Top 10 The SSI Group Alternatives & Competitors

Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

In an environment where codes and billing regulations are always changing, ensuring accurate charge capture can be a huge challenge for providers. Waystar handles this to ensure you aren’t leaving money on the table.  

Protect your revenue + prevent revenue loss

• Increase FTE productivity
• Rebill payers with more confidence
• Get deeper visibility into your data to identify root causes
• See just how much Charge Integrity could benefit your bottom line. Click below to get an estimate of your potential ROI.

Implementation is seamless, and you’ll see immediate results.

How is Waystar different?

• Predictive analytics go beyond a basic rule-based approach
• Machine learning algorithms analyze historical data to identify patterns
• Hospital and physician data sets are cross-referenced to identify incompatible codes and missing or incorrect charges
• In-house auditing team of certified coders (AHIMA/AAPC, RHIA, RN, CPC)
• Web-based or HIS-integrated user workflows
• Comprehensive review process across all payers and patient classes

What our clients are saying:

"We don't have time to constantly read journals to find out the latest code--I don't know anyone who does. Just one cardiology code paid for the Charge Integrity product for a few years."

-Assistant Director, Revenue Integrity, Floyd Health Care System

Ambience Healthcare’s AI platform for documentation, CDI, and coding has been deployed at health systems such as Cleveland Clinic, UCSF Health, St. Luke’s Health System, John Muir Health, and Memorial Hermann Health System. Ambience is the only AI scribing and coding solution designed to support 100+ specialties and subspecialties, and is directly integrated with Epic, Cerner, athenahealth, and other leading EHRs. 

By partnering with Ambience, healthcare systems reduce documentation time by an average of 80%, improve clinical documentation integrity, and achieve at least a 5X return on investment with more accurate E&M coding. Ambience is also the only AI solution that provides clinicians with AI-assisted CDI support. Ambience surfaces precise diagnosis codes for clinicians to review based on patient conversations, then structures documentation to support selected codes. 

This solution automates the process of checking requests under review as well as continued status changes and updates. It supports many portals such as Evicore, Magellan, UHC and others. The solution includes business rules, exception handling and daily reporting functionality with customizable dashboard views. AI is also used to do analysis and supply predictive capabilities. The solution can also be hosted and supported by CampTek as an ongoing managed service.

Payers constantly change the rules. Sift evens the playing field. Sift equips healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash.

Actionable Denials Intelligence, delivering a longitudinal view of clinical, coding, claims and remittance data. Sift establishes a data foundation that gives providers unprecedented access to their payments data and intelligence tools to better manage their denials, identify root causes and prevent future denials. 

• Unified, normalized and organized claims and remittance data.
• Delivering an accessible and complete picture of claim behavior, payer trends and the drivers of denials.
• Curated, consultative analysis pinpointing where your team can take action to prevent denials and optimize workflows.

Denials Prioritization & Intelligent Automation to better manage touches and lower the cost of delivering each dollar of cash.

• Sift’s machine learning optimizes workflows by prioritizing your team’s denial work efforts around ROI and by delivering Smart Claim Edits that improve first-pass yield. 
• Active-Learning Claim Scrubber analyzes daily claims and remittances to curate high-impact claim edit recommendations.
• Machine learning models that score denials at an atomic claim level, using over 500 attributes to determine each denial’s likelihood to overturn.
• ROI-based denials worklists seamlessly integrate into your EMR, prioritizing high-recovery denials in staff workqueues.
• Scoring that enhances existing automation capabilities, enabling the strategic automation of low-yield accounts while avoiding over-automating recoverable accounts.

Denials Prevention. By unifying clinical, coding and payments data, Sift's ML predicts denials before claims are created and provide recommendations for upstream interventions. 

Sift’s ML models predict the likelihood of denial and provide pointers for intervention and prioritized user analysis, working to optimize payment outcomes.

• Machine learning models score encounters around their likelihood of being denied, proactively flagging encounters for intervention before claim submission.
• Denial category prediction and root causes pointers enable routing to the appropriate mid-cycle workflow for mitigation.
• Mid-Cycle Denials Intelligence that ties back-end billing, denial and overturn patterns to upstream workflow data inputs to deliver root cause analysis and prevention recommendations.

Optimize your policy management.

The Most Comprehensive Database

Access the most complete database of live and historical medical and pharmaceutical policies and related documents on the market.

Real-Time Notifications

Stay ahead with email alerts on any changes to medical and pharmaceutical policies by payer and therapy, allowing you to respond swiftly to developments that may impact your stakeholders.

Central Access

Effortlessly search and review Medical & Pharmacy policies, draft policies, prior authorization documents, coding guidelines, reimbursement updates, and more—all in one centralized location.

Comparison View

Easily identify differences between current and historical versions using our intuitive viewer that highlights changes for quick reference.

Research Control

Focus your research by filtering specific payers, plan types, states, therapies, devices, or document types, ensuring you find exactly what you need.

Visit https://www.policyreporter.com/industry/providers/ for more information and a free trial.