DME/HME

Durable Medical Equipment
The DME/HME market continues to grow with more than 40,000 such organizations of various sizes in the U.S. Because of this growth, there is a definitive need to streamline the fiscal operations of most DME/HME organizations.

The SSI Group provides effective revenue cycle products through the company’s innovative ClickON® Technology for this unique market with an emphasis on streamlining the claims management process and reducing the amount of paper that moves within the organization. With a payer mix that includes Medicare and Medicaid nationally, SSI delivers superior service through proven products in the healthcare industry. The billing process is automated and claims are sent to payers utilizing the company’s ClickON technology available with both application service provider (ASP) and turnkey platforms.

Managing the HIPAA claims transactions process SSI provides DME/HME vendors a complete revenue cycle solution. Key transactions addressed through ClickON technology include:

837 I/P/D – Institutional/Professional/Dental Claims

835 – Remittance Advice

270/271 – Eligibility Inquiry and Response

276/277 – Claims Status Inquiry and Response

Scalable Claims Processing Solutions
Because the business processes may vary for each vendor, ClickON Technology for claims management and billing is scaleable meeting the needs of any sized type of DME or HME vendor. Available in either an onsite solution with either clearinghouse connectivity or direct-to-payer submission or an application service provider solution (APS) SSI’s claims processing software fits the unique needs of any large healthcare enterprise.

Along with SSI core technology for claims editing and transmission, there are a range of vertical products that facilitate and enhance claims management. These include:

ClickON Secondary Billing enables the production of secondary and tertiary claims, along with a one-page Explanation of Benefits (EOB) attachment by posting 835 files (electronic remittances) to claims already in the billing package. Along with 835 files, the Secondary Billing package can post lock box files, payment files produced from the mainframe systems and the Medicare pending payment files that the Accelerated Secondary Billing and ClickON Claims Status packages produce.

Capturing revenue from secondary or tertiary claims is vital to the financial success of a large healthcare enterprise and being able to capture it quickly is extremely important. ClickON Accelerated Secondary Billing assists with just that. This package is an enhanced version of the ClickON Secondary Billing package. Enhanced functionality enables the posting of pending Medicare payments to the appropriate claims in ClickON Billing after the checking the Medicare Common Working File (CWF) for their status. The entire accelerated secondary billing process allows claims to be billed to secondary payers before the primary payment has been received.

Tying the steps of the billing cycle together into a seamless, integrated process provides for major advantages. For instance, the billing secondary claims before the primary is billed can result in an eight-to-ten day collection advantage. The ClickON Claims Status Module is one solution that brings together multiple activities for working claims and providing detailed reporting. This advanced claims management system works directly with the ClickON Billing package to status Medicare claims using the Medicare Common Working File (CWF) as well as claims submitted to any other payers that provide the 276 and 277 claims status transactions.

With 14 percent of all claims denied, the healthcare industry is losing valuable revenue that negatively impacts the bottom line. ClickON Revenue Recovery Manager is an innovative denial management tool improves the overall revenue cycle by analyzing denied claims, providing workflow solutions and offering comprehensive reporting. This application can even prevent denied claims. Transaction data is analyzed and, based on predefined criteria specific to a particular healthcare entity, tasks to handle denied claims are automatically assigned to individual users or to everyone in a designated group.

Enhanced Functionality Offered by ClickON
Because no revenue cycle solution ends with simple claims management and transmission, ClickON technology provides additional solutions to help with managing contracts, auditing claims and posting.

Viewing the details of changes made to claims during the billing cycle is a necessity in these days of HIPAA and automated workflow. The ClickON Claims Audit Module is an add-on module that documents all system and user changes made on claims in ClickON Billing down to the transaction level, even viewing a claim. Anyone who views or makes a change to a claim can be tracked.

Posting solutions can aid claims tracking by posting notes directly to the collection comment area of an accounting system, thereby facilitating reporting as well as revenue recovery.

Remit/cash posting can be an automated process of posting 835 files to the accounts receivables system. With ClickON Remit/Cash Posting, remits are retrieved electronically from participating payers and posted to the individual patients’ accounts in the AR system automatically.

Ensuring the HIS is updated with information provided by the carrier for claims marked as rejected can be accomplished through the ClickON Reject Note Posting module.

Automating the posting of electronic payer confirmation reports to the notes/comments section of an information system is accomplished through the ClickON Confirmation Note Posting.

By posting the actual bill date for each claim billed into a mainframe and/or collection system automatically improves data management capabilities. ClickON Bill date posting enables users to post the actual bill date for each claim billed in the ClickON Billing application into a mainframe.

Claims with attachments are a challenge facing the healthcare industry with request for documentation to accompany the claim. Doctor’s notes, accident reports or other related information might be integral in getting a claim paid. ClickON Attachment Processing System addresses the paper claims attachment challenge, enabling the consolidation of paper claims with accompanying attachments for processing and mailing.

Document management and workflow can be streamlined, digitized and, in general, made more efficient to help large healthcare facilities with managing the massive amounts of paper and processes abundant in providing medical equipment and supplies. ClickON Document Management System is a scalable solution enabling the capture, archiving, storage, access and reporting of vital data and paperwork. All this is accomplished with an intuitive workflow solution that provides further efficiency.

ClickON Document Management System includes:

Imaging and SAN Utilization: This is the basis for all other document management functionalities. Retaining documents digitally and indefinitely, Imaging offers secure, remote access to information through applied archiving and retrieval technologies.

Enterprise Report Management: This application provides for the input and storage of computer print files. Enterprise Report Management eliminates substantial and recurring printing costs and is applicable to any department including human resources, general accounting and medical records.

Optical Character Recognition (OCR): Reading scanned images and extracting editable text information, OCR allows documents to be automatically indexed, data to be automatically posted and workflow management processes to be started.

Workflow Management: As an innovative tool for creating efficiency and reducing costs for information handling, this process-oriented solution is specific to this market’s unique needs. Once information has been captured digitally, Workflow Management provides document management, routing, workflow and tracking capabilities that follow a specific document or documents through all steps needed to complete information processing.