Increase revenue
Changing payment models and health care reform are requiring hospitals to change as well. Those that will be best positioned to provide high-quality patient care in this shifting environment will be hospitals that can achieve optimal financial performance by managing the revenue cycle with a holistic and patient-centered approach.
OptumInsight helps you overcome pressing revenue cycle challenges with end-to-end innovation. We’re building the industry’s most comprehensive suite of unified, patient-centered products, services, and consulting solutions to strengthen your revenue — and ultimately, your foundation for care.
Opportunities
Coding
Achieve fair and accurate reimbursement with industry-leading coding resources:
- Streamline coding system-wide with web-based coding tools.
- Improve compliance and first-pass pay rates with the right code sets for MS-DRG, ICD-10, CPT®, and HCPCS Level II.
- Manage the complexities of code-based reimbursement from a single content management system for your entire enterprise.
- Increase your Case Mix Index with computer-assisted coding.
Improve staff efficiency and reduce costs with web-based coding reference tools.
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Compliance and Audit Management
Protect revenue by strengthening your compliance, audit, and appeals processes.
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Electronic Data Interchange (EDI)
Employ next-generation EDI solutions tailored to your facility. Improve transaction accuracy and improve reimbursement by managing all your EDI from a single application. Achieve high-performance HIPAA transaction testing and certification. Increase auto-adjudication rates and coder productivity.
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Performance Improvement and Data Analysis
Identify areas where you can capture more revenue and cut costs without jeopardizing quality of care. Compare performance against other hospitals to prioritize performance-improvement initiatives.
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Revenue Cycle Management
Customize revenue cycle consulting, services, and state-of-the-art technologies to create exponentially more powerful processes. For example:
- Identify eligibility and propensity to pay prior to care delivery.
- Integrate claims management system-wide.
- Review and edit Medicare claims in real-time.
- Minimize secondary claims write-offs.
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Strategic Planning and Financial Management
Get strategic guidance on the best strategies to drive revenue, gain market share, utilize capital, strengthen clinic affiliations, and negotiate health plan contracts.
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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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