Outpatient Prospective Payment System Calculator
Know upfront what can cause claims rejection rather than wait for a clearinghouse to pass back negative returns.
Know About Risks Upfront
OPPS Calculator intuitively identifies items that will be paid, not paid, or subject to adjustment based upon CMS Integrated Outpatient Code Editor specifications.
Determine Net Payment Amounts with the Following Validations and Calculations
- Claims subject to OCE edits resulting in rejection, denial, suspension, and return to provider
- Applicable complexity adjustments and procedure discounts are auto calculated and explained on a line-item basis
- The impact of modifiers, revenue codes and condition codes affecting payment is included in the final calculations
- Includes special processing conditions applied to OPPS claims
"With VitalWare's OPPS Calculator, we are twice as productive, cutting our processing time in half."
-Hackensack Meridian Health
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