Page 12 - HME Business, January/February 2020

ages are increasing.
So, providers must learn how to deal with third-
party payers, and especially the commercial insur- ance companies that sponsor Medicare Advantage plans and Medicaid Managed Care plans.
That’s not always easy. As industry legal expert Jeff Baird, Esq., chairman of the Health Care Group at law firm Brown & Fortunato, pointed out in a recent HME Business webinar, the chal- lenge of obtaining, negotiating and working
with these insurance companies is foreign to most DME suppliers, because it has not been in the DME space until just recently. That means providers don’t have much experience in terms of working with these third-party payers.
However, once a provider does the work and jumps through the right hoops to get on a panel and has signed a contract with a third-party payer, then it is a lot easier working with that third-party payer than it is working with traditional Medicare or traditional Medicaid, he noted.
So the hard work that providers do in 2020 to better understand and work with these plans will pay dividends in the coming year and beyond.
Strategic Software Advancements
HME Software has grown to be a pivotal business asset for many providers. Rather than just carry out billing, software orchestrates just about every workflow within an HME business. Now, providers’ software tools are helping them operate at a much more strategic level when it comes to managing their businesses.
This is certainly the case for the revenue cycle management (RCM) tools that are finding their way into HME software. Several years ago, enti- ties such as hospitals and health plans started defining and refining the practice known as revenue cycle management, and it helped them optimize their businesses’ incomes.
Not to be confused with billing (which is a part of RCM), RCM optimizes functions such as how claims denial is handled, how patient co-pays are collected, and how much staff time is expended on claims. RCM tracks the revenues and costs related to a patient’s interaction with a health- care provider from the beginning and end of the process. RCM is the umbrella under which all revenues are managed and maximized.
The goal: automation. The more that providers can implement RCM solutions that automate the revenue cycle and align it with existing work- flow, the more that they will create a system of “no-touch” claims. In that scenario, most of the data entry takes place at the outset, when a patient and claim are entered into the system. If done right, for the majority of claims there will be no edits or revisions, the documentation will be solid, and the claim will be funded and any co-pays will be collected. This leaves most of the
remaining hands-on work in the system to deal with the exceptions to this workflow.
Now HME software companies are integrating RCM tools into their systems and it will be providers’ job in 2020 to work on integrating them into their businesses. That said, much needs to be done in terms of outlining RCM workflows in the HME industry.
RPM for Oxygen
Remote patient monitoring (RPM) has been
an undeniable trend in post-acute healthcare, starting in sleep. For years now, PAP devices have been monitoring patient performance and feeding that data back to care management systems that physicians can use to see unique health events and tweak care. Those devices can also connect with personal apps that patients use to better manage their care.
Use of remote patient monitoring in sleep has exploded and is poised for more growth. In 2015 market research firm Berg Insight reported the global number of remotely monitored patients grew by 51 percent to 4.9 million. In 2019, ResMed reported that it alone has 10 million users of its cloud-connected devices and it had a database of 4.5 billion nights monitored.
Now remote patient monitoring is starting to find its way into diabetes, and in some respects, oxygen. The first forays into remote POC moni- toring came with devices that were largely founded on the concept of fleet management: providers would remotely monitor POCs to ensure they
were being used and that they were functioning properly. Moreover, depending on the situation, providers could remotely diagnose problems.
That soon gave way to the notion of moni- toring usage data and clinical data. HME providers could become champions to both their referral partners and patients, and would benefit from an ever-growing reputation for effective- ness and forward-thinking care that produces results in an outcomes-oriented care environ- ment. That’s a hard value proposition to ignore.
Now we’re seeing this happen. Last November, ResMed upgraded its AirView for Respiratory system to include interactive reporting options
for HME providers and physicians. New features include a “management by exception” function that lets clinicians identify which patients are experiencing ventilation issues or disease progres- sion. Also, providers and physicians will have inter- active reporting functions to help them analyze granular clinical data and trends over time.
Anyone doubting that RPM with clinical data would find its way into oxygen care needs to know that the gates are now open. How this plays out in other oxygen products, such as portable oxygen concentrators, will happen this year and onward.
Wearable Health
Wearable health has been a revolution for fitness-minded individuals. We track our steps, our sleep, our calories, how many glasses of water we drink and just about any metric you can think of — at least when it comes to prevention.
But now wearable health is entering the realm of post-acute care. In fact, it’s already here. Already, we’ve seen wearable health items for diabetes patients, such as continuous glucose monitors that pair with smartphones and smartwatches to help patients manage their conditions.
Another great example would be incontinence solutions company Triple W’s DFree, a device that focuses on the urge management side of incontinence. It’s a device that acts as an early warning system by employing ultrasound and Bluetooth to help patients realize that their bladder might need emptying.
The DFree system uses a small ultrasound device a little bigger than a quarter, which is secured to the patient’s lower abdomen using medical tape. A transmitter that measures roughly three inches in diameter is connected to the sensor and hooked to the patient’s belt or clothes, and it sends information to the user’s phone using Bluetooth.
That’s a game-changer for incontinence patients. Now other wearable health solutions are starting to emerge for other patient groups. Providers will need to keep a sharp lookout
for these tools in 2020, because their patients certainly will be.
e-Prescription
E-prescription has been a regular component of U.S. healthcare IT systems for years — except when it comes to the HME industry. Physicians can send prescriptions electronically to pharma- cies, for example, but prescribing a portable oxygen concentrator electronically is a no go.
That’s not necessarily all that surprising given the complexity of HME prescriptions (and the documentation, claims and billing procedures entailed).
However, e-prescription is coming to the world of HME. The amount of back-and-forth between referral sources and providers is staggering
in comparison to the simplicity of prescribing drugs. Now, imagine a system employing elec- tronic forms that make sure all the pertinent
data is collected and entered and won’t let the process move forward until the proper boxes have been checked.
And that workflow includes documentation. Given that 64.1 percent of improper payments resulted from poor documentation in 2017, and that DMEPOS had a 46 percent error rate that year, according to CMS, a system that helps to
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