Healthcare Artificial Intelligence Outlook: Benefits, Projected Growth & Challenges

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.

It’s Not Too Late to Ramp Up Price Transparency Compliance

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.

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.

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.

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.

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.

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

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.

Have you registered SSI as your Health Information Handler?

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.

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.

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:

  1. By keying claims into DDE, work already done in the Host system is duplicated, taking twice the time to work a claim.
  2. 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.