Products & Technology
Annual Software Roundup: The Fine Art of Being Prepared
More than any resource, providers' software systems will help them prepare for an tumultuous 2013.
- By David Kopf
- Nov 01, 2012
Providers are in for a wild 2013, so they had better be ready. As last issue’s Roundtable of HMEB’s Editorial Advisory Board pointed out, they are not only facing CMS’s rush toward Round Two of competitive bidding, but the continued onslaught of pre- and post-payment Medicare audits, the fight to replace the bid program with the Market Pricing Program (MPP), and a host of additional challenges. (See “Bracing for 2013,” October HME Business)
No business asset can help providers better prepare for the coming year than their information systems. The functionality, data and efficiency HME software systems offer HMEs can give them the flexibility, strategic insights, and perspective that will help them ready their businesses for the changes 2013 is sure to bring.
That’s why, for this year’s annual HME Business software roundup, we’ve decided to examine the various features that help providers be ready for anything a tumultuous 2013 has to throw at them. Here are the features we surveyed from the various software manufacturers:
- Document Imaging/Management
As the heading states, features and support for document imaging and management.
Tools to help providers prepare for RAC, CERT, ZPIC and other preand post-payment audits.
- Patient interaction and customer contact
Features that help automate customer contact, such as IVR and automatic email notification.
- Competitive bidding
Elements that help providers better prepare for life under Round Two of competitive bidding, or the market based approach for setting Medicare reimbursement rates the industry is proposing (i.e., the Market Pricing Program). This could be tools to help providers develop new revenue streams or deal with the loss of a category, for example.
- Human resources/staff management
Features that help management track various team members’ and departments productivity and help them increase staff performance.
- Key datapoints and dashboards
Reporting tools that offer summaries of pivotal datapoints for measuring provider performance, or any sort of “executive overview” or “dashboard” that helps providers manage their businesses.
Billing tools, authentication, and processing features offered.
- Inventory Management
Management and control features, such as barcoding, scanning and auto reordering, that lower a key point of provider overhead.
Features that let providers implement more streamlined and efficient workflows.
Tools and support that enable providers to take advantage of cash sales opportunities.
Ankota HDM for HME (Healthcare Delivery Management Software)
Years in business: 4
Number of installed systems: (not disclosed)
Type of System: A hosted, web-based/SAAS system; mobile features also support use of tablets, smartphones, telephony (IVR), etc. while offline.
Programming languages and database environments: The software uses the .NET development environment and is primarily developed in the language C#
Document Imaging/Management: Ankota associates all documentation with the patient record and delivery records to improve security and compliance. For electronic documentation, it supports conversion of existing paper processes to electronic documentation (interfaced with tablets, smartphones, etc). New documentation is created within the Ankota system and maintained and shared (electronically) among partners via a Care Coordination portal. Use electronic versions of your own documentation, or approved forms from ACOs, referring partners, and payers. Bi-directional integration with the provider’s and its partners’ systems to access data and documentation as needed (i.e., order entry, referral management, etc.). Documents are scanned and attached directly to the patient record, and documents can be managed among partners via the Care Coordination portal to reduce documentation challenges and further reducing DSO.
Audits: The software employs multiple mechanisms to verify that care was delivered, including voice telephony from the client’s home and signature capture on the mobile.
Patient interaction: Patients and family members have secure access to schedules and notes through the Family Communications portal. Built-in messaging system provides reminders (including text and email) and patient calendar assures that patients and family caregivers are notified of important events and kept up to date. CRM module helps manage business relationships and objectives, including sales and marketing staff.
Competitive bidding: The system helps providers balance product margins with operating costs to help them contend with lower reimbursement. Ankota says its solution improves the
efficiency of HME delivery operations, lowering operating expenses 10 percent to 30 percent, and increases delivery capacity as much as 20 percent with existing staff.
Staff management: Ankota’s scheduling & resource optimization assures optimal use of staff and resources, and always considers care plan requirements, skills/certifications, availability, proximity and even patient or caregiver preferences when scheduling. Point-ofcare documentation is electronic and updated in real time using tablets or telephony (IVR). Planning and routing features help caregivers provide more services and make more deliveries each day at lower costs, as well as travel fewer miles. Manage caregiver and technicians’ schedules, oversee dispatch, monitor on time delivery and rate caregiver/technician performance. Track expenses, miles traveled and on time performance of staff.
Dashboards and datapoints: The system provides more than 100 pre-formatted reports. Dashboards provided for schedules, dispatch, on time delivery, care plan attainment, compliance and financial performance.
Claims/Billing: The Ankota solution is focused on the delivery of care and the delivery of HME. There are mechanisms to bill for these delivery services, but Ankota is not a traditional HME order management, claims billing and inventory solution.
Inventory Management: Ankota partners with inventory and barcoding partners for best in class solution.
Workflow: Ankota provides web-based software to improve the delivery side of HME to operating costs and DSO while increasing capacity. The system providers care coordination tools and portal technology to manage workflow with care transitions initiatives, hospitals and ACOs. The software has three main functions: 1) optimize scheduling and delivery routes while respecting customer timing and allowing schedulers and dispatchers full control over the operation; 2) track deliveries on a tablet or smart phone app with signature capture, barcode reading and GPS positioning; 3) provide the analytics needed for operations and finance managers to measure business performance.
Years in business: 11
Number of installed systems: 2,500
Type of System:
A hosted, web-based/SAAS system
Programming languages and database environments: Built using Microsoft’s .NET framework and MS SQL Server for its database environment.
Document Imaging/Management: The Brightree Document Management solution enables providers to capture, manage, share, and secure documentation. Going beyond simple document imaging, this solution recognizes document types and status to let providers know when it is safe to confirm and deliver orders. With Document-Aware capabilities providers can bill, deliver, and respond to audits more efficiently.
Audits: Brightree provides systematic workflows that guide users to proactively gather thorough documentation and automates manual tasks, directing employees through the complete process. Electronic Audit Response helps providers respond directly to CMS audits through an integrated, electronic application that helps you collect and submit documentation, then track status. Brightree Document Management lets providers leverage document-aware capabilities to quickly capture, manage, share and secure required documents on the patient record for future reference Automatic CMN Renewal and Brightree’s Electronic Fax combine to automatically identifies expiring CMNs, sends renewal requests, and receives renewals. Also, Providers can track changes in the system by user Integrated, automated eligibility avoids delivering products to ineligible patients.
Patient interaction: The Brightree Connect patient interaction platform, powered by the IntelligentQ engine, uses patient data to help providers contact the right patient at the right time to increase resupply revenue, improve outcomes, and maximize compliance. The platform now offers an enhanced Voice solution for automated calls and a new Live Call solution that supports HME representatives calling chronic care patients to replenish supplies.
Competitive bidding: Brightree says its automation and business insight tools help providers increase efficiencies by 30 percent or more and while increasing cash flow. Brightree’s Product Profitability Analyzer can help providers determine inventory mix by calculating profitability at various reimbursement rates. Results can be summarized by product category or detailed by HCPCS code. The Executive Dashboard tracks trends from intake to invoice to highlight operational processes. The Business Scoreboard provides a snapshot of key performance indicators like asset utilization and DSO.
Staff management: BrightSALES, Brightree’s sales force automation tool, unites the billing and sales/marketing operations into one system to streamline activities such as referral source management, contact management, and scheduling of appointments. Your entire staff, including your marketing reps, can collaborate fluidly via Brightree’s notes, tasks, and
reminders. And because BrightSALES is part of the Brightree platform, any updates you make to a referral source are done once. There’s no more re-entering key contact information or activities into multiple systems.
Datapoints and dashboards: Brightree’s Business Scorecard provides updates on nine Key Performance Indicators with drill down capabilities. The Executive Dashboard looks at business trends in a graphical format. The system’s ad-hoc reporting system is also part of the core Brightree solution, and standard reports provide visibility into the key performance metrics of your business.
Claims/Billing: Nightly electronic claims processing and automated alerts – allow billers to focus on exceptions in submission, rather than spending time preparing and submitting batches. Streamlined rejection and denial management – offers opportunities to analyze the data for improvements in intake and billing processes to avoid delays in reimbursement. Electronic processing of secondaries and posting of ERA payments help improve cash flow. Integrated Real-time and batch eligibility enables verification for recurring rentals and supplies; and same or similar verification to reduce denied claims by delivering only products that are reimbursable. Automatic CMN renewal automatically identifies expiring CMNs, sends renewal requests, and receives renewals to speed up the billing process.
Inventory Management: Integrated ordering and inventory tracking maximizes inventory turnover, tracks repair and maintenance and flags obsolete and superseded products. Brightree supports handheld scanning devices to quickly and accurately count inventory items. Integrated ePurchasing with major suppliers enables seamless and accurate ordering from within the Brightree system. When integrated ePurchasing is combined with drop shipping, providers can reduce delivery charges and inventory carrying costs. Also, the system works in real-time, so that when shipments are received they are immediately reflected in inventory.
Workflow: Brightree automates the HME operation from intake through collections. Examples include: nightly automated electronic claims; tracking work in progress to monitor order status and identify bottlenecks; ERL management through an online central work queue; individual tasks and alerts on each user’s home page to guide the process to completion and document-aware capabilities to ensure that the right documentation is in place before delivery and billing.
Retail: Brightree offers a complete, easy-to-use, and fl exible Point of Sale (POS) solution for your retail operation. The system’s retail sales module is fully integrated with the rest of the Brightree system, so inventory quantities, receipts, and all other relevant data are automatically updated with each transaction. Retail sales data can be tracked by specific patient or handled as a simple cash sale. Finally, Brightree provides daily reports to summarize sales activity and reconcile tendered amounts.
Caretinuum, HomeCareNet, Ascend, MestaMed, Pharmed
Mediware Information Systems, Inc.
Years in business: 42
Number of installed systems: not provided
Type of System: A stand-alone system installed on-site, and a hosted system that uses
special client software
Programming languages and database environments: Mediware software uses Microsoft.NET, Microsoft SQL DB, and C#
Document Imaging/Management: Can capture, process, collaborate, protect, and access data. Uses records management, workflow processes and web content management and so forth as means to do so. Software supports Cabinet NG, MedForce, Filebound, and RemitData. Mediware allows integration with applications such as MedForce from within the Patient record for easy access to patient documents.
Audits: When preparing for audits, reports can be generated to show a full history of charges and adjustments to aid in audit analysis. Existing reports and custom reports can be generated from the SQL DB. Tools are used to help share important information as needed delivering meaningful, actionable metrics , data trends, and much more.
Customer contact: Mediware can interface with Medsage for automated customer re-ordering. Mediware offers an integrated Recurring Sale Module to allow automatic scheduling of the delivery of supply items based on a user specified frequency. There are workflow notifications and document output management capabilities to help with any process needed.
Competitive bidding: Reports can be generated to analyze by payor and product class, analyzing the business to see where helpful changes may be implemented. Successful tracking information in regards to competitive bidding allow customers to plan appropriately.
Staff management: Analysis can be done through custom reports of HME order entry by customer service rep. For A/R, collectors and status can be assigned to claim to allow for A/R Collection analysis. Tools and tracking systems within the software allow for productivity tracking and process and content management and reporting to increase efficiency, determine bottlenecks, and optimize performance.
Data points and dashboard: Mediware offers an library of standard and custom reports from the SQL DB. In addition, InSight from Mediware offers a performance management system that gathers analysis and delivers key, actionable metrics to management’s desktop for improved business performance. Providers gets the information they need, when they need its, delivered in a simple, straightforward fashion.
Claims/Billing: Mediware software automatically evaluates all claims for required data and missing documentation such as physician orders to ensure a clean claim is generated. The system can hold claims for various reasons and navigate with ease to complete necessary data. Statuses, follow-up dates and notes help to view the claim, complete submit easily with our claims browser. Integration with Zirmed automatically submits the EDI claims returning an immediate response message.
Inventory Management: Mediware offers full inventory control with bar-coding functionality. Inventory features include purchasing and receiving, physical inventory and asset maintenance for serialized equipment.
Workflow: The Order Entry module organizes all these elements into logical components with easy navigation through each. Business rules for required data such as CMNs, physician orders and authorizations are embedded throughout to make data entry quick and accurate. A Claims Management module allows tracking of statuses, follow-up dates and notes for effective management of A/R collections and resubmissions. The InSight tool allows monitoring these workflows for tracking and enhancements.
Retail: Mediware’s Order Entry module supports the entry of Cash Sale transactions with collection of patient payments. In addition, Caretinuum partners with Millenium Retail Solutions for a full-featured Point of Sale Solution that includes bar-code integration and Check/Credit Card processing.
Definitive Homecare Solutions
Years in business: 19
Number of installed systems: 1,200
Type of System: A stand-alone system installed on-site
Programming languages and database environments: SQL, Visual Foxpro, .Net, C#
Document Imaging/Management: The software has a built in document management system that allows documents to automatically be attached to any entity within CPR+.
Audits: CPR+ helps prepare for audits through the ease of access to the pertinent data. Patient interaction and customer contact: CPR+ offers a patients to contact list to help maintain cyclical orders.
Competitive bidding: CPR+ help providers manage their business through the automation of identifying their competitive bid areas and the products that those patients within those areas can receive.
Human resources/staff management: The unlimited access to data that will allow for custom reports to be run to track team member and department productivity.
Datapoints and dashboards: CPR+’s executive dashboard allows management teams a graphical view into critical CPR+ datapoints.
Claims/Billing: CPR+ offers a variety of billing tools such as customizable front end edits, and automated 835 postings.
Inventory Management: The software allows for the creation and receiving of POs via handheld scanners and managing serialized inventory in the field with point of delivery system.
Workflow: CPR+ supports efficient workflows through the use of pre-defined workflow queues to help manage an order through its lifecycle.
Retail: The system offers an integrated Point-of-Sale solution.
Fastrack HME Enterprise System
Fastrack Healthcare Systems Inc.
Years in business: 19
Number of installed systems: 1,236
Type of System: A stand-alone system installed on-site, or a hosted system using special client software
Programming languages and database environments: Microsoft SQL
Document Imaging/Management: Fastrack’s Document Management allows the user to store a wide range of document types including sound files in user defined tabs in the patient, physician, employee, insurance carrier, referral source, cash posting, product, company file and more. Utilizing the system’s Custom Forms Generator, bar codes can be added to nay form such that forms can be batched scanned into the system and will automatically move to the
appropriate tab. The system will create a separate 835 for each patient and auto-insert it in that patient’s record.
Audits: Fastrack’s CMS Audit Response System lets providers collect, track and electronically send all documentation requested direct to CMS. The system will post and maintain all responses from CMS, and will maintain a record of all documentation sent and by whom within the organization. Required documents can be accessed from the Fastrack Document Management feature in each patient record, as well as from any scanned, faxed or emailed document on any workstation or the server.
Patient interaction: The system lets providers automatically send an email to a patient or facility upon shipment of an order, as well as to email any document from within the system to the patient or a physician. Fastrack’s integrated IVR system, automates the contacting of patients for reorders and compliance purposes.
Competitive bidding: Fastrack Business Intelligence and reporting system help providers analyze their cost and profitability for purposes of submitting a bid. The system’s integrated e-Commerce Storefront, Web Portal and IVR system are geared to help generate increased revenue from existing patients and facilities as well as help generate new business.
Staff management: The Fastrack ScoreBoard displays user definable key indicators showing productivity by each team member within their department including billing, cash posting, etc. The Workflow Management tool provides the ongoing status of an order so that managers can see the elapsed time between order stages and respond accordingly.
Datapoints and dashboards: The system provides an Executive Dashboard with key business indicators; a ScoreBoard that provides real-time updated information on business processes including number of new orders/dollar value entered and processed orders picked/shipped, etc.; and a Business Intelligence tool for data mining designed to solve business problems including denials, to analyze how well referral sources are performing, and more. Business Intelligence lets the user pick and choose which fields to show up in a spreadsheet or graphical format. The system comes standard with hundreds of management reports offering numerous sort capabilities. Client can write their own reports with the industry standard Crystal Report Writer.
Claims/Billing: Fastrack is 5010 compliant and provides direct on-line claims submission to Medicare and Medicaid, as well as to over 2000 commercial carriers through Emdeon and Zirmed. Fastrack offers on-line eligibility, ERA auto cash posting and CSI-Same or Similar checking. Advanced order and billing edits help insure only clean claims are submitted by verifying user definable requirements are met. The system also bills for retail, wholesale, facilities and Hospices as well as workers compensation claims. Fastrack provides for up to four payor sources plus private pay per patient with a simplified process to accommodate for changes in the patient’s insurance.
Inventory Management: Utilizing wireless technology, warehouse staff can receive orders on their PDAs from the CSRs for fulfillment. Upon picking and scanning the product the system will confirm that the right product was selected to avoid delivery errors. These PDAs can also perform real time receiving, physical inventory and automate the delivery of products offering real time order confirmation from the field. The system supports an unlimited number of branches and warehouses providing the user with the ability to see where inventory of a particular product resides and the option of choosing the appropriate warehouse to ship from. The system also allows for drop shipments from a vendor which is enhanced with our electronic (EDI) purchase orders to Invacare Supply Group, McKesson, Graham-Field, Independence Medical, Gulf South, Medline, Cardinal Health and First Choice.
Workflow: The Fastrack Automated Workflow Manager tracks every step of a provider’s operational processes from patient intake and the receipt of a new order (by fax, phone and Internet) to picking the products in the warehouse and routing the delivery trucks. The provider will always know what stage each order is in, if there is any reason it is
being held up (i.e. missing CMN/RX, etc.), and who is responsible for the next step in getting it out the door. Also, the Fastrack Task Manager alerts key staff to significant events that require action including follow up on new orders.
Retail: Fastrack offers a touch screen-enabled POS system that manages the retail operation including both insurance and cash transactions including full credit/debit card processing, inventory control, tracks customer deposits, prints courtesy 1500 form, offers extensive security by cash drawer, and supports multi-site locations.
Years in business: 25
Number of installed systems: 600
Type of System: A stand-alone system installed on-site, and a hosted, web-based/SAAS system
Programming languages and database environments: MedAct Software Client/Server Edition is a Windows based system utilizing a SQL based RDB.
Document Imaging/Management: MedAct Document Manager is fully integrated into the MedAct workflow and is designed to streamline document management from patient intake that includes physician and insurance documentation, to final payment posting. The Document Manager utilizes bar code technology to automate intelligent document filing and retention. Built-in HIPAA security access and backup of critical documents are also easily managed. The system scans, files and saves documents to easily blend into the HME environment allowing suppliers to focus on patient needs while ensuring more efficient file sharing, retrieval and filing during all aspects of managing documents.
Audits: MedAct’s integrated workflow engine assists providers in submitting clean claims, and the system also employs tools and checklists during order intake to minimize and eliminate claim rejects and denials, which could trigger audits. LCDs can be attached to inventory items and to ensure compliance to regulations. File Audit Checklists are used to ensure orders have the proper documentation before claims submission. MedAct’s Compliance Center can generate more than 20 pre-payment and post-payment reports. Responding to CERT audits are handled by Review Code tracking and reporting for each invoice and line item. Integrated Document Management utilizing automated bar code recognition ensures all documents are available at a patient, doctor and insurance level for audit review.
Patient interaction: MedAct provides a report area specific to customer demographic and customer contact data, which includes customer contact labels by zip codes, account numbers, and name, which can be exported directly from the software in 15 different ways for email notification and other communication methods. MedAct tracks customer contact and can schedule follow up calls, and the Customer Callback Report provides users a listing of customers needing callbacks for a specific period of time to meet delivery forecasts, customer service and accreditation objectives.
Competitive bidding: An integrated Competitive Bidding (CBid) Center lets contract and non-contract bid suppliers manage patients, beneficiaries and other contract suppliers in the CMS Competitive Bidding Program. MedAct’s Competitive Bidding Center facilitates the submission of winning CBid contracts by managing contract item categories and price levels. MedAct CBid Center includes both round one and round two competitive bid areas (CBA) by zip code for easy referrals. CBid Center makes providers more efficient by easy look ups of procedure codes by contract item categories. Traveling beneficiaries and sub-contractor ordering, billing and deliveries can be handled with ease with MedAct CBid Center.
Datapoints and dashboards: A real-time graphical dashboard, with core executive and management data, such as aging detail and aging summary data, sales data, current day delivery and pickup totals, along with claim pending submissions, voided submissions, and denials data measured in dollar amounts. MedAct also functions as a decision support tool as well as forecasting or trending tool. The reports that help manage a DME/HME business include tracking deliveries; denial management; Accounts Receivable; end of month, end of year and quarterly financial reporting; aging and other revenue related reports. Sales reports show which items are selling the most, which salesperson is generating the most sales and the source of the most referrals.
Claims/Billing: MedAct has integrated billing and authentication tools directly into the software, MedAct provides for realtime eligibility request at the point of patient intake, automated PECOS and NPI registry utilities. MedAct ensures clean claim submission utilizing 37 audits before and during automated claims batch creation. MedAct provides for automated claims submission and remit posting via MedAct Claims Manager and Claims Network.
Inventory Management: The Inventory Management Module provides mobile inventory management tools needed to optimize your capital inventory, and provides mobile and automated capabilities to maintain inventory items, transactions, audit trails, multi-warehouse environments, vendors, lot numbers, and serial numbers. The module uses bar code scanning to track inventory shipments to patients. MedAct can set minimum and maximum reorder levels to assist in effectively managing inventory costs and counts. When it’s time to reorder inventory, the fully integrated Purchase Order Manager creates accurate POs that can be sent to vendors electronically, via fax, or paper.
Workflow: MedAct uses a workflow of checks and balances to ensure all claims are sent with confidence and return with payment. MedAct creates defaults for inventory items and associating those items with insurances or insurance groups, ensuring steps are not missed in the billing and delivery process. The defaults created for workflow and delivery verifies orders are processed with the highest level of accuracy every time.
Retail: The MedAct retail solution with the MedAct Point of Sale Module provides DME businesses a way to ring up sales without a cash register and with all the benefits of automatic updates to inventory. The module is fully integrated into the MedAct application so providers can service both cash and insurance transactions in the retail environment, and the Point of Sale Module automatically calculates the patient portion due. The MedAct bar code scanning system scans bar coded equipment and supplies for easy transactions. Credit card processing is built in, and receipts are generated for both cash sales and charges to accounts. Cash receipts can be printed on 3 inch paper or full size 8 X 10 inch receipts.
MedFORCE Scan, D&R Manager, WorkFLOW
MedFORCE Technologies Inc.
Years in business: 10
Number of installed systems:
Type of System: A stand-alone system installed on-site, and a hosted, web-based/SAAS system
Programming languages and database environments: Software is designed in Delphi and SQL SERVER database to securely store data. The Web-based application is written in ASP.net
Document Imaging/Management: MedFORCE suite of products provide high level document management solutions architected to provide a simple and secure way to scan, retrieve and auto-file all documents including patient records, faxes, EOMBs, HR, AP etc. MedFORCE is much more than an electronic filing cabinet. MedFORCE can barcode all documentation that is printed and tracked for future retrieval. Documents that are scanned are automatically captured and auto-filed where applicable and be located thru an auto search feature.
Audits: MedFORCE Technologies is enrolled in the esMD program to let providers electronically submit pre- and post-pay audit documents. Users can collect and prepare all supporting documentation required to manage and monitor audit requests to satisfy the stringent requirements mandated by the various auditing agencies.
Patient interaction: Customer contact can be managed through the business process management tools provided in our suite of solutions. Patient interactions can be accomplished through communication provided through the forms designer tool integrated within our application.
Competitive bidding: To compete in today’s market place providers need to maximize their greatest resource, their employees. Each employee must accomplish more with less resources and time. MedFORCE solutions provide efficiency and monitoring tools to achieve that goal.
Staff management: Mapping workflow processes within MedFORCE helps ensure consistent performance as well as provide the tools to monitor and manage productivity.
Datapoints and dashboards: What reporting tools offer summaries of pivotal datapoints for measuring provider performance, or any sort of “executive overview” or “dashboard” features does they system offer to help providers manage their businesses?
Claims/Billing: D&R Manager aims to increase provider efficiency when working with claims and denials. Data is available by custom reports and at-a-glance screens. Importing ERNs automatically places patient-specific EOMBs in each patients file.
Workflow: MedFORCE WorkFLOW lets providers to map processes, the steps to complete, timelines, escalations etc. to ensure consistent performance, no missed steps or lost orders, real-time indication of any possible bottle-neck in ways not possible without an electronic tool.
Years in business: since 1989
Type of System: A stand-alone system installed on-site
Programming languages and database environments: Delphi with SQL database running under Windows or Linux.
Document Imaging/Management: Noble*Direct’s document imaging features are integrated throughout patient intake and claims management. Images may be created as PDF, BMP, JPG, PNG, TIFF files or as WAV or MP3 sound files and may be scanned from hard copy, directly from incoming fax files or by using a batch scanning function using bar codes for indexing documents.
Audits: Supporting documentation as the result of an audit request may be quickly selected and electronically transmitted to CMS using esMD (Electronic Submission of Medical Documents) technology. Following the transmission of the required documentation, the progress of a particular audit may be monitored and recorded.
Patient interaction: A patient record “screen-pop” can be coupled with a provider’s phone system to help streamline intake and customer service. Batch custom letters may be sent to clients using email addresses which have been stored. Custom letters may be sent or phone calls scheduled for clients who require particular supplies. An integrated patient scheduler is included as well.
Competitive bidding: As part of the bidding process, CMS has requested historical sales information by MSA and HCPCS code for those items being bid. This time-consuming process has been automated and is included within Noble*Direct’s reporting system. In addition, Medicare patients residing within an MSA and requiring supplies in a category for which the provider does not have a CMS contract are identified so that suitable action may be determined.
Staff management: Salesperson performance may be tracked by month through salesperson commission reports or through an Executive Dashboard. Log files which have automatically recorded detailed billing activity may also be accessed to report user performance.
Datapoints and dashboards: An executive dashboard may be invoked which presents current and prior period revenues, reimbursements, A/R breakdowns, DSO and other critical metrics. Filters to indicate desired periods and conditions for analysis may be used. All reports requested through Noble*Direct also allow extensive filtering which permit specific user requests.
Claims/Billing: Online patient eligibility both for CMS and private insurance patients. Eligibility may be accessed by individual patient or in batches of patients, such as “give me patient insurance eligibility for all patients that I’ll be servicing this week.” Automatic recurring billing may be defined for cap rentals or replenishment of supplies. Transaction macros serve to predefine claims entry involving start-up or accessory kits for patients. Noble*Direct interfaces with NPPES, PECOS and USPS databases for verification and extraction of data.
Inventory Management: Inventory management may be utilized to generate and deliver purchase orders and manage inventory levels across multiple branches and warehouses. It includes serialized inventory tracking, lot number and expiration date reporting, administration of inventory levels and valuations as well as enhancement for recording service dates for inventory items requiring regular maintenance.
Retail: An integrated cash receipt” program is included to service walk-in patients by issuing a quick receipt and logging walk-in, non insurance claims separately. Inventory levels are automatically adjusted as a result of walk-in sales and scanners may be used to scan inventory bar-codes for data entry. For those providers requiring point-of-sale hardware (cash drawers and scanners), a Quickbooks synchronization function integrates the Noble*Direct insurance database with Quickbooks. Quickbooks Point of Sale system can be used to record walk-in sales and integrate with Quickbooks. Providers using Quickbooks will then have access to all of the Quickbooks financial reporting in addition to financial reports generated through Noble*Direct.
Years in business: 35
Number of installed systems: 1,100
Type of System: A stand-alone system installed on-site, a hosted, web-based/SAAS system, or a hosted system, but uses special client software
Programming languages and database environments: Proprietary
Document Imaging/Management: Integrated document imaging and interfaces to MedFORCE Technologies, RemitDATA’s WebScan and Integra’s DocuTrack.
Audits: Billing edits help ensure Medicare required information and documentation is completed and on-file prior to claim submission. Electronic signature capture, date of service reconciliation and comprehensive patient documentation is managed through automated processes.
Patient interaction: Integrated IVR provides automated, 24-hour resupply requests, outbound resupply reminders, rental compliance surveys and patient satisfaction surveys.
Competitive bidding: Patient census and sales analysis tools provide insight into buying habits and trends and assist in forecasting. This information is available for both retail and third-party billing.
Staff management: Activity by unique user ID provides security, accountability and performance reporting.
Datapoints and dashboards: Integrated reporting filters allow all data to be extracted in multiple formats for review.
Claims/Billing: Electronic claims billing and management to Medicare, Medicaid and third parties. Eligibility checking, claim status inquiry and same or similar checking is available for Medicare and hundreds of third-party payors.
Inventory Management: Rental and sale inventory management utilizes barcode technology to identify items, confirm delivery and assign unique asset numbering. Integrated purchase orders monitor min, max and par levels for auto-ordering. Electronic drop ship purchase ordering is available with Independence Medical, Invacare Supply Group and McKesson Direct.
Retail: Integrated Point-of-Sale management provides expedited checkout by processing cash, check, credit, debit and IIAS approved fl ex spending and health savings account cards. QS/1’s Point-of-Sale ensures accurate pricing according to Medicare guidelines and automatically updates inventory and accounts receivables. Customized reports provide sales and trending analysis as well as activity reports for increased security.
Years in business: 34
Number of installed systems: (not available)
Type of System: A stand-alone system installed on-site, or a hosted, web-based/SAAS system
Software programming languages and database environments: Microsoft .Net and SQL server
Document Imaging/Management: TIMS unified document imaging streamlines providers’ offices, ensuring their patient, physician or insurance documentation is ready at any time. Providers scan any document and easily create electronic patient files while satisfying medical necessity requirements. TIMS Software also creates searchable and accessible documents directly in the system.
Audits: Provides upfront validations needed to minimize denials or take-backs based on insufficient required documentation or lack of medical necessity before equipment is released to the patient. Providers can access any scanned documents through TIMS Imaging such as CMNs, doctor orders, ABNs or clinical notes, for example.
Patient interaction: TIMS will automatically email order confirmations for patient or referral sources, thanking them for placing their order. Also, the system’s medSage Technologies interface helps businesses schedule combined in-person and automated calls to patients. This robust scheduling tool monitors therapy compliance and provides assistance when re-ordering healthcare supplies. The TIMS interface with A/R Allegiance manages providers’ billing communication with the patient for each account. And, through the system’s interface with Strategic AR, providers have patient-pay billing and collections services that improve cash flow, streamline patient communication and decrease the labor costs.
Competitive bidding: TIMS offers Microsoft BI reporting tools to analyze profitability based on sales history or anticipated sales volume. The provider can utilize imported Round One competitive bidding single payor amounts, fee schedule allowables, branch and store location, DME category and HCPC, plus patient permanent zip code to help guide it through challenging competitive bidding decisions.
Staff management: TIMS’ intake process delivers critical HME workflow needed to improve both operating procedures and the provider’s CSR performance while providing management with simple ways to track and measure productivity and distribute workloads, giving staff more time to care for patients.
Datapoints and dashboards: Pre-built data cubes make it quick and easy to create richly formatted reports. Providers can perform powerful ad hoc analysis directly from Excel to answer pressing information needs. Dashboard metrics, reporting and analytic tools give providers the up-to-date and timely executive overview they are looking for.
Claims/Billing: TIMS provides automated electronic CMN and authorization processing. Supports secondary and tertiary insurances. Integrates with ZirMed for complete revenue cycle management, including eligibility verification, claims validation, denial management, EOB explanations and ERN automation. Also, 5010 and D.0 compliance are certified and in use.
Inventory Management: Supports single and multiple warehouses and bin locations. Bar code tracking for supplies, medical gases and rental equipment, including lot number tracking and recalls. Handles rental equipment tracking and repairs. Offers wireless warehouse management for cycle counting, picking and receiving.
Workflow: TIMS Patient Intake offers a customizable workflow and priority system. The
intake process is mapped out in user-defined stages from first contact through delivery of
product. Providers can view the current state and ownership, pending orders at a glance, and
history of the workflow process complete with dates and times events occurred.
Retail: TIMS Point of Sale (POS) lets HMEs track payment methods of theirs customers, which gives a clear picture of the organization’s retail business transaction. POS tracks cash, check and credit card payments through a cash drawer and features a one-to-one relationship between each terminal or PC and its respective cash drawer. Management can break down summary reports by branch, cash drawers and transactions, and easily reconcile cash by cash drawer. The TIMS Credit Card system offers complete secure credit card orders while taking care of recurring transactions – without re-keying information. Credit card numbers are securely stored offsite with the credit card processor, completely eliminating provider liability.
TITAN, Reimbursement PRO and WebScan PRO
Years in business: 12
Number of installed systems: 1,200 installs
Type of System: A hosted, web-based/SAAS system
Document Imaging/Management: WebScan PRO is a HIPAA-secure document management solution that uses optical character recognition to identify, index and file all patient records, EOBs and all other documents for immediate online use through a SaaS-based system.
Audits: The interactive TITAN database provides real-time, peer-to-peer benchmarking and Comparative Analytics on reimbursement, utilization and productivity measurements. This real-time reporting capability enables providers to measure their performance and compare themselves to their peers, thereby determining if they are an outlier that the RAC, CERT, and ZPICs would focus on.
Competitive bidding: Providers can leverage TITAN, Reimbursement PRO, and WebScan PRO to improve the efficiency of their office operations and to identify any opportunities to realize lost money. By improving their operations, providers will be better positioned to successfully operate in the Competitive Bidding environment and to bid in future rounds.
Staff management: Reimbursement PRO’s workflow tools enable staff members to quickly and efficiently prosecute denials while its monitoring tools enable management to organize the billing staff to most effectively handle the workload. TITAN provides management and staff with the ability to monitor performance in real time while comparing themselves to their peers. That comparative context gives management the knowledge of how well, or how poorly, their staff is performing compared to their peers.
Datapoints and dashboards: TITAN provides in-depth executive dashboards on key performance indicators such as aged cash, denials, reason codes, payer productivity, staff productivity and utilization. The dashboards can be customized for any payer, procedure, reason code, claim status, location and the combination of several filters. Additionally, TITAN offers Comparative Analytics which help providers determine how well, or how poorly, they’re performing compared to the peers.
Claims/Billing: Reimbursement PRO is a SaaS-based denial management workflow solution that works in conjunction with any practice management or billing system to control and streamline the denial management process. Users can differentiate between expected and unexpected denials and automate the denial management process so that they can take the appropriate action in a timely manner to improve cash flow. Reimbursement PRO will improve the efficiency of your billing operations through OnDemand EOB retrieval, OnDemand Query analysis, Denial Q workflow tool and OnDemand Form generation.
Workflow: TITAN’s Insight reporting tracks workflow processes such as total processing time, staff processing time, payer processing time and cash flow with ability to perform an interactive drill-down to further investigate the details of issues and the related causes/effects through various measures and perspectives to proactively resolve issues within the user’s business or practice. Reimbursement PRO provides quick-turn collection tools to prioritize workflow. Real-time reports help identify and fix problematic collections issues and the denial management process can be automated for more timely claims processing to improve cash flow.
This article originally appeared in the November 2012 issue of HME Business.