Automation in HME Billing: What You Need to Know

Understanding the HME Billing Workflow

As with medical billing for other kinds of health care services, HME billing comes with its fair share of difficulties and complexities. In spite of a provider’s best efforts to ensure a streamlined billing process, errors creep in silently and collections fall through the cracks. The entire HME billing process is made up of two main areas of operation.

The first of these is managed by the Front Office and pertains to activities that concern practically everything before the prescribed product or service reaches the patient. Some of the typical activities performed at this stage are inbound referrals, new patient intake/registration, records and documentation, prior authorizations, scheduling, etc.

The other area comprises activities performed by the Back Office. In simple terms, they are related to tasks performed after the product or service has reached the patient, and include, among other things, order confirmation, billing, collections, and cash posting. This is a part where the main players are the billers, collectors and cash posters.

Importance of Automation

In spite of the growing proliferation of software-driven automation, HME billing is still stuck with many of the last century’s sensibilities. Quite frankly, it is a process that desperately needs an overhaul and drastic modernization. The proof of this can be seen in the widespread use of paper-based systems or outdated billing systems that HME providers still adhere to, without fully realizing by how much they are setting them back.

Let’s face it, traditional HME workflows are manual and tedious, prone to human errors and consequently, to gaps in the revenue. Automation comes with many benefits that go way beyond a simple amelioration of the few points mentioned above. Modern HME revenue cycle teams are generally centralized (where both front and back-office activities are combined) and structured by process, payer or product, as appropriate for the provider.

By leveraging Decision Support Systems (DSS) to guide employees through the process, providers can dramatically reduce their learning curve, quality errors and wasted time.

Automation is an extremely viable proposition in areas such as data entry, benefits verification, prior authorization, order confirmation, cash posting, A/R & denial management, and re-supply. It can significantly reduce human errors, improve billing efficiency and speed up the cash-flow.

After all, it is worth remembering that most missed opportunities in ensuring a successful and efficient Revenue Cycle Management are perpetrated by human errors and poorly utilized technology. Thoughtful process automation using purpose-built tools is crucial for eliminating such slips.