HME professionals have
likely heard from software
vendors that they should take
advantage of data and metrics
tracking to improve their business
and operations strategies. But what
does that actually mean in practice,
and how do providers translate these
gold mines of data into insight their
employees can actually use?
Software solutions are making
that question easier to answer, with
some platforms pulling relevant
data automatically and helping staff
identify why claims are being denied.
In addition to tracking potential
issues with claims, HME software also
allows providers to be more forward-thinking
when it comes to predicting
future business activity. Future
patient reorder data can be analyzed
to anticipate restocking needs and
purchasing trends can help determine
which product category is earning the
most attention from customers.
At the same time, providers
continue to favor traditional
reports to see their metrics or other
key performance indicators. But
with constant innovation in HME
software, providers should step
outside of their standard operating
procedure and consider trying out
new ways of measuring their metrics.
The support of a competent
software vendor means that the
short-term investment in time and
resources could lead to a growth in
profit margins that HME businesses
have not seen in years.
METRICS WORTH TRACKING
There are a few staple metrics that
HME providers should be paying
attention to at all times if they hope to
maintain their bottom lines and eventually
improve them. Number one
among those performance indicators
are medical documentation metrics.
Documentation remains the
slowest and most difficult part of any
HME provider’s business, making it
crucial for them to track how long
it takes to acquire valid medical
documentation. In addition, providers
should take a hard look at how much
of the documentation they acquire is
not valid and how they are storing this
data so that it can be easily recalled
for an audit. Several software solutions
in the industry, including those
offered by Computers Unlimited
and Universal Software Solutions,
are specifically designed for HME
providers to track documentation –
the linchpin of their business.
In addition, another must-have
metric is claims denials, which
should be approached from two
different angles. A claim that denies
one time, or a first pass, can show a
provider nearly all of the issues they
are having on the front end of their
business.
Process breakdowns become
doubly obvious if the claim is denied
a second time, allowing management
to see what is going wrong
with billing staff and A/R collection
teams in terms of common errors.
From there, providers can decide
how to remedy the situation through
increased training for staff who
handle claims or more oversight of
the entire process.
Other metrics that deserve
providers’ attention include order/sales volume, held revenue by
average daily sales on hold, held
revenue by volume, claim submit
volume and cash collection. These
metrics are often developed into
reports, formatted in the form of
a “check-up” or “report card,”
that can be shared with referral
sources, vendors and even patients
themselves.
As software develops further,
more HME professionals are relying
on real-time dashboards that create
custom reports without having the
data bottlenecked by one or two
employees, making it more accessible
to staff members dealing with
claims or other crucial parts of the
business.
CHARTING YOUR SOFTWARE PATH
Providers are all over the map
when it comes to software familiarity
and implementation. While some are
up to their elbows in data metrics
that they can use to improve business
practices and market themselves
to referrals, others are still
fresh to the possibilities of metrics
reports and data analysis.
The path of least resistance is
getting started with the software
solution’s standard reporting feature.
Most solutions have configurations
and criteria that can display
reports in either detailed or summary
formats. CU’s TIMS Software
provides reporting data that can be
exportable to spreadsheet format,
with the option to use other business
intelligence tools like MS Power BI.
If providers need a concrete
example of how software can solve
a business process issue, look no
further than a claim denial called
CO-16. The issue, commonly
addressed by Universal, involves a
claim that lacks information about
what needs to be paid. A provider
may look at any 30 claims that
received the same rejection from the
same payer, but the provider may
have taken 30 different actions to
resolve each case.
The only way to identify trends
in case resolution is through taking
advantage of the data that has
already been collected – and by
creating smarter processes or service
choices to prevent that claims denial
from happening in the first place.
These are the types of “gold mine”
moment that software solutions
make possible.
RESPECTING PATIENT PRIVACY
Providers may worry that sharing
reports or other meaningful feedback
externally could put their
patients in jeopardy. But HME businesses
can easily respect patient
privacy while still connecting with
referral sources and finding ways to
greatly improve business processes.
When tracking medical documentation,
providers are looking to
answer the question: Who are the
doctors who are slower in returning
information? Are we not getting them
what they need in order to respond
faster? Office managers and HME
sales representatives will have an
easier time resolving these issues
if they have hard numbers of how
long it takes for a prescription to get
returned, even if it’s only broad statistics
that do not identify patients.
These are just a few of the ways
that software solutions and their
data analysis capabilities can make a
difference in providers’ businesses.
Each software solution is different,
but all vendors share a common trait
of seeking creative ways to process
and share data across the homecare
continuum, whether it’s providers,
referral sources, manufacturers or
patients.
POINTS TO REMEMBER
- While most HME providers are now aware of the
potential of software solutions, businesses are
all over the map when it comes to truly utilizing
metrics tracking. - Some key metrics to track through HME software
include medical claims documentation, claims
denials, order/sales volume and cash collection. - More providers are taking advantage of real-time
dashboards that allow a larger portion of staff to
engage with data rather than leaving management
to send out reports on select issues. - Providers can share data with external partners,
including referral sources and even patients,
without sacrificing patient privacy as long
as the statistics are broad enough to not be
identifiable.