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Stay in-the-know on healthcare revenue cycle industry challenges and trends with proven strategies from SSI thought leaders.
Welcome to the healthcare landscape of 2024 – a complex terrain where high stakes meet numerous challenges, defining a dynamic and demanding era in healthcare. This year promises to be a crucible of transformation, testing the resilience and adaptability of industry leaders while offering fresh perspectives on managing revenue cycles more efficiently and effectively. Join us as we dive into the intricacies of these changes and emerging trends, exploring how they’re set to redefine the financial heartbeat of healthcare in 2024 and beyond.
The Evolution of Medical Billing Clearinghouse Vendors in Revenue Cycle Management: Spotlight on The SSI Group, LLC (SSI)
In the intricate tapestry of healthcare finance, the journey of a medical claim from inception to resolution is critical. Here, providers, payers, and patients engage in the complex dance of bills, claims, and reimbursements, creating a rhythm that underpins the entire healthcare delivery system. At the core of this rhythm is the revenue cycle, an essential sequence of financial events that requires precision and coordination. Playing a critical role in maintaining the cadence of this cycle is the medical billing clearinghouse, an entity that has evolved to become the conductor of this financial orchestra.
Decoding the Intricacies of Healthcare Billing: Navigating Claims Denials and Revenue Cycle Management
Professionals in the medical billing sector are tasked with navigating a landscape filled with varied payer policies, continuous coding updates, and ever-changing legislative mandates. Their skill in managing these elements is critical to ensure healthcare providers receive proper compensation for their services. Let’s dive into the complexities of healthcare billing, shed light on the common issues that lead to claims denials, and discuss the importance of adept revenue cycle management.
In the constantly evolving landscape of U.S. healthcare, the story of electronic medical claims and revenue cycle management stands out as a testament to technology’s transformative power. From handwritten claims to the digital revolution of electronic submissions, this journey has reshaped the backbone of medical billing and financial transactions in healthcare. Let’s dive into the fascinating history of this transformation.
In the digital age, innovation often means mastering the fundamentals. With everyone buzzing about artificial intelligence and the latest and greatest technological advancements, sometimes it’s worth getting back to the basics. If we could hit pause for just a moment and take a look at the fundamental claims management blocking and tackling to see where we can tighten up on best practices before embarking on any net new technology – we may find some quick wins that add up to significant dollars.
In today’s rapidly digitizing healthcare landscape, technology is ubiquitous. From telehealth to advanced robotic surgeries, from AI-driven diagnostics to automated administrative tools, we’re in the midst of a technological renaissance. Yet, even amidst this digital transformation, one element remains irreplaceable: the human touch.
The healthcare sector is no stranger to the myriad complexities associated with medical claims and billing processes. Among them, the 275 electronic attachment is emerging as an essential tool in the realm of Revenue Cycle Management (RCM). A component of the X12 set of protocols, the 275 electronic attachment (sometimes referred to as EDI 275 attachments) is an electronic version of patient-specific medical information or supplemental documentation to support a claim (837) transaction. But why is this important for healthcare providers?
The Next Era of Healthcare Revenue Cycle Management: Why Experience and Expertise Matter More Than Ever
In an industry characterized by tightening margins, workforce reduction, and the omnipresent rise in medical claim denials, hospitals and health systems find themselves grappling with an age-old question: How do you do more with less? The answer may be simpler than one might think—partner with experts.
As a bridge between healthcare providers and payers, healthcare clearinghouses simplify billing processes, ensure compliance with insurance regulations, and enhance the overall efficiency of revenue cycle management. But change is a constant in this dynamic environment, and due to numerous factors, many hospitals have started to explore new horizons with a different clearinghouse vendor. Let’s dig deeper into the why hospitals or physicians practices might change to a different clearinghouse.
The Windy City is about to get a gust of transformative ideas as Becker’s 2023 Health IT + Digital Health + RCM Annual Meeting blows into Chicago. And if you’re passionate about ensuring the success of your healthcare organization in these fast-paced times, this is the place to be!
The healthcare claim life cycle is an intricate and complex journey that starts from when a patient first checks in at a facility to when they receive a bill from their insurance provider. In this blog, we will explore each step in detail, shedding light on the intricacies of medical billing and its crucial role.
As hospitals and health systems strive to optimize revenue cycle management, the role of edits in streamlining claims processing and expediting payments has become increasingly crucial. Medical claim edits serve multiple purposes, from preventing denials to ensuring compliance with regulations and enhancing revenue capture and standardization. In this blog post, we will explore the significance of edits and the various types that can be employed to maximize efficiency and financial outcomes.
Consistently ranked high among Epic users, discover how SSI’s deep integration and expertise help make Epic medical billing easy.
Discover the crucial questions revenue cycle leaders should ask their claims clearinghouse vendors to ensure a seamless and efficient partnership for managing complex claims, integrations, and more.
As the healthcare industry moves towards greater interoperability using electronic exchange of health information, EDI transactions are becoming increasingly substantial. Although various methods exist for obtaining claim status information from MACs (Medicare Administrative Contractors), CMS (Centers for Medicare and Medicaid Services) recommends using EDI 276/277 transactions as the preferred method of obtaining claim status.
Mastering Patient Eligibility Verification: Best Practices, Proven Solutions, and Real-World Examples [SSI Preventing Eligibility Denials Series: Part 3 of 3]
Discover best practices and solutions for patient eligibility verification to prevent claim denials and maximize reimbursements.
The State of Eligibility Verification in Hospitals and Health Systems [SSI Preventing Eligibility Denials Series: Part 2 of 3]
Learn the state of eligibility verification in hospitals and see SSI’s latest claim data to understand its vital role in preventing denials.
Eligibility Denials: A Major Challenge for Hospitals [SSI Preventing Eligibility Denials Series: Part 1 of 3]
Get an overview of the widespread eligibility denials problem that is leading to significant revenue loss for healthcare providers and frustrating patient experiences.
Learn how Michigan’s Health Can’t Wait initiative is leading the way in prior authorization reform by reducing administrative burdens on healthcare providers and improving patient access to necessary medical services.
Unwinding Medicaid Continuous Coverage: Understanding the Importance of a Solid Eligibility Verification Strategy and PBE
This is an in-depth look at Medicaid unwinding, including valuable tips and best practices for staying on track during the Medicaid unwinding process. The importance of having a solid system in place for verifying patients’ eligibility and how solutions like SSI’s PBE can help protect against rejections and denials related to eligibility is also addressed.
Learn about the differences between hospital billing and professional billing. While both involve similar functions, there are key distinctions in complexity, insurance claims, payment types, and risk of denied claims.
This infographic addresses the prior auth (PA) problem in healthcare and how to solve it. It highlights why PA is a problem worth solving, why now is the time to do it, and how automation is part of the solution.
Here are prior authorization FAQs to answer providers’ most pressing questions about prior authorizations and how they can improve their processes.
There are many reasons why hospitals should consider automating Prior Authorization. Here are the top 3 reasons.
From the CMS proposed rule for Advancing Interoperability and Improving Prior Authorizations to gold carding & state programs, here’s what hospitals need to know about Prior Authorizations in 2023.
Reboot Your Revenue Cycle: Get Proactive with Prior Authorization Automation [HFMA Webinar Key Takeaways]
In a recent HFMA webinar, David Mistkawi, VP of Access Management Solutions at The SSI Group, LLC (SSI) and Tyler Wince, Chief Product Officer at Myndshft, discussed the critical need for improving the prior authorization/pre-certification process and why automation is such a game changer. Here is a list of the top 5 takeaways from that webinar.
SSI is pleased to announce that we were named the 2022 Collaboration Award Winner at the recent Oracle Cerner Health Conference. This award recognizes a partner who demonstrates strong cooperation and a commitment to meet client expectations…
Has your cost to run paper patient statements significantly increased in the past six months? If you answered yes, you’re not alone. What’s driving up the price, and what can be done to drive more patients to pay via mobile?
With claim denials on the rise and nearing the “danger zone” at many hospitals, it’s important to leverage all the tools available to help you identify, manage, and ultimately prevent as many denials as possible. This infographic explores the impact and cost of denials, along with a smarter strategy for how to win at denial management.
After attending the most popular healthcare and Revenue Cycle Management (RCM) conferences of the year, including HIMSS, Becker’s, and HFMA, we have gleaned several key insights. Here’s a quick mid-year recap of the five most talked about issues.
With the premier event for healthcare finance, the 2022 HFMA Annual Conference, right around the corner, there will be plenty of opportunities to glean insights from experts and talk shop with industry leaders. This year’s conference theme is Above and Beyond, as it relates to the Cost-Effectiveness of Health initiative. Discover how SSI is uniquely aligned with this theme.
Q&A with Revenue Cycle Expert on Key Denial Management Strategies [SSI Claims Denial Management Series: Part 3 of 3]
RCM expert Lori Brocato shares key strategies to help you and your organization make improvements in denials management.
The Five Most Common Types of Medical Claim Denials [SSI Claims Denial Management Series: Part 2 of 3]
Medical claim denials are a constant headache that negatively affects hospital and health provider revenue, cash flow, and operational efficiency. Fortunately, we can avoid many denied claims with the right expertise and processes. While it’s impossible to eliminate denials 100%, improving your understanding of and preparation for the most common types can help eliminate the chance of them ever occurring in the first place and substantially impact your bottom line. Let’s take a look at the top five types of denials in healthcare starting with eligibility-related denials.
Two Critical Revenue Cycle KPIs Your Organization Needs to Watch to Prevent Healthcare Denials [SSI Claims Denial Management Series: Part 1 of 3]
Stopping denials from happening altogether, on the front end of your revenue cycle, is a much better strategy than managing denials on the back end. Recent research shows hospital claim denial rates are nearing the “danger zone,” with average denial rates increasing over the past few years to between 6% and 13%. This blog post addresses the latest industry insights about these types of healthcare denials plus offers denial prevention strategies.
Without revenue cycle management, providers can’t make a living and healthcare organizations can’t remain in operation. Keep reading to explore the foundations of healthcare revenue cycle management, what makes it so complex, and the solutions that healthcare organizations should implement to achieve an effective revenue cycle management process based on a real-world example.
The ability to use Direct Data Entry (DDE) into Medicare Fiscal Intermediary Shared System (FISS) has been around for decades and is still widely used today. Even with the proliferation of Electronic Data Interchange (EDI) transactions that can be used instead, users still use DDE to manually enter, correct, adjust, or cancel Medicare transactions in FISS.
Hospitals continue to struggle to regain baseline inpatient and outpatient volumes following the COVID-19 outbreak—and many anticipate that volumes won’t return to normal until July 2021, an American Hospital Association analysis shows.
This paradigm shift demands that hospital revenue cycle departments reimagine the patient journey with an eye toward self-service, highly transparent, highly digital interactions. In a post-COVID environment, price transparency isn’t just about compliance.
Telehealth visits could top 1 billion in 2020, with 900 million visits related to COVID-19 alone, a recent report predicts. But even as the Centers for Medicare & Medicaid Services broadens access to virtual care, navigating telehealth and e-visit reimbursement during the pandemic presents unique challenges for providers.
The SSI Group — a certified Health Information Handler (HIH) is happy to announce that all of our current providers can get their Additional Documentation Request (ADR) letters electronically (as eMDR) through SSI as their registered HIH.
Despite the initial capital investments and maintenance costs, healthcare artificial intelligence (AI), is here to stay and projected to grow rapidly in the coming years. Learn more about the industry outlook and how AI benefits providers and health systems, improve population health & reduces healthcare expenses.