The Benefits of Outsourcing HME Billing Processes

Efficiently managing your revenue cycle is possible with advanced outsourcing solutions. 

Outsourcing has been a mainstay of the HME & Pharmacy industry for years. However, mixed feelings about the quality, efficacy, and necessity of outsourcing abound to this day. Some HME professionals swear by outsourcing, while others only trust in-house teams. That said, the argument against process outsourcing has lost some steam, as strategic outsourcing allows an HME business to outsource highly specific processes — from IT to billing services — addressing specific problems and pain points along the way.

In any case, it’s important to evaluate the potential advantages of implementing any major change in your business before taking action. So, let’s take a look at some of the benefits of outsourcing HME billing processes.

HME Partners Can Cover a Wide Range of Responsibilities

One assumption among detractors of HME billing outsourcing is that third-party partners can only handle basic tasks like invoicing and collections. However, this could not be farther from the truth. In fact, a trusted HME partner can help provide quality services in all of the following areas:

• Order Intake — Order intake involves processing new orders, from the management of inbound referrals via fax, web portal, or email, to data entry related to patients and orders. This process also requires checking eligibility and verifying that patients are qualified for coverage.
• Billing and Collections — These processes confirm that new orders and prescriptions have been dispensed appropriately. The billing and collections department reviews billing, enables claims transmission, manages front-end rejections, and oversees denials and open A/R balances. 
• Cash Posting — Cash posting matches EOBs and ERNs with funds received in the bank. In addition, this area applies payments, denials, and adjustments against A/R balances.
• Prior Authorization — This process entails compiling medical records and other key data, and submitting it to payors via web portal, fax, or phone. 
• Eligibility Verification — EV includes gathering financial responsibility information using payer websites, clearinghouses, and phone calls. This area determines whether providers are in or out of network and whether patient deductibles are met. It also examines patient benefits and patient/payer responsibility for orders.
• Resupply Management  — Resupply management involves multiple aspects of a providers’ resupply programs, from patient outreach to the processing of orders, and ensures this key revenue stream remains a priority.

Strategically Outsourcing HME Billing Processes

While it’s great to see the extent to which an outsourcing partner can provide quality billing services, it’s even more important to understand why strategic process outsourcing is so vital for HME businesses. Staffing shortages are rampant across the entire industry, causing issues for more than 80% of providers. Thus, it is now a daily struggle to hire, train, retain, and manage new staff for the majority of HME businesses.

Not only does outsourcing reduce the need to take on and retain new staff, but it also helps address the underlying reasons for staffing shortages. High turnover, absenteeism, and frequent leaves of absence are often the result of too much work and too few employees. Having your entire workforce (or your entire billing department) experiencing burnout is a quick way to create backlogs, miss revenue opportunities, and even lose control of your cash flow. Although providers cannot avoid these realities completely, they can eliminate a major source of these issues with strategic outsourcing of HME billing processes. 

With Prochant, providers have opportunities to strategically outsource their processes to drive down costs, improve quality, and deliver consistent results. Providers can outsource specific payers, products, and/or branches of their business as they see fit. And with Prochant, you can trust that the transition will be seamless and professional. We have a proven track record of helping HME providers meet (and exceed) their financial goals. Moreover, our scalable solutions, years of experience, and advanced technology provide high-quality results to the HME and healthcare community. 

Does your company need the benefits of outsourcing HME billing processes? If you’d like to learn more about implementing strategic process outsourcing, finding billing solutions, and solving your staffing issues, reach out to Prochant today!