Upbeat forecast for HME billing systems

The future of HME billing systems looks bright, market specialists say, with advances in patient portal technology and artificial intelligence expected to play a leading role. 

“We're beginning to witness transformative trends that are not only enhancing operational efficiency but also significantly improving patient engagement and satisfaction,” said Joey Graham, chief revenue officer for Charlotte, N.C.-based Prochant. 

Patient portal technology, in particular, shows enormous promise, Graham said. 

“This innovation marks a pivotal shift toward a more interactive and patient-centered approach,” he said. “By granting patients direct access to their accounts through online platforms or mobile applications, we empower them to take charge of their healthcare journey.” 

This process includes the ability to reorder necessary supplies with ease, make payments seamlessly, and schedule appointments without the need for traditional, time-consuming communication methods.  

“The result is a more streamlined, transparent and satisfying patient experience,” Graham said. 

Leaping forward 

Likewise, artificial intelligence and machine learning represent a leap in technology for HME billing systems, said Adam Nadler, co-founder and advisor to Coral Springs, Fla.-based CompliantRx and CEO and co-founder of Quest Health Solutions. 

“AI/ML [boosts] automation and improves accuracy for medical record review,” he said. “This leap in technology streamlines tedious and error-prone tasks and decreases the amount of time it takes to accurately review medical records.” 

For instance, Nadler mentioned that one revenue cycle management company has seen this method reduce review time by up to 10 minutes per progress note.  

“This technological advancement enables billing systems to proactively detect missing or incorrect payer criteria in claims prior to submission,” he said. “Such proactive measures are pivotal in avoiding costly denials and unnecessary resubmissions.” 

Harnessing systems 

In the current climate of tighter reimbursement and escalating expenses, the significance of providers harnessing efficient business systems “cannot be overstated,” said Wayne Hudson, director of sales for Middletown Township, N.J.-based NikoHealth. 

“Today, more than ever, the necessity for a modern, agile, and user-friendly platform is paramount,” Hudson said. “Outdated processes and systems not only consume excessive manpower but also hinder productivity. Platforms like ours offer a transformative solution, empowering providers to accomplish more with fewer resources. By upgrading to an all-in-one, cutting-edge system, providers can streamline operations, reduce administrative burden, and navigate the challenges of the industry with ease.” 

To be sure, HME providers are navigating a challenging environment in today’s health care landscape, Graham said. 

“Consider the hidden enemy – administrative burdens,” he said. “A staggering 20% of claims are denied due to missing information, while a 2019 JAMA study revealed 25% waste in health care spending due largely to complex billing processes. These inefficiencies impose financial strain on patients, providers and the healthcare system at large.” 

Attracting interest 

In Hudson’s view, providers are seeking billing systems that streamline their workflows and simplify operations.  

“Outdated systems often require excessive staff, present adoption challenges, and incur higher costs compared to modern solutions,” he said. “Providers are experiencing fatigue from add-on expenses associated with essential modules, prompting a demand for all-in-one platforms with transparent pricing models.” 

Along with minimized administrative load, elevated accuracy and fewer errors, better efficiency and assured compliance, Nadler contends providers want a greater focus on patient care. 

“Ultimately, providers seek solutions that alleviate the burden of administrative tasks, allowing them to devote more energy and resources to patient care,” he said. “Systems that efficiently handle the backend work empower providers.” 

Upgrading security 

In the wake of the Change Healthcare cyberattack, the focus on cybersecurity within the HME industry has intensified, Graham said.  

“Providers are rightfully concerned about the security of their billing systems, and vendors must step up to provide not just assurances, but tangible evidence of their systems’ robustness against such threats,” he said. 

To address security concerns, “it's imperative for billing system vendors to go beyond mere claims of being ‘HIPAA secure,’” Graham said. “Achieving and maintaining recognized security certifications such as HITRUST, ISO-27001, and SOC 2 Type 2 serves as a testament to a vendor's commitment to stringent security practices. These certifications are not easily attained; they require a comprehensive audit of the vendor's technologies, processes, and controls, ensuring that they meet the highest standards of data protection and privacy.” 

One key strategy to reduce vulnerability involves establishing multiple clearinghouse partners to ensure redundancy and operational continuity.  

“By diversifying partnerships, companies like NikoHealth remain agile and can seamlessly integrate alternative solutions as needed,” Hudson said. “This approach not only enhances resilience but also reinforces the commitment to providing uninterrupted service to clients, even in the face of cyber threats and disruptions.”