to retrieve a document, you need to locate the file, bring it to your desk, search through the file for the document you need to retrieve, either copy the document from the file or look up what you need and put the file back. Not only do you need to file the paperwork, you need to refile it each time you need to review the document. The patient file is the lifeblood of the billing and collections functions. More often than not, when someone is working claims they will have to look at the actual paperwork or pull the file in order to copy a document that has to be attached to a claim. Each time a file has to be pulled, the following steps have to be taken: get up from your desk, go to the filing cabinet, find the file, pull the file, bring it back to your desk, flip through and find the document you need, pull it, take it to the copier, copy it, put the original back in the file, put the file back in the cabinet. Studies show this takes between four to six minutes each time. So what does that mean in real numbers? If each employee retrieves an average of five documents per hour for six hours of the day, this translates to 30 documents per day—multiply by five minutes per document = 150 minutes or 2.5 hours retrieving documents. At $15 per hour this translates to almost $10,000 per employee each year. And that?s just the retrieval. You still have to calculate the cost of filing, copying, pulling EOMBs for coinsurance and so forth.

To figure out filing cost, you need to calculate how many documents you handle on a daily basis. Every new patient generates approximately 10 documents. Every claim generates a couple more. An average patient file contains approximately 20-25 documents. Multiply this by the number of patients you have. Then multiply by .25, which, according to the Department of Labor, is the filing cost per document. Now multiply by 19, the approximate number of times documents are refiled.

With document imaging, you scan your documents and store the images on your server. The goal of document imaging is to make your office paperless. All of those filing cabinets can be scanned and stored on your computer system so that anyone who needs a document can simply access it on the computer right from their desk.

Imagine being able to respond to a patient phone call without leaving your desk, responding to a Medicare audit request for multiple documents in minutes and being able to analyze the contents of a patient's file with reports. Imaging also provides controls simply not possible with paper files, such as the ability to monitor and control who looked at a document and when. Keep records of how many times a document was printed or e-mailed.

Document imaging / paperless office technology is the newest buzz word in the DME / HME business and is one of the most powerful options available to add into any organization.

When selecting a system, keep in mind that vendors with industry relevant experience and customers will help you make a smooth transition. Follow up on industry-specific references. If the vendor has a customer in the business near you, you might want to take the time to actually visit them and see how they are using the system and how it is working. With many systems you will have to "train the trainer." They will have to come into your business, figure out your needs and then set up the system for your needs. Checking industry-specific references will ensure that the vendor has had successful implementations in companies with your specific business model and maybe even using the same billing software you use. When checking references, ask about support; specifically ask about the responsiveness and the quality of the support.

HIPAA and fraud compliance requirements are a lot more complicated than just making sure the documents are stored securely. Reporting on the disclosure of protected health care information (PHI) and preventing modifications or the appearance of modifications to the original are two important things needed. For example, if you can cut a portion of one document and paste it on another, you are creating a potential for fraud. Another feature to be wary of is the use of virtual white out—or the imaging term—redact. When using this feature to white out a portion of the document, you want to make sure when reproducing this document you can see that something was covered on the original.

In some systems where indexing or storing the documents requires a lot of typing, you would need to elevate the filing clerk's position to a data entry position which will incur additional cost over the cost of the system. If the system takes a long time to roll out, there will be additional management and implementation costs. Some of the really cheap systems will require a lot of set up and management which would be built into a more sophisticated system allowing you to roll it out months faster. In the end it will cost you less if you spend less time on the implementation and roll out of the system.

Going paperless is one decision that will help you stay efficient and competitive and a decision you will not regret.

This article originally appeared in the March 2005 issue of HME Business.

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