Revenue Cycle Management
OptumInsight revenue cycle management offerings provide hospitals and health systems with unprecedented control over their coding, compliance, and reimbursement data and processes.
We’ll help you capture more accurate patient billing data, refine eligibility verification, and make essential financial information accessible across your entire care community, including IDNs, hospitals, academic medical centers, and contracted physicians.
Billing Management
Optum billing management products provide direct access to Medicare’s online system, confirming claim accuracy prior to actual submission. For both government and commercial payers, it applies the required edits, tracks adjudication status, and automatically generates secondary claims when appropriate.
Benefits:
- Improve first-time acceptance rate
- Automate claim submission and status inquiries to increase productivity
- Accelerate secondary claim submission
- Perform pre- and post-submission compliance checking
- Improve productivity and strengthen decision support
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Coding and Reimbursement
OptumInsight offers an array of coding 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
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Patient Access Management
Patient Access Management helps you get it right the first time, helping you to eliminate registration errors, streamline patient access processes, and determine self-pay responsibility. Our integrated functions help you minimize denied claims and drive effective up-front collection efforts while enabling you to directly tie your front-end work to the back-end results.
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Payment Management
Optum Payment Management works with your in-house scanning solution or bank’s lockbox to automate payment processes and enable comprehensive, efficient management.
Benefits:
- Streamline payment processes
- Consolidate and standardize information from multiple formats
- Automate data flow and batch verification
- Increase efficiency and improve reporting
- Eliminate labor-intensive, error-prone manual processes
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Resolution Management
Our resolution management technology and services help you improve denial capture, recovery processes, and cash collections, while providing meaningful and actionable denial data from all sources.
Benefits:
- Gather data from disparate systems to create patient-centric financial records
- Automate and standardize denial capture for all payers
- Increase cash collections
- Reduce denials by identifying root cause early in the process
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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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