New Medicare Preventive Services Edits to Provide Guidance and Reduce Violations

The SSI Group, Inc. (SSI) released Preventive Services Edits to enhance the SQL version of the ClickON® Claims Editor (Billing Module), helping clients check for potential violations of Medicare’s Preventive Services limitation rules. These rules state that certain services can only be performed a limited number of times during a given time period.

With the addition of Medicare Preventive Services Edits, SSI’s ClickON Claims Editor will contain such service edits as mammography screening, prostate cancer screening and cardio vascular disease screening. Provider-Specific edit requests can be used to customize or delimit the Preventive Services Edits as well as apply them to other payers such as Medicaid carriers.

“These edits will help our clients by providing guidance on services to reduce violations of Medicare’s Preventive Services limitation rules,” said Debbie Short, COO. “This will positively impact a healthcare organization’s bottom line by ensuring procedures are not performed outside the window of service limitations stated by Medicare.”

In addition to the 200,000 built-in edits already offered by ClickON Technology, the latest edits added make this an even more powerful tool for managing the healthcare revenue cycle.

With workflow functionality that provides seamless connectivity to such capabilities as insurance eligibility verification and claims status functionality, SSI provides a complete solution that covers a patient from admission to discharge and beyond.

SSI’s ClickON Technology automates the healthcare revenue cycle, enabling processing tasks to be accomplished in less time by fewer people. Benefits derived from this seamless integration include eliminating the reformatting of electronic data, reducing redundant data entry and increasing data validation and reporting. SSI also offers an extensive payer offering with more than 800 available payers.

The SSI Group, Inc. is a national, diversified information technology company established in 1988. The company operates the nation’s second largest institutional healthcare claims clearinghouse. It maintains corporate headquarters in Mobile, Ala., and branch facilities in Clearwater, Fla.; Dallas, Texas; Denver, Colo.; and Chesapeake, Va. With approximately 385 employees and 2,200-plus clients nationwide, SSI leads the healthcare field in healthcare claims management technology, EDI platforms and networking. ClickON technology has more than 200,000 built-in edits, delivers HIPAA-certified transactions from Claredi, is EHNAC certified and has 800 payer connections. As a testament to the company’s leadership, the company’s technology processes 250 million transactions annually, totaling in excess of $300 billion.
The company offers a wide range of provider/payer/physician services and technologies for managing the revenue cycle - claims processing (ASP/Direct/Clearinghouse), document management and business office outsourcing for paper claims. http://www.thessigroup.com.