Key Features and Benefits
- Optum360Edge—Robust 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.
- Optum360Edge—Essential DRG calculator. The DRG calculator gives you a more accurate DRG-level payment rate using hospital-specific DRG calculations for each DRG based on the operating and capital values in effect for each provider number.
- Optum360Edge—APC Calculator. Sophisticated outpatient calculator helps you validate and manage outpatient APC and composite APC reimbursement under Medicare, identify and resolve underpayments, and determine the patient’s copayment amount.
- Access a complete library of medical code sets, UB-04 billing and coding tips, and reimbursement information. Address problems that are core to hospital revenue cycle processes.
- Simplify research processes and boost productivity. Use the robust search engine to quickly find codes you are looking for—using acronyms, abbreviations, or medical terms. Plus, exclusive code crosswalks and coding tips provide quick links from clinical codes to CMS source documentation, billing, and reimbursement information.
- 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.
- Resolve leading coding and billing errors and prevent rejections. Use the latest UB-04 data set and Medicare billing guidelines as well as revenue codes linked to CPT®/HCPCS codes.
- Complete, updated Part A and Part B LCD policies and medical necessity data and national coverage determinations (NCDs) with crosswalks to CPT®/HCPCS, ICD-9-CM/ICD-10, revenue codes, and type of bill codes.
- Access information from top-selling Optum DRG products, such as the DRG Expert and DRG Desk Reference. With a click of your mouse, you will be able to identify new ICD-9-CM/ICD-10 codes, the DRGs they group to, all ICD-9-CM/ICD-10 codes associated with each MDC and DRG, detailed DRG, RW and length of stay information, transfer DRGs, and DRGs that may be optimized. Guidelines are designed specifically for improving hospital reimbursement and financial forecasting and alerting the facility to possible coding problems.
- Comprehensive DRG data and documentation guidelines guide your coders to better and more compliant code assignment. Identify what generates a CC, which DRGs have the potential to be optimized, and which codes group to targeted DRGs.
- Make sure you are using CPT®, HCPCS Level II, and ICD-9-CM/ICD-10 codes correctly. Lay descriptions, code book annotations, images, and Optum proprietary content will help you make sure that the procedure, drug, item, and diagnosis codes submitted on claims are valid, accurately assigned, and appropriately linked.
- Easily find and resolve inpatient and outpatient edits using one source. Edit icons identify facility PPS edits—outpatient OCE, MUEs, device code edits, hospital CCI edits, and all inpatient MCE edits. Plus, clear edit explanations and edit resolution tips help you resolve them. Understanding how to resolve claim edits is one of the keys to improving your denial management process.
- Link clinical code sets to billing and payment information. Help your staff make the correct coding decisions and increase the efficiency across every revenue cycle department.
- Improve coordination and problem-solving among key revenue cycle departments such as HIM, CDM, PFS, and admitting. This will help improve revenue capture and accelerate cash flow.
- Cross-coding relationships. Quickly link to codes that are unique to hospital billing, codes used with specific revenue codes, interventional radiology codes, and related surgical procedures.
- Exclusive code crosswalks, links and coding tips simplify the research process and increase productivity. Crosswalk from ICD-9-CM/ICD-10 procedure codes to CPT® or HCPCS Level II procedure codes; ICD-9-CM/ICD-10, CPT®, and HCPCS Level II codes to Medicare inpatient, outpatient, and device code edits; clinical codes to CCI, OCE and MCE edits, modifiers, revenue codes, coverage and related procedures, and CPT® or HCPCS Level II codes to revenue codes.
- 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. Optimize your skill within the complexities of ICD-10-PCS as 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 increase your efficiency and accuracy.
CPT® is a registered trademark of the American Medical Association.
The price of Revenue Cycle Pro does not include add-ons. Add-ons sold separately.
AHA Coding Clinic for HCPCS Add-on (Item WA03) $250 per user, per year
AHA Coding Clinic for ICD Add-on (Item WA02) $450 per user, per year
Coders’ Dictionary Add-on (Item WA05) $75 per user, per year
CPT® Assistant Add-on (Item WA01) $250 per user, per year
CPT® Changes: An Insider’s View Add-on (Item WA27) $199 per user, per year
DrugReimbursement.com Add-on (Item WA08) $499.95 per user, per year
Stedman’s Dictionary Add-on (Item WA04) $125 per user, per year