Integration Applications

A combination of applications involving up-front review, bill editing, and facility and patient documentation, SSI's Integration Applications are primarily focused on proactively addressing compliance issues of the OIG. This starts with the user determining if a procedure is deemed a medical necessity, based on a given Medicare/Medicaid Fiscal Intermediary's published rules. Compliance inquiries can be submitted in automatic-real-time, manual, or batch mode. If the procedure is not found to be a medical necessity, an Advanced Beneficiary Notice (ABN) may be created for review and certification with the patient prior to the procedure being performed. Additional checks may also be performed based on the Correct Coding Initiative (CCI), Inpatient Only requirements, the Medicare 72-Hour Rule or any other payer rule limiting admissions within a certain time period. Reports on all of the aforementioned checks are available and customizable to assist in flagging certain problem areas needing examination or change.