RCM Blog

Latest Blog Posts

Stay in-the-know on healthcare revenue cycle industry challenges and trends with proven strategies from SSI thought leaders.

How Healthcare Billing Departments Can Maximize AR Potential Before Year-End

How Healthcare Billing Departments Can Maximize AR Potential Before Year-End

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.

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The Unbeatable Value of the Human Touch in a Digital Healthcare World

The Unbeatable Value of the Human Touch in a Digital Healthcare World

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.

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Advancing 275 Electronic Attachments in Medical Billing: A Move Towards Efficiency

Advancing 275 Electronic Attachments in Medical Billing: A Move Towards Efficiency

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?

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Navigating Change: Top Reasons Hospitals are Switching Healthcare Clearinghouse Vendors

Navigating Change: Top Reasons Hospitals are Switching Healthcare Clearinghouse Vendors

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.

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Leveraging the Power of Medical Claim Edits: Expediting Payments for Hospitals and Health Systems

Leveraging the Power of Medical Claim Edits: Expediting Payments for Hospitals and Health Systems

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.

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Healthcare Industry Shifting to More Efficient Claim Status

Healthcare Industry Shifting to More Efficient Claim Status

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.

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Unwinding Medicaid Continuous Coverage: Understanding the Importance of a Solid Eligibility Verification Strategy and PBE

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.

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Solving the Prior Auth Problem [Infographic]

Solving the Prior Auth Problem [Infographic]

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.

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SSI Wins Oracle Cerner 2022 Collaboration Award

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…

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Infographic: Get Out of the Denial Danger Zone

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.

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What’s Top-of-Mind for Revenue Cycle Leaders in 2022

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.

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Above and Beyond at HFMA 2022. Say Hi to SSI!

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.

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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.

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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.

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How SSI Simplifies Revenue Cycle Management

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.

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DDE v. EDI – Does Claims Submission Method Really Matter?

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.

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Accelerating COVID-19 Revenue Recovery with Analytics

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.

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Virtual Care During COVID-19: Making the Right Moves for Reimbursement

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.

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The Personal Factor in Support for Revenue Cycle Software

When it comes to support for revenue cycle software and HIT solutions, how often can you expect a quick answer from a friendly, U.S.-based support representative?  SSI’s Vice President of Client Services, Brian DeWeese, is proud to lead a team that offers top support to client health systems.

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Winning the Battle: Hospital Patient Access Best Practices

In a time of increasing patient payment burdens, many hospital revenue cycle teams are exploring patient access best practices in an attempt to get a handle on accounts receivables. Some hospitals have doubled point of service collections. How do they do it? We take a comprehensive look at patient access best practices including systems, denials, pre-registration, and training for teams dealing with patient financial discussions.

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Improve Your Healthcare Organization’s Claims Denial Management Processes

Revenue cycle management (RCM) technology modernization is the next phase for hospital IT software since the completion of the massive electronic health records (EHR) implementation. Now, the challenge hospitals, ambulatory surgery centers, and providers are facing is the the process of updating their RCM software to support value-based care and minimize revenue leakage.

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Patient Access Management Challenges, News, and Progress

Patient Access Management Challenges, News, and Progress

One of the most overlooked, but arguably one of the most important aspects of the hospital experience is patient access. Patient access encompasses the front-end registration process and all of its supporting financial dealings with providers, patients, and payers

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