ASCExpert.com, created specifically for freestanding ASCs, brings together the billing, coding, and payment resources you need to achieve accurate reimbursement under the Medicare ASC payment system. Inaccurate billing and reporting can result in underpayments that your ASC can’t afford to lose!
Key Features and Benefits
ICD-9-CM to ICD-10-CM & ICD-10-PCS Mapping: Simple mapping capabilities and complex combination mapping information for diagnosis and procedural information enables users to get a head start on learning the new ICD-10 coding system. Identifies GEM and Optum recommended mappings as well as Optum proprietary Map Selects. Optum ICD-10 MapSelects utilizes GEMS, the ICD-10 CM/PCS index and tabular documents, and clinical and coding expertise to identify the most relevant ICD-9 to ICD-10 crosswalk code.
• ICD-10-PCS Code Builder: Learn the complexities of the new coding system while you identify codes. This intuitive electronic format helps you understand the relationships between root operation, body system, and section. Definitions and guidelines provide insight to get you up to speed and ready for the new coding system.
• Complete medical code sets for ICD-9-CM/ICD-10, CPT®, and HCPCS Level II codes with intuitive functionality. Use the Optum CodeLogic™ search engine to search all codes sets using acronyms, abbreviations, or medical terms.
• Easily crosswalk from codes to NCCI, modifiers, revenue codes, coverage policies, and related procedures. Exclusive code crosswalks and coding tips provide quick links from clinical codes to CMS source documentation, billing, and reimbursement information.
• Complete LCD policies, medical necessity data, and national coverage policies (NCDs). Improve medical necessity validation on the front-end and better manage the ABN process to reduce denials.
• Optum Edge—Robust ASC medical necessity checker and ABN generation tool. Used to screen physician orders and generate an advance beneficiary notice (ABN) to get patient signature. This valuable tool can help hospitals decrease write-offs, improve and obtain revenue capture, decrease claim denials, automatically produce required forms for patients in advance of service, and help inform patients for point-of-care decision making.
• Optum Edge—Physician compliance editor (with ClaimsManager rules). Check your work by running your selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses, and more prior to submittal to a clearinghouse/vendor/payer. Includes an 18-month historical content database for use during claim adjudication.
• Historical data organized by quarter. Nine quarters of historical data enables you to resolve older claim problems using the codes, billing, coverage, and reimbursement rules in effect at the time the service was provided.
• Immediate access to value-added coding references such as CPT® Assistant, CPT® Changes, and AHA’s Coding Clinic.
• Tools to help reduce coding and billing errors. Revenue codes are linked to specific HCPCS and CPT® codes and HIPAA claim edits.
• Wage-adjusted ASC payment calculator at the code or claim level. Validate expected reimbursement from Medicare, identify and resolve underpayments, and determine the patient’s copayment amount.
• Physician Fee Schedule Information. Calculate the adjusted Medicare reimbursement rate for your area.
The price of ASCExpert does not include add-ons. Add-ons sold separately.
CPT® is a registered trademark of the American Medical Association.