Discover Even More Clinical Coding Content with Add-on Modules

Transcription

1 Discover Even More Clinical Coding Content with Add-on Modules In addition to the wealth of coding content we provide, Optum360 also delivers current and historical AMA, AHA, ASA, ADA, CDI, DRG, PAC, content and more. Discover all the possibilities of using an Optum360 webbased coding product. Ryan Devey, Physician esolutions Product Manager

2 Presentation disclaimer All of the information provided is believed to be accurate and reliable; however, Optum360 assumes no responsibility for any errors. Optum360 is providing this information for educational purposes only and not as a replacement for professional judgment and experience; therefore any use of this information is at your sole risk and Optum360 neither assumes nor is responsible for its use. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2

3 The complete coding tool: 1 Core coding content (CPT HCPCS, ICD10) with complete code book content (indexes, guidelines, appendixes, etc.) 2 Updates: Provides the most current information available with access to historical content Code compliance and claim review (commercial payers, Medicare, Medicaid) Coding content from the source; coding organizations that create the guidelines, such as the AMA, AHA, ASA, ADA, CMS, Dr. Z, Micromedex and many more An Optum360 web-based tool has all of this to give you back time and money Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3

4 What you may already know Optum360 offers real-time, web-based coding tools designed specifically for users to quickly and accurately access and assign codes. Search, research, validate and print: CPT HCPCS ICD-9-CM v1, v2, v3 ICD-10-CM and PCS Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4 4

5 Content you know Features include, but not limited to: CodeLogic Search Engine Color code edits (over 30 icon alerts per code type) Lay descriptions/annotations Deleted code crosswalk Real-time updates User notes and favorite lists Print code summary All code book resources (indexes, tables, appendixes, notes, guidelines) ICD-10-CM/PCS and HCPCS crosswalks Modifier crosswalks with sourcing Future codes PQRS (MIPS) per code CMS HCC information Medicare CCI (Correct Coding Initiative) edits MPFS Fee Calculator (with reductions) LCD/NCD policy lookup tools A complete claims review tool (Compliance Editor Powered by Optum ClaimsManager) Merck Manual Content (NEW!) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5

6 What you may not know add-on capabilities Core coding combined with coding guideline information you need from the coding sources you know. Post acute care AMA CPT content CDI AHA coding clinics ASA and dental cross-walks Advanced claim review and sourcing Core coding CPT, HCPCS, ICD10 Specialty articles Dr. Z intervent. radiology DRG grouping NDCs, and other drug info Access to historical content Claim appeal and denial support Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6

7 I just purchased an Optum360 webbased product why do I need one of these add-ons? Optum360 EncoderPro.com Expert has cut down on the number of rejections, reduced rework and decreased the average number of A/R days. It has also improved our productivity and ensured that we get reimbursed properly for the services we provide. Mary Beth DeGray Revenue Cycle Manager Indian Stream Health Center Content specific to your needs Added value from content these organizations deem highly proprietary Produce efficiency and accuracy well above and beyond simple code lookup Volumes of historical content without additional physical space Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7 7

8 The AMA CPT Content Module The American Medical Association (AMA) Content Module Add-on includes three different publications IN THEIR ENTIRETY: The CPT Assistant Newsletter. Every article from every monthly edition for multiple years. The CPT Changes: An Insider s View. Every publication from 2006 to The AMA Knowledge Base: Access to thousands of answers to questions asked by AMA members and customers regarding CPT codes and their use. AMA/Optum360 EXCLUSIVE: Users have the ability to access any publication in its entirety. Users no longer are limited to just articles associated with codes. AMA/Optum360 EXCLUSIVE: Users can gain unique insight into a CPT code by accessing questions asked by coders who use these CPT codes. If you have a question about the use of a CPT code, chances are, others had that same question, asked, and the AMA provided an answer. AMA/Optum360 EXCLUSIVE: Search by newsletter month/year, keyword, code, etc. Access years of newsletters, publications, and questions. There are literally hundreds of volumes of content, all easily searchable by code/keyword, and we add to the library each month with the latest newsletters and question/answers from the AMA. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8

9 The AMA CPT Content Module Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9

10 The AMA CPT Content Module Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10

11 The Clinical Documentation Improvement add-on The Clinical Documentation Improvement (CDI) add-on includes four different sources for CDI improvement content: Optum360: The ICD-10-CM Clinical Documentation Improvement Desk Reference Optum360: The Guide to Clinical Validation Documentation and Coding Reference Optum360: Physician Consulting ICD-10-CM CDI Improvement Training Content Optum360: Clinical Documentation Guidelines for Facilities Identify and clarify... any confusing, incomplete, conflicting or missing information in the physician-documentation portion of the health recorded that is related to diagnoses or procedures. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11

12 The Clinical Documentation Improvement add-on (cont.) Search clinical terms, codes, keywords, print and/or documentation that can be necessary for any clinician, coder or any other health care individual needing information for accurate code identification and a more robust and accurate depiction of patient severity. Foster and enhance... communication between members of the CDI team, coders, and medical staff. Provide ICD-10-CM education to medical staff members on the increased granularity inherent in ICD-10-CM and how it necessitates more detailed documentation in the medical record, as well as educating coding staff members clinical knowledge as it relates to the specificity in ICD-10. Provide continuity of care for the patient, between members of the health care team that rely on documentation in the health record for determining ongoing treatment decisions. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12

13 The Clinical Documentation Improvement Add-on Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13

14 The AHA Coding Clinics (ICD and HCPCS) Access to a complete library of all AHA Coding Clinic newsletters in their entirety (volumes and quizzes back to 2001 for HCPCS and 2003 for ICD). The most up-to-date advice on correct code assignment of HCPCS supply and service codes (AHA Coding Clinic HCPCS) The most current code assignment information based on new technologies and newly identified diseases (AHA Coding Clinic for ICD) Capabilities to: See all articles specifically tied to any HCPCS or ICD code for official coding guidelines and advice from the source Search by year/quarter and see the all the newsletter articles and quizzes in any of those quarterly publications Search any newsletter article by keyword, code or modifier, or by ICD9 or ICD10 specifically Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14

15 The AHA Coding Clinics (ICD and HCPCS) (cont.) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15

16 DrugReimbursement.com This online drug coding and reimbursement reference tool and database that provides up-to-date Medicare coding, billing, and reimbursement information for FDA-approved drug codes as well as AWP and WAC pricing and any NDC for any drug, generic or by manufacturer. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16

17 DrugReimbursement.com (cont.) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17

18 Optum360 specialty articles Access to the most recent and relevant specialty newsletter content available today. This specialty information is derived from multiple specialty organizations such as the ASA or AAOMS and other notable coding sources like the AMA and CMS. This give you information that will not only assist you to understand the nuisances of your specialty, but to better code those unique circumstances based on your specialty. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18

19 Post Acute Care Designed specifically to address the challenges faced by home health, hospice, skilled nursing and rehabilitation services. This add-on delivers access to every description, guideline and instruction in the Post-Acute Care Expert code books, but in a more convenient format and just as affordable. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19

20 DRG Grouper Quickly group diagnosis and procedure codes to their applicable DRG and exact provider s reimbursement for both ICD-9 and ICD-10 codes. This logic has formerly been very expensive and very proprietary, only affordable to large organizations. Now any organization can do DRG grouping with the same logic at a fraction of the price. Possibly the add-on with the most value of any other Optum360 add-on. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20

21 DRG Grouper (cont.) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 21

22 Claim Appeal and Denial Management After a complete scrub of your claim, whether it is a single claim or your entire 837 batch, identify any coding issues and the sourcing of that coding guideline even for state level Medicaid. Also includes E&M logic support and auditing tools. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 22

23 Claim Appeal and Denial Management (cont.) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 23

24 Claims Batch Editing (837 file) and Claim Repair This tool not only provides the capability to review hundreds of coding compliance checks for Medicare, Medicaid and commercial payers, but it has the capacity to do so on all your claims on your 837 batch file before it is submitted for adjudication from your payer. Don t be fooled this goes well above and beyond the claim review your clearinghouse may claim to do. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 24

25 Dr. Z s Medical Coding Series: Interventional Radiology Coding Reference This add-on gives you access to the appropriate coding and charging for both vascular and non-vascular Interventional Radiology procedures, covering rules for physicians and hospitals. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 25

26 ASA and Dental (ADA) Code Crosswalks Obtain crosswalk information from both the ASA and the ADA information from CPT to Dental or Anesthesia codes, and vice versa, as well as other information about these important code sets (e.g., base units). ASA Crosscodes and information Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 26

27 ASA and Dental (ADA) Code Crosswalks (cont.) Dental Crosscodes and information Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 27

28 Thank you. Contact information: Tom Shiner Outbound Sales Manager