RevenueCyclePro.com is an up-to-date, referential tool hospitals can use to access data and medical code sets, answer questions about coding, billing, coverage and reimbursement, and resolve edits, problems and issues to minimize noncompliance exposure. Now with ICD-9 to ICD-10 Mapping information and an enhanced APC calculator
Key Features and Benefits
NEW! ICD-9-CM to ICD-10-CM & ICD-10-PCS Mapping. Simple mapping capabilities and complex combination mapping information for diagnosis and procedural information enables users to get a head start on learning the new ICD-10 coding system. Identifies GEM and Optum recommended mappings.
NEW! ICD-10-PCS Code Builder. Learn the complexities of the new coding system while you identify codes.This intuitive electronic format helps you understand the relationships between root operation, body system and section. Definitions and guidelines provide insight to help you get you up to speed and ready for the new coding system.
OptumEdge—Robust medical necessity checker and ABN generation tool. Used to screen physician orders and generate an advance beneficiary notice (ABN) to get patient signature. This valuable tool can help hospitals decrease write-offs, improve and obtain revenue capture, decrease claim denials, automatically produce required forms for patients in advance of service, and help inform patients for point-of-care decision making.
OptumEdge—Essential DRG calculator. The DRG calculator gives you a more accurate DRG-level payment rate using hospital-specific DRG calculations for each DRG based on the operating and capital values in effect for each provider number.
OptumEdge—APC Calculator. Sophisticated outpatient calculator helps you validate and manage outpatient APC and composite APC reimbursement under Medicare, identify and resolve underpayments, and determine the patient’s copayment amount.
Access a complete library of medical code sets, UB-04 billing and coding tips, and reimbursement information. Address problems that are core to hospital revenue cycle processes.
Simplify research processes and boost productivity. Use the robust search engine to quickly find codes you are looking for—using acronyms, abbreviations, or medical terms. Plus, exclusive code crosswalks and coding tips provide quick links from clinical codes to CMS source documentation, billing, and reimbursement information.
Historical data organized by quarter. Nine quarters of historical data enables you to resolve older claim problems using the codes, billing, coverage, and reimbursement rules in effect at the time the service was provided.
Resolve leading coding and billing errors and prevent rejections. Use the latest UB-04 data set and Medicare billing guidelines as well as revenue codes linked to CPT®/HCPCS codes.
Complete, updated Part A LCD policies and medical necessity data and national coverage determinations (NCDs) with crosswalks to CPT®/HCPCS, ICD-9-CM, revenue codes, and type of bill codes.
CPT® is a registered trademark of the American Medical Association.