Observation Charging Application
All hospitals continue to face the challenge of understanding Medicare
rules about observation charging. The rules seem to change on an
annual basis. Whenever Medicare makes a significant change to
observation-related charge rules, it requires a process change for multiple
departments within the hospital to appropriately capture revenue.
Reliable observation charging
At one time, reimbursement from observation services played a small role in a
hospital’s overall financial health. But that has changed. Observation has its own
set of calculations and charging requirements that must be compliant with payer
expectations. The Optum™ LYNX Observation Charging Application can help
hospitals achieve appropriate and consistent charging in observation services.
The Observation Charging Application can help you:
•Achieve a consistent charging methodology for the patient observation encounter
•Accommodate the charging parameters that are affected by the patient’s origination,
acuity and payer
•Gain access to the Observation Charging Application from anywhere in the hospital
Observation services may address the cost-conscious environment that is a part of
today’s health care environment. Patients in observation may occupy the same space
and benefit from the same staff as those receiving inpatient care. However, there
are significant logistical and charging challenges that must be addressed in order to
receive proper reimbursement.
Hospitals need consistent and reliable
charging for observation services. The
Optum LYNX Observation Charging
Application provides the support to
achieve this.
The Observation Charging Application assists hospitals in addressing their
compliance concerns, particularly with respect to the hospital meeting Medicare
and other payer reporting requirements. To maintain the infusion hierarchy for
the services administered during the patient’s initial treatment encounter, the
Observation Charging Application includes the Optum LYNX Infusion Charging
Application.
Another key feature is the ability to easily calculate carve-out time for procedures
performed outside of observation monitoring. The Observation Charging
Application is a key component to a comprehensive and consistent charging
methodology.
Flexible and scalable deployment
The Observation Charging Application is a web-based application that can be
easily deployed from a single user to multiple centers and facilities.
Audit support
The Optum LYNX algorithms were developed and are managed by an experienced
team of compliance experts. In the event of a payer audit, Optum360 will provide
auditors with information to help gain an understanding of how the Observation
Charging Application adheres to charging regulations and guidelines.
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Performance monitoring
Optum360 supports its clients with performance monitoring that sets the standard
for results analysis for the revenue management industry. Optum360 provides
insight on the potential value of an Optum LYNX Outpatient Charge Capture
application before implementation and continues with quarterly analytic reports to
provide insight on charging patterns and other key operational metrics.
Key features
• Observation duration time.
Calculates total reportable observation
units for assigning Medicare G-Codes.
• Observation charging severity. CPT based assignment accounts for patient’s
observation, care, and discharge.
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• Procedure carve-out time. Accounts
for actively-monitored procedures
from the reportable observation time;
calculations can be based on average or
actual exclusion time.
• Infusion services support. Maintains
the infusion charging hierarchy from the
patient’s initial treatment encounter; the
intuitive user interface allows clinicians
to focus on clinical documentation.
• Procedure charge capture. Accounts
for separately billable procedures.
• Diagnosis coding. ICD-9 and ICD10 coding with general equivalence
mapping (GEM) tool.
Standardized charging for
observations services.
CPT is a registered trademark of the American Medical Association.
For more information:
Call: 866.223.4730
Email: [email protected]
Visit: www.optum360.com
www.optum360.com
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