Page 23 - HME Business, May 2017

Diagnosis Data Gems
One of the big gems that a provider can uncover is the spots in its business where it can extend its revenue per customer. Taking the time to review customer-level data can help providers identify some serious cross-selling and upselling opportunities, according to Richard Mehan, president of HME software maker Noble House.
So, for instance, with patient groups that are regu- larly prone to specific types of comorbidities, there could be opportunities to determine which of those types of patients that a provider serves might need solutions for those comorbidities. Diabetic patients are a good example, Mehan points out. Some might need special footwear, or some might need knee braces, or incontinence supplies.
Those types of upselling opportunities can mean a lot, especially given that reimbursement on many diabetic supplies for not only Medicare but other payer sources leave the provider with paper-thin profit margins.
“Right now, everybody is looking to maximize the potential revenue out of a patient,” he says, citing
the example of a provider that might have one a bid for diabetic supplies. “I believe that the consensus is there is no money in strips anymore. A box of strips costs, bare bone cost, is around $1.50, $3.00, right around there. Then you add in postage, processing fees and handling, and of course you got the audits. All of a sudden it’s a negative expenditure or revenue.
“If you look at each of the bid winners, they’re not making money on strips,” he continues. “They’re cross selling and they’re messaging their patient base for other lines of business, whether it be catheters, or braces. They establish a rapport and a relationship with their customer base. With the next box of strips that the patient receives, there is a slip in there for certain patients about braces, or other products that [the provider is] expanding into.”
Claims data is where providers can find those sorts of opportunities for cross-selling and upselling. All
it takes is for a physician diagnosis code to present providers with an opportunity to generate a report on patients with similar ICD-10 codes.
“When providers receive a doctor’s order form, and the information for a specific patient on there includes the diagnosis codes that the physician
is labeling a patient with, the provider can then drill into its patient base on that specific diagnosis code,” Mehan explains. “If there’s any other diag- nosis codes that a physician presents, they could drill into that data. ... For each CPT code, there
is a a matrix of supporting diagnosis codes. If any of them overlap, then just drilling into your data would afford you a whole new realm of prospects or customers.”
This approach of correlating patient purchase habits or probable comorbidities against diagnosis code might uncover a whole new line that providers could add. Providers just want to make sure that they are playing by Medicare’s rules when it comes to reimbursable items.
“As long as the products are not under competi- tive bidding and the door is still open for them to be
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able to provide those products,” Mehan advises. “Medicare is slowly but surely tightening the noose on them and it’s becoming next to impossible to go into certain lines of business if you’re not a bid winner.”
Digging Deeper
A common difficulties in naming the variables for digging deeper into provider data is that companies have operational differences, goals and
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