Outpatient Prospective Payment System Calculator

OPPS Calculator

Know upfront what can cause claims rejection rather than wait for a clearinghouse to pass back negative returns.

Product Overview

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

Complete Access to VitalKnowledge™

We give you the added benefit of access to the most current regulatory information critical to accurate, compliant coding and reimbursement.

Features / Benefits
Competitive Advantage

"With VitalWare's OPPS Calculator, we are twice as productive, cutting our processing time in half."

-Hackensack Meridian Health

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