Achieve compliance
Health reform will have a significant impact on health and human services organizations, your programs, and the people you serve — both in the short term and for years to come. Meeting these shifting regulatory requirements presents daily challenges that can bog down your people and processes, increasing operational costs and straining relationships with health care partners. Discover what OptumInsight innovation can do to improve compliance and efficiency.
Issues and challenges
Health reform
Under health reform, it will remain imperative for public sector organizations to optimize program performance through careful planning. In addition, programs will need to prepare for increased oversight and interaction with the federal government.
OptumInsight can assist your team in determining the impact of reform on your programs and developing effective strategies to both comply with the new mandates and meet your benefit goals.
Opportunities
Coding, Billing and Reimbursement
Effectively and accurately process ICD-9 and ICD-10 transactions according to pre-defined GEM standards. Quickly and easily transition to future coding classification systems. Lay the operational groundwork for meaningful-use compliance.
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Consulting
Ensure accurate risk-adjusted coding and documentation in the event of an audit by CMS. Perform prospective payment audits and HCC code improvement reviews.
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Program Integrity
Comply with ever-changing prompt-pay legislation. Spend less time tracking state regulations and accreditation requirements.
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Network Operations Efficiency
Mitigate compliance risk with end-to-end provider credentials verification. Spend less time tracking state regulations and accreditation requirements. Fulfill the NCQA requirement for facilities credentialing; achieve primary-source verification for hospitals, ambulatory surgical centers, home health agencies, and long-term care facilities.
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