Quick Answer: HME providers should prioritize order management systems with automated intake, insurance verification, inventory integration, claims automation, and compliance tools. Valere’s Order Management (https://valere-health.com/poc/order-management) delivers centralized tracking with billing-ready documentation and clean order processing.
Key Takeaways:
- Automated order intake systems slash processing time from days to minutes while reducing costly errors.
- Modern systems verify insurance eligibility upfront and adapt to different payer requirements, cutting denial rates dramatically.
- Real-time inventory management across all locations optimizes stock levels and enables automated reordering based on usage patterns.
Top 5 Essential Capabilities for HME/DME Order Management Systems
The right order management system can transform how Home Medical Equipment (HME) providers operate. With healthcare becoming more complex, providers need systems that do more than just track orders. Today’s best healthcare order management systems offer capabilities that streamline workflows, ensure compliance, and boost revenue. Let’s explore the five most important features HME providers should look for when choosing a system.
Automated Order Intake and Documentation Processing
Manual data entry is one of the biggest bottlenecks in HME operations. Advanced order management systems now use smart technology to capture information automatically from faxes, emails, and electronic referrals.
These systems can read different types of documents – from doctor’s prescriptions to insurance forms – and pull out the key details without staff having to type everything in. This cuts processing time from days to just minutes and reduces costly errors that can lead to claim denials.
For example, when a new oxygen therapy order comes in, the system can recognize the document type, extract patient information, diagnosis codes, and prescription details, then route it to the right workflow. This means your team can handle more orders without hiring more staff.
Valere’s Workflow Automation takes this a step further by offering document intake and triage that works with your existing systems, helping you process orders faster while maintaining accuracy.
Seamless Prior Authorization and Insurance Verification
Getting equipment to patients quickly often hinges on swift insurance approvals. Modern order management systems make this process much smoother by automatically checking if an order meets coverage rules and sending the right paperwork to insurance companies.
The best systems check patient insurance eligibility upfront and estimate what the patient will need to pay before processing orders. This approach can cut denial rates dramatically and get you paid faster.
These systems adapt to different insurance companies’ requirements and flag orders that need more documentation, saving your staff from having to memorize countless payer rules. When requirements change, the system updates automatically, keeping your team compliant without extra training.
Valere’s Business Interoperability connects directly with payer systems, streamlining the verification process and reducing the back-and-forth that delays patient care and payments.
Real-Time Inventory Management and Supply Chain Integration
You can’t fill orders if you don’t have the equipment on hand. Effective order management systems show you exactly what’s in stock across all locations and automatically reorder supplies based on usage patterns.
These systems connect with your suppliers, enabling drop-shipping options and automated purchase orders that arrive just when you need them. This means less money tied up in excess inventory while still ensuring patients get their equipment on time.
For HME providers managing rental equipment, these systems track serialized items, schedule maintenance, and optimize asset utilization. When a CPAP machine comes back from one patient, the system helps track cleaning, testing, and availability for the next patient who needs it.
Revenue Cycle Management and Claims Automation
Getting paid in the HME industry involves complex billing requirements. Integrated revenue cycle management features create accurate claims automatically using the order information and documentation already in the system.
The best systems catch potential claim issues before submission, track where claims are in the process, and help manage denials when they happen. This leads to higher payment rates and faster payments.
These systems support various billing models including one-time purchases, rentals, and recurring supplies. For example, when managing a patient on monthly CPAP supplies, the system can automatically generate compliant claims each month with the right modifiers and documentation attached.
Valere’s Order Management solution creates billing-ready documentation and performs pre-submission quality assurance, helping ensure clean claims that get paid the first time.
By prioritizing these five capabilities, HME providers can select an order management system that not only streamlines daily operations but also supports growth and profitability in today’s challenging healthcare environment.
Evaluating and Implementing the Right Order Management Solution
Finding the perfect order management system for your HME business isn’t just about checking feature boxes. It requires a thoughtful approach that aligns technology with your specific business goals. Let’s walk through how to evaluate and implement a solution that truly fits your needs.
Assessing Your Organization’s Specific Workflow Needs
Before looking at any vendor demos, take time to map out your current order processes from start to finish. Follow orders as they move through your business—from initial referral to delivery and billing. Document each step and note who handles it, how long it takes, and where bottlenecks occur.
Ask your team where they spend most of their time. Is it chasing documentation from referral sources? Dealing with insurance verifications? Managing inventory? Their answers will reveal which capabilities matter most for your business.
Different business models have different needs. If you operate multiple locations, you’ll need strong inventory visibility across all sites. If you focus on sleep therapy, you’ll want robust resupply automation. Retail-heavy providers might prioritize point-of-sale features, while insurance-focused businesses need stronger documentation and claims capabilities.
Track key metrics like average order processing time, denial rates, and labor cost per order. These numbers will help you set clear goals for improvement and measure success after implementation.
Integration Capabilities with Existing Systems
The best order management system won’t help if it can’t talk to your other software. System integration is crucial for eliminating double-entry and ensuring data flows smoothly between applications.
Ask potential vendors how they connect with the systems you already use. Do they offer pre-built connections to popular billing platforms and EHRs? What about your accounting software or delivery management tools? The answers will help you understand implementation complexity and ongoing maintenance needs.
Look for solutions that use modern integration approaches like APIs and healthcare standards such as FHIR. These methods create more reliable connections than older file-based integrations. Open platforms that support industry standards will adapt better as your technology needs evolve.
Valere’s Business Interoperability solutions offer seamless connections between order management and other critical systems, reducing the IT burden while maintaining data accuracy across platforms.
Implementation Timeline and Staff Training Considerations
Realistic timelines help set proper expectations. Most HME order management implementations take between 8-16 weeks depending on complexity. This includes system configuration, data migration, integration setup, testing, and training.
Break the project into clear phases with defined milestones. Start with core functions that deliver immediate value, then add more advanced features as your team gains comfort with the system.
Staff training deserves special attention. Different team members need different training approaches. Order intake specialists need detailed workflow training, while managers might focus more on reporting and oversight tools. Create role-based training materials that address each group’s specific needs.
Identify potential “super users” early—these team members show natural technical aptitude and can help support their peers during the transition. Give them extra training and involve them in testing to build their system knowledge before go-live.
Measuring ROI and Performance Improvements
To justify your investment, track specific metrics before and after implementation. Key performance indicators should include operational metrics like average order processing time, documentation completion rates, and inventory accuracy, as well as financial metrics like days in accounts receivable, denial rates, and labor cost per order.
Set realistic improvement targets based on your baseline measurements. Most HME providers see 30-50% reductions in order processing time and 15-25% improvements in first-pass claim rates after implementing a quality order management system.
Create a simple dashboard to track these metrics monthly and share results with your team. This visibility helps maintain momentum and identifies areas where additional training or configuration might be needed.
Valere’s Workflow Automation solutions include built-in analytics that make tracking these improvements straightforward, helping you demonstrate clear ROI from your technology investment.
Overcoming Common HME/DME Order Management Challenges
Running an HME/DME business comes with unique hurdles that can slow down operations and cut into profits. The right order management system can turn these challenges into opportunities for growth. Let’s look at how top systems help providers overcome common roadblocks while keeping the focus on patient care.
Streamlining Documentation and Compliance Requirements
Documentation requirements for medical equipment can feel like navigating a maze that constantly changes shape. Advanced order management systems now include built-in compliance tools that automatically create checklists based on the specific equipment ordered and the patient’s insurance.
For example, when processing a power wheelchair order, the system can prompt staff to collect the face-to-face evaluation, detailed written order, and specialty evaluation—all required for Medicare coverage. These smart systems flag missing elements before submission, dramatically reducing denial rates.
Valere’s Workflow Automation tools can track when requirements change and automatically update your documentation templates. This keeps your team current without requiring them to constantly research changing rules. The best part? These systems store all documentation electronically, making audit preparation a matter of minutes rather than days of digging through paper files.
Managing Complex Payer Relationships and Changing Regulations
Most HME providers work with dozens of insurance plans, each with their own rules, forms, and portals. Rule-based order systems can automatically apply the correct requirements based on the specific payer and product.
When a patient needs a CPAP, the system can check if their specific insurance plan requires a sleep study with a certain AHI score, determine if prior authorization is needed, and even populate the correct forms with patient data. This level of automation helps prevent denials caused by staff applying outdated or incorrect payer policies.
Valere’s Business Interoperability solutions connect directly with payer systems, allowing for real-time eligibility checks and authorization submissions. This direct connection means your team spends less time on payer websites and more time helping patients.
Balancing Operational Efficiency with Patient Care Quality
Efficiency shouldn’t come at the expense of patient experience. Patient-centered order management systems include features that actually improve care while streamlining operations.
Modern systems can send automated text updates when orders are processed, scheduled for delivery, or ready for pickup. They can provide patients with digital access to user manuals, setup videos, and reorder options through simple patient portals. These tools reduce call volume while giving patients more control over their care.
Valere’s Point-of-Care Platform helps providers maintain the human touch by freeing staff from paperwork. When administrative tasks are automated, your team can focus on answering questions, providing equipment education, and solving problems that require a personal touch.
Scaling Your Order Management System as Your Business Grows
The system that works for your business today might become a limitation tomorrow if it can’t grow with you. Cloud-based order management solutions offer significant advantages for growing HME businesses.
Unlike older on-premise systems that require server upgrades and IT maintenance, cloud solutions can add users, locations, and order volume without major infrastructure investments. This flexibility allows you to expand into new product lines or geographic areas without worrying if your system can handle the growth.
Valere’s Order Management platform is designed to scale with your business, whether you’re adding new product categories or opening additional locations. The system grows alongside your operation without requiring complete overhauls or migrations to new platforms.
When evaluating systems for scalability, look beyond current features to the vendor’s development roadmap. Providers like Valere that regularly release updates and new capabilities will help ensure your system remains current as both technology and healthcare requirements evolve. This forward-looking approach protects your investment and positions your business for continued growth in an ever-changing industry.
SOURCES:
- Universal Software Solutions: HME and DME Software URL: https://universalss.com/hme-dme-software/
- Community Home Medical Equipment: Medicare Supplier Standards URL: https://www.ecommunity.com/sites/default/files/uploads/2021-06/CHME-Welcome-Booklet-June2021.pdf
- NikoHealth: 8 Must-Have Features for Your HME Software URL: https://nikohealth.com/8-must-have-features-for-your-hme-software/