Medicare 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. This can cause major impact to revenue cycle management, including key issues to time and data reconciliation:
- By keying claims into DDE, work already done in the Host system is duplicated, taking twice the time to work a claim.
- If a Provider is only working claims in DDE, changes made to the claims are likely not being updated in the Host system, which could cause data discrepancies.
There are many scripting or robotic processes that are used to automatically key claims into FISS as well as run automated claim status checks. At one time, when Medicare only paid claims on certain days of the month, providers could gain Accounts Receivable (AR) days using robotic processes to enter claims. Some providers continue this practice today even though it seems there is no real benefit gained by doing so.
In 2021, the SSI Group did an in-depth analysis to determine if using robotic processes to key claims into FISS returned a faster payment turnaround than submitting claims using EDI. Over a four-day period, we monitored claims for two different providers using the two different methods. Below is a sample of what we found.
|Claims Billed Using EDI||Claims Billed Using Automated DDE Capability|
|20 claims billed successfully||18 claims billed successfully|
|20 claims appeared in a Suspended status in FISS on day 2||3 claims received RTP status on day 2|
|10 claims appeared in a Paid status on day 2|
|5 claims remained in a Suspended status for the 4-day period|
Additional findings after monitoring the claims in FISS until the majority of them reached a Paid status were:
- Claims appear to process (move through all the applicable system statuses) 2-3 days faster using DDE
- Claims appear to reach a “Paid” status 1-2 days faster using DDE
- Claims entered using DDE have a faster return on errors allowing for claims to be corrected sooner
- Regardless of the submission method, claims reached the same Paid Date
Regardless of how the claims are submitted, payment is not returned any sooner. This indicates that the big benefit of using DDE is not entering the claims but ensuring ongoing status checks are happening so that you are able to address exceptions sooner.
Contact us to learn more about how The SSI Group can support you and your organization’s claims management processes.