Let’s face it, the pandemic pushed too many workflow issues to the surface, and providers can no longer ignore them. Recently, we introduced the HME revenue cycle and the topic of workflow management as it pertains to the industry. To allow your company to thrive in this new climate, you need to examine what the modern HME office looks like. In our ongoing workflow management series, Prochant’s Chief Revenue Officer Joey Graham breaks down traditional workflow—where the industry came from—and modern workflow—where we need to go.
Traditional Workflow Management
Paper-Based System
A traditional workflow management system is what a lot of HME providers grew up around. It’s also what some providers are still used to. “What I remember from my early days in the industry, everything was paper-based,” Joey said. “Just piles of it everywhere. Big, industrial type fax machines, just rolling through the referrals.”
“A clipboard was next to the fax machine to log new referrals, otherwise nobody knew what new referrals were coming in.” What happened if a paper got lost? “The order got dropped, which made for an unhappy referral and patient.”
Office Organization and Manual Input
If your office was or is big on printing out referrals, you may be familiar with organizing via accordion files and the sheer number of them on the shelves. “You had to organize by Alpha or Day of the Month, and you had all this paper in boxes. You had your inbox, your problem charts, and your outbox.”
With humans manually filing large amounts of paperwork and inputting data, errors were and are still common. “You saved the last name, but you put a space after it before you hit save, and then, nobody could find the referral.”
Traditional Front Office and Back Office
People managing the front office were sometimes called the customer service representatives (CSRs). “Before a delivery or a service was provided, it was all organized by branch. Every branch would manage all the patients in their region.”
In the back office, you would have your billers—called reimbursement specialists or A/R people. “They were typically split by payer. For larger providers, there would be a central billing office and then each of the branches would have its own CSRs.”
With a lot of manual input happening in both front and back offices, along with paper referrals provided without proper documentation, errors and denials stacked up. “If you were to look at the top five denial reasons, prior authorization was on that list.” Prior authorization is still on the list today, but it’s getting better.
Modern Workflow Management
No More Paper
Joey recommends going as paperless as possible. “If somebody wants to print something, ask them why. There are still people like me who need a little paper to-do list, and that's fine. What we don't need to be doing is printing out all these reports and faxes.” If you need to print something, save it as a PDF and upload it to your document work.
Everything lives on the computer and is digital. Fax machines are being replaced by efax, and the importance of e-referrals is more present than ever before.
E-referrals
E-referrals (electric referrals) are an emerging frontier inside of the HME industry. It’s important to get in front of this trend. An e-referral allows you to get everything you need upfront: the physician's order, prescription CMN, the medical necessity documentation, and anything else you might need.
“If it’s integrated into your billing system, then when a referral comes in, it comes into the billing system and maybe even creates the patient record.”
Intelligent Work Queues
Accordion files have been replaced by intelligent work queues. “We don't need to use accordion files, our inboxes, and our charting. That's been replaced by the EMR (electronic medical records). Dot-matrix printers have been replaced by on-demand digital reports.”
For most modern billing systems, you can run whatever report you want, whenever you want. You can also schedule reports to be emailed to you automatically. Even those are actively being replaced by business intelligence systems where you can create dashboards.
Modern Front Office and Back Office
In a modern HME office, teams are centralized for both front office and back office, and they're structured by process payer and product. “Whatever makes sense for your company, you create small specialist teams who focus on particular groups.”
The future's looking bright for the modern HME office. Providers need to be willing to make necessary transitions for their offices to stay organized, save on costs, and support their employees in times of staffing shortage.
In our upcoming guides of workflow management, we’ll dive into specific sections of the modern HME office. Learn about decision support, automation, and more.
Want to explore modern HME billing solutions now? Reach out to Joey directly at (980) 999-4293 or email joeyg@prochant.com to see how Prochant can help simplify your business.
Prochant has DME/HME clients from all over the country and handles front-end and back-end billing functions. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national HME and pharmacy providers and health systems.