Page 24 - HME Business, May 2017

The Great Claims Data Treasure Hunt
“By analyzing the data, you
can provide visibility to areas
of the business that may not be
operating efficiently or may be
contributing to unnecessary
costs or decreases in cash flow,
such as denials. In today’s
reimbursement environment, any excess costs or decreases in cash flow can put the survival of the business at risk.”
— Melissa Wagner, Brightree LLC
niches. Therefore, the nature of what you are looking for may depend
on how well a company understands its own business, customer demo- graphics, product sales, etc. Simply put, one provider’s data treasure may not have the same level of appeal to another provider.
“Every aspect of a provider’s business can be improved with better data reporting and analysis,” Deschaine says. “This includes everything from order intake to posting payments. For example, by doing an inventory turn- over analysis, a provider can make an intelligent decision about which items they should stock in their warehouse and which items should be ordered through a third-party fulfillment partner like McKesson. Only by having
this data on hand can a provider make a sound decision on this and other aspects of their operations.”
However, Deschaine warns that because providers have their own unique market niche, which can be defined by a specialty, customer base, geography, etc., it is essential for providers to formulate an initial analysis that allows them to articulate the questions that data analysis can answer for them.
“Our experience at Universal Software Solutions is providers are going to find their own data gems that will be unique and valuable to their distinctive HME operations,” he explains.
Mining Referral Data
Another way to find data gems is through referral source management. Seth West is the Director of Marketing and Communications for PlayMaker CRM, a partner of the VGM Market Data Division. The PlayMaker CRM system offers business-to-physician management. PlayMaker, designed specifically for post-acute care companies, including HMEs, offers providers a mobile app that helps them manage their business-to-physician relationships and
a way to identify high-value physicians using integrated market intelligence data that can be purchased. West says this service allows for:
• Real-time order data to flow down to sales reps in the field, which wi ll let them respond to new orders.
• Analysis of existing customers to understand where the business is coming from, which allows for the identification of trends and the ability to focus on the highest value accounts.
• Market intelligence data to reveal new opportunities based on claims data for their market.
“Using data mining can provide details as to specific staff that may have been involved in a referral processed from intake to confirmation that was lacking the proper criteria for a clean claim,” Wagner explains. “Specifically, the lack of a commitment to software training, especially in which the soft- ware offers functionality to assist with notifying of missing data. Investing
in training can provide a valuable return on investment if the right tools in the software are accessible to be used to prevent denials and subsequent audits.”
She also says that examining referring patterns by practitioners can offer data on the quality of referrals received. This process can assist with educating physicians on payer guidelines with the goal of saving both the provider and physician time and resources with medical documentation requests.
Ball pointed out that using your data to find out which patients could use a resupply program that presents them with options above and beyond what is reimbursed by insurance is a great way to grow incremental revenue.
“You can’t measure success without tracking referral volume,” he says. “By understanding your relationship with key referral sources, providers have additional opportunities with physician offices to truly be a partner in the management of the care of patients in need of HME equipment, rather than just an equipment supplier.”
Commito says that data mining starts with the evaluation of features
and functions that your software offers. She suggests that providers that may have not had the time previously or may have since forgotten the full features of their software since initial implementation should now review the release notes or manuals provided to ascertain if there is a feature that was not critical to basic operations when going live on the application. Leveraging these features now could get you to the next step in using your application as a tool to support your business objectives.
“In addition, reaching out to your vendor to supplement staff training from time to time is a good investment,” she says. “Too many times organizations cut funds to invest in educating their staff in new features and functions that are available on the tools they use day to day to successfully manage their responsibilities. Some vendors offer free training and training resources that can assist here — so just ask. If you need a deeper level of focused training, then investing in that training can support efforts to continually improve your operation by leveraging the tools in place.
“Understanding the financial health and wellbeing of a company is critical to the ongoing success for any provider,” Commito continues. “Reports and analytics should be leveraged to their fullest for this purpose. Analytics, data mining and reporting can assist in identifying areas for improvement in various operational processes, such as number of referrals processed, deliv- eries completed successfully, inventory turns and management. Assessing and evaluating cost of goods and inventory management are critical to any HME provider. Tracking of patients, clinical progress and outcomes on key therapies provided can support accreditation, marketplace differentiation and overall patient satisfaction.” n
Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business. He can be reached via e-mail at joe@prooferati.com.
“Our experience at Universal Software Solutions is providers are going to find their own data gems that will be unique and valuable to their distinctive HME operations.”
— Phil Deschaine,
Universal Software Solutions Inc.
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