Coding

Enhance overall operational efficiency, automate time-consuming tasks, improve accuracy, and achieve accurate reimbursement with industry-leading coding resources. Use computer-assisted coding to improve coder productivity, accuracy, and revenue.

Compliance and Audit Management

Integrate time-consuming compliance and audit activities into your reimbursement processes. Automate key tasks to increase efficiency, improve productivity, and enhance accuracy. Protect all areas of your revenue cycle with reliable, accurate MS-DRG documentation. Simultaneously verify medical necessity for Medicare Parts A & B outpatient services prior to service.

Cost Clinical and Quality Management

Manage multiple audit deadlines, minimize your workflow burden, provide accurate and timely information, and prevent future issues.

Streamline your transition to ICD-10 and HIPAA 5010 requirements. We provide impact planning, gap analysis, implementation, and education services.

Electronic Data Interchange EDI

Increase overall efficiency and productivity with next-generation EDI solutions. Automate critical operational processes. Streamline transactions with health plans. Access a wealth of real-time patient and reimbursement information throughout the claim submission and reimbursement process.

Performance Improvement and Data Analysis

Pinpoint opportunities to improve organizational efficiency by comparing your hospital’s financial ratios against data from other individual hospitals.

Revenue Cycle Management

Holistically manage your revenue cycle at the patient level with our unified set of solutions. Achieve the following efficiencies:

• Significantly impact areas of your revenue cycle — including denial recovery and prevention, Medicare accounts receivable services and comprehensive secondary claims management by outsourcing key functions.

• “Get it right the first time” by directly tying your front-end work to the back-end results.
• Improve first-time acceptance rates and automate claim submission and status inquiries.

Strategic Planning and Financial Management

Reach new, sustainable levels of productivity with the strategic planning and financial management expertise of OptumInsight. For example, unite your interests with your affiliate clinics to streamline interactions and coordinate care. Or, evaluate various contracting strategies and implement the models that make the most sense for your organization.

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.