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VitalKnowledge™

Now there's a single source for all areas of care.

VitalKnowledge is your single source for advanced coding, regulatory and reimbursement resources, compliance and revenue cycle. It gives your coding teams access to meaningful and current information critical to the goal of achieving accurate, compliant coding and reimbursement. Enjoy accurate results, faster.

User-defined, single-screen display of code-specific information

This unique interface lets users review payment information, related codes, coding guidelines, wage-adjusted tables and modifiers without alternating screens and losing search criteria. Users can customize and save their view for future logins.

Access to current and historical coding and billing references

Eliminates the need for multiple hard copy resources and websites for users throughout your organization, providing content update transparency to assure accurate, timely and meaningful information.

CodeValidate™ Module

Checks code pairs for possible Medicare medical necessity or bundling issues with easy verification of NCD, LCD and NCCI edits. An MS-DRG grouper and OPPS payment calculator are also available to assist in providing Medicare reimbursement guidance.

More Benefits

ICD Crosswalk and Mapping

Facilitates quick identification of ICD code options for a single code or a set of codes.

MyAdvisor™

Review and receive guidance on your toughest IP, OP, Professional and ASC coding and billing challenges.

CodeValidate™ Module

Checks code pairs for possible Medicare medical necessity or bundling issues with easy verification of NCD, LCD and NCCI edits.

VitalAlerts™

Provides notifications of inpatient and outpatient coding and compliance updates according to user-defined profiles.

Add-Ons

VitalABN™

Quickly validate medical necessity through user-defined forms and up-to-date local and national coverage determination information; instantly produces any required Advanced Beneficiary Notice for patients.

OPPS Calculator

Knowing upfront what could cause rejection of our claims is preferable to waiting for a clearinghouse to pass back negative returns. Our OPPS  Calculator is your essential tool to avoid the wait and to rightful reimbursement.

Data Sets and Coding Resources

Provide your users access to additional data sets and coding resources directly from VitalKnowledge. Access to AMA CPT® Assistant, AHA Coding Clinics® (HCPCS, ICD-9-CM and ICD-10-CM/PCS), ADA CDT content and ASA Anesthesia editorial content.

Benchmarking/Peer Comparison

Provide financial pricing information based on defined peer hospital groups for CPT/HCPCS codes.

VitalABN™

This add-on allows staff to quickly validate medical necessity through user-defined forms and up-to-date local and national coverage determination information, and quickly produces any required Advanced Beneficiary Notice for patients. The robust design and customizable user interface saves time and minimizes frustration.

Key Benefits

  • Additional code information through VitalKnowledge directly from the results screen
  • Secure, custom access for authorized users
  • Minimal IT involvement, web-based platform allows for automatic updates and access
  • Generates government mandated ABN required by CMS in a PDF format (English & Spanish)
  • Multiple pricing field options available
  • Leverages charge description master (CDM) descriptions and pricing with the additional purchase of VitalCDM™

OPPS Calculator

VitalWare's OPPS Calculator module intuitively alerts users of which charge items will be paid, not paid, or subject to payment reductions based upon the rules outlined in the CMS Integrated Outpatient Code Editor (I/OCE) specifications.

The VitalWare Advantage:

  • Quickly evaluate expected wage-adjusted payments on claims and/or identify claims rejected for non-payment.
  • No additional research necessary, a detailed explanation accompanies each line item subject to reimbursement variation, allowing users to easily gauge the impact of coding changes before the claim is even submitted.
  • The most intuitive and organized user interface: Our OPPS Calculator surfaces procedures qualifying for a complexity adjustment as well as other edit explanations and expected reimbursement.

VitalWare's OPPS Calculator provides (but is not limited to) the following types of validations and calculations determining net payment amounts:

  • Claims subject to OCE edits resulting in claim rejection, denial,
    suspension, and return to provider. Line item rejections or line item denials are identified along with explanation of the issue(s) triggering the edit.
    • Applicable complexity adjustments and procedure discounts are auto-calculated and explained on a line-item basis.
    • The impact of modifiers and revenue codes affecting payment is included in the final calculations.
    • VitalWare's OPPS Calculator includes the special processing conditions applied to OPPS claims.
    • Wage-adjusted composite APC payments are now calculated.

Take the next step.

Contact one of our world class Product Specialists to schedule a live demo.

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