Achieve compliance
Meeting shifting regulatory requirements presents daily obstacles that can challenge even the most talented staff and best practices. Health care reform will intensify scrutiny. Healthy hospitals are preparing today to improve quality of care, manage costs, and maintain a strong financial foundation — all while adhering to mandated requirements.
Opportunities
Coding Solutions
Improve coding accuracy, improve reimbursement, and meet compliance requirements with industry-leading coding and claims management solutions. Employ low-cost, online coding solutions that keep your staff current on ICD, CPT®, severity-adjusted DRGs, and HCPCS code changes. Complete coding processes faster and more accurately with computer-assisted coding, or take advantage of our on-demand coding service.
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Compliance and Audit Management
Configure audit management programs to your facility’s workflow, including RAC, MAC/Fl ADR and probes, CERT audits, MIC audits, other Medicaid, and more. Track audit activity and automate workflow, and integrate audit management with EHR technology and reporting.
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Cost Clinical and Quality Management
Receive comprehensive analysis, strategy, and support services to help you address the requirements of compliance while improving or maintaining clinical quality. Our consulting services include ICD-10, HIPAA 5010, JCAHO, and RAC audit support.
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Electronic Data Interchange EDI
Electronically submit HIPAA-compliant claims to thousands of insurance companies nationwide with easy-to-use, low-cost EDI tools. Test and certify HIPAA transactions efficiently and cost effectively.
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Revenue Cycle Management
Capture more accurate patient billing data, refine eligibility verification, increase productivity and make essential financial information accessible across your entire care community, Transform every aspect of your revenue cycle from beginning to end with our advanced technology, expert consulting, and managed services.
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Strategic Planning and Financial Management
Bring in experienced hospital consultants who can help you identify and implement cost reduction strategies, improve productivity across the revenue cycle, and make the most of your IT investments.
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Outpatient Charge Capture
Tighter reimbursement regulations are an ongoing cause of concern for hospital administrators who need a compliant and consistent charging strategy across all outpatient services within their organization. Services provided within outpatient care are governed by complex rule sets that frequently make compliant and consistent charging an error-prone task. Health care facilities need tools that help facilitate revenue opportunities and maintain compliance with payer guidelines.
OptumInsight helps facilities charge consistently across the entire outpatient care spectrum. From the emergency department and primary care clinics to specialty clinics and infusion and oncology treatment centers, our outpatient charge capture solutions can help your facility obtain appropriate and defensible revenue.
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