Managing Billers and Collectors

One of the features of the CPR+ system is you can assign a default biller and collector to each insurance company.  The flexibility allows you to override this at the patient, delivery ticket and invoice level.  This can be a very powerful feature if you need to override the collector responsible for a specific patient or invoice.  However, if you are not careful, you can end up with an unmanageable mess if your biller / collector assignments don’t easily fit into the CPR+ rules, you have significant turnover in your reimbursement department or your payer mix requires that you adjust collectors for workload balancing.

Rock-Pond recognizes this and provides powerful reports you can use to manage collectors based on the default insurance collector or the collector currently assigned to the invoice.  In addition, audit reports are available to alert you when the default collector is not the same as the collector assigned to the invoice.  This is critical because you have to manually reassign the collector when you transfer the balance to another payer or to the patient if the collectore who will rework the remainging balance is different than the one for the payer the invoice was transferred from.

Bottom line, in order to effectively use the biller and collector fields in CPR+, you’ll likely need some additional reporting to manage your data quality based on your current collector assignments and you may need additional reporting to produce reports for your collection manager and collector to effectively do their job.  If you have cases where you have payers that are divided based on the first letter of the last name of the patient, you’ll need some custom reporting unless you are going to have a process to manually assign these at intake.

If there is one thing an infusion company must do it is manage their A/R and determine how to get the most productivity out of the billing and collection staff.  It’s not always easy, but the effort is worth it.

CPR+ gets a LIFE

Each year CPR+ delivers one major upgrade that is announced and demonstrated at their Fall user conference.  2009 is no exception and this year the buzz is that CPR+ is releasing LIFE (Line Item Financials).  Simply put, this breaks out each invoice into multiple claims.  Gone is the limitation that you can only have money due from one payer at a time.  If you want to collect a co-pay up front from the patient prior to billing the insurance company, with LIFE you can do this without putting the money in unapplied cash.  There are many other reasons that this is a very good and needed upgrade.

However, it will not come without some serious consequences.  Consider this:

1. Line item financials will require a data conversion from your current data formats to the new data formats and there is no turning back.
2. The process changes required in your business are so significant that customers who wish to “get a LIFE” are required to go through training.
3. The 3 tables in the database that hold all of the invoice data will be expanded to 9 tables.  All custom reports you have written against these three tables will have to be reviewed, rewritten and retested as part of the implementation process.
4. The changes are so major that CPR+ is allowing customers to upgrade to 8.3 without “getting a life”.

There are more consequenses, but these are enough to indicate that this is a serious upgrade.   When you ask for major change from your software vendor, what do you get?  Major change.  This is not like the interim updates and program fixes that are received throughout the year.  Read the release notes, listen to CPR+, pay attention, invest the time in testing and training and most of all, make sure you “need a LIFE” before you “get a life”.

Rock-Pond Solutions is working hard to stay on top of the changes at the data level.  We are identifying all of our reports that need to be changed and offering new version (no cost) to our customers who need reports that support the new structures.  Our advice?  Be sure and call us before you “get a LIFE”.  You’ll be glad that you did.

Inventory File Integrity in CPR+

The impact of accurate inventory files in CPR+ can not be underestimated.  Inventory drives pricing.  Inventory is the basis for compounding and dispensing.  Key billing codes (therapy types, NDC codes, HCPCS codes, pricing codes, etc.) are set in inventory and carry forward through the home infusion process.  Whether you use the old term GIGO (Garbage In Garbage Out) or more descriptive terms like data accuracy and data integrity, the issue is the same.  The effectiveness of your home infusion company is significantly impacted by the quality of the data in your inventory and pricing files.

Reporting in CPR+ and other home infusion software products often assumes the data is accurate.  Over 50% of the fields in the system do not appear on any report.  The result is you have to view the information on the screen they are entered in or a browse screen such as the grids available in the CPR+ Enterprise module.  This might be sufficient if your data is correct (key word here is “might”) but it will not be sufficient if you have data errors (key words here are “will not”).

Whether you use Rock-Pond Reports or learn to use a report writer to write your own reports, be sure you have reports available that will support your need to validate that the information in your inventory file is accurate as well as reports that alert you when inventory items are added or changed.