Compliance and Audit Management

Coding Billing and Reimbursement

OptumInsight offers an array of coding, billing, and reimbursement solutions that help you remain compliant and maintain an efficient path to fair and timely reimbursement.

• Significantly improve coding accuracy and compliance

• Simplify regulatory content management
• Transition smoothly to required clinical documentation changes
• Prepare for a successful transition to the new ICD-10 code sets and HIPAA 5010 mandates
• Keep up with ever-changing prospective payment systems (PPS) rules

   

DRG Compliance

The Centers for Medicare & Medicaid Services is proposing enormous changes to its inpatient services payment system — most notably clearer definitions of a patient’s condition severity via Medicare Severity DRGs (MS-DRGs).

We can help you prepare your staff and internal systems for the change so that you don’t miss out on reimbursement.

With OptumInsight, you can avoid disruptions to revenue cycle management:

• Identify financial and coding impact
• Safeguard cash flow
• Protect operational efficiency

RAC Compliance

The OptumInsight RAC Support Program has all the products, services, and expertise you need to save valuable time and resources in the audits and appeals process.

Benefits:

• Minimize the cost of preparing, submitting, and following up with appeals
• Educate stakeholders
• Identify and address areas of exposure
• Assist with process improvement and appeals to minimize the effects of RAC

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.