Too Many [Billing] Rules...I’M OUTTA HERE!!

If you are an HME Provider, do you know how many rules your billers have to set up? No?

Ask them...“How do we set up Billing Rules?” If they answer, “We set them up by item,” then maybe your billers are sharing Charlie’s frustrations.

Charlie's Story

TIMS HME Software | Too Many Billing Rules...I Outa Here!

Everyone sat nicely in the circle playing Uno, eagerly waiting to see if they would receive a gold star from Miss Bell. Everyone, that is, except Charlie.

Charlie, all three-feet-four-Kindergarten-inches of him, was getting restless, and once he realized that he would NOT be receiving his gold star—well, that was it for him.

“I’MMMM...OUTTA HERE!!!” Charlie exclaimed at full volume as he struggled to get his little backpack on.

“No, Charlie—it’s only 1:30. It’s not time to go yet. Remember? You have to finish playing the game and follow ALL of the rules to get your gold star,” Miss Bell explained. Her soft-spoken plea did not appear to register with him the way she had hoped.

So, there he stood, feet planted firmly by the door ready to leave immediately upon Miss Bell’s approval.

“I’MMMM...OUTTA HERE! This is TOO HARRRD!! There are TOO many RULESSS!” he continued in a seriously perfected whine in hopes of making his point very clear.

Do 10 Items & 10 Payers = WAYYY Too Many Rules?

Maybe Charlie had a point. Maybe, dealing with too many rules really is too hard, even if it is your software that determines you need them.

Think about it. If your billers have to set up your Billing Rules by item, then this is what their process looks like for a mere TEN items...

For every ITEM and PAYER combination, the biller must set up one Billing Rule. So, if you have 10 items and 10 payers…you are looking at a cool 100 Billing Rules that must be set up.

That’s a boatload of work. And, since you certainly have more than 10 items to deal with, your billers will likely be setting up Billing Rules until the cows come home.


So, let’s flip this around for a moment and play “What if” to see what your process COULD look like if you considered a different method for handling your Billings Rules.

  • What could cut your Billing Rules set up process by 90%?
  • And what could decrease the time it took to make changes to or create new Billing Rules by simply consolidating how you associate items and payers?
  • Or, what could reduce errors within those item/payer associations by just using a smarter method?

...what would you say? It better be a resounding, “SIGN ME UP!”

No More Games

Test strips are test strips. And, if you’ve seen one CPAP machine, you’ve seen them all. The thing is, if payers are telling you that all test strips have the same set of rules...then why would you continually set up the same rule for 10 different kinds of test strips...over, and over, and over—for the same payer? That just sounds like a lot of unnecessary work.

A smarter way to handle your Billing Rules is to group items together by HCPCs. That way, you don’t need to set up a new Billing Rule for every. single. test strip—for every. single. payer.

You see, when you group your items by HCPC...the process looks like this:

10 different test strips & 10 payers to set them up = a maximum of 10 Billing Rules.

10 is a whole lot more manageable than 100.

This way, the association occurs at the item/HCPC level. And, since you set up all of your test strips with the same HCPC code—you only need to set up one rule for each. You only have to work on the exceptions to the rules, rather than working on all of the rules for every. single. item. for every. single. payer.

And there you have it. At the end of the day, the way your software handles Billing Rules, really shouldn’t make you put your backpack on and scream “I’MMMM...OUTTA HERE!”

To see how TIMS Billing Rules and Fee Schedules can help your HME business keep it simple, schedule a demo!

Contact me for a tailored demo of TIMS.    Gail Turner HME System Sales