Should you become a non-participating HME Medicare provider?

HME businesses continue to face an alarming decrease in reimbursements and a devastating increase of pre- and post-payment audits. Responding to Medicare audits can be a costly, time-consuming in addition to being disruptive events. Is this the time to do more cash sales, private pay and avoid being caught in Medicare’s grasp? Is Medicare participation in the best interest of your organization?

HME organizations who decide to become a non-participating provider need a software solution that will help them increase profitability by improving business efficiencies, identifying new revenue streams and taking steps to be more connected with the healthcare continuum.

Here are 3 areas to consider:

Upgrade Your Billing Software

Maximize your billing, operations and document processes by equipping your business with a robust, intelligent and automated billing solution. If you decide to become a non-participant provider and increase your cash sales, your customers might opt to submit these claims to their health insurance providers themselves to be reimbursed. Ensure outstanding patient/customer service by providing them the necessary documentation to get reimbursed – otherwise, you risk losing them to another provider. Your HME need billing software that provides alerts and safeguards that ensure you complete all documentation that supports your invoices and gets your patients paid with a minimum of hassle.

It’s imperative you automate your workflows with a solution that will electronically follow up on denials and track claims that have been submitted to payers, but have no payment or denial activity in a user configurable timeframe. Know where your money is and where it’s coming from with features that will allow you to focus on high-value accounts, or accounts that have not been making payments. If a patient makes a payment, get a system that will automatically take that off your list so you can focus on collecting what you’ve earned.

Generate New Revenue Streams

Consider expanding your services with features like patient resupply. Improve your business efficiency and profitability by achieving a higher percentage of contacts versus manual resupply efforts using phone, email and text messages. Best-in-class technology enables providers to track patients who may be eligible for resupply by launching automated, intelligent patient contact campaigns to reach patients. Other opportunities in resupply optimization include the ability for providers to capture appropriate reimbursement and drive long-term compliance. Being able to track and reinforce compliance also strengthens the relationship with your referrals’ sources as you can assist them in delivering successful patient outcomes, not just episodes of care. You get to become a reliable partner for their care team!

Track Your Success with The Right Business Intelligence Tools

Keep track of your sales. Make it your business to not only project, but measure the actual profit by product. Companies that manage their reports on spreadsheets are likely to make miss opportunities, make mistakes and end up with inaccurate data. Invest in a solid business intelligence solution that will help you oversee every aspect of your business in real time. Keep up to date with inventory, marketing, cash and A/R, and track which products are having the greatest effect on patient rehabilitation so you can report patient outcome to your referral sources.

Tracking historical data of sales and profit by product type allows you to know, with real-time regulatory changes, which products are driving profits to your bottom line. Rely on fully integrated billing software that tracks and measures what effects of changing reimbursements have on your products without the hassle of using standalone spreadsheets and tools, or employing a costly consultant. Identify a problem with a specific product line the minute it dips, and use your sales data to instantly calculate gross and net profit for all payers or selected payers, giving you the opportunity to adjust your formula and sales strategy.

HME providers have survived some tough times. Now, it is time to look forward and determine your road to success. Let Brightree be your guide. As your technology partner, Brightree will deliver solutions built to maximize the efficiency and profitability of your business. More than just a billing software, our solutions streamline processes, connect you to the healthcare continuum, create new revenue streams, and help your business succeed and thrive. Drive results with Brightree!


Back to resources