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OPPS Calculator

A New Standard For Outpatient Billing Efficiency


Vitalware OPPS Calculator puts you in control of your own outpatient (OP) billing. OPPS Calculator is an analysis tool designed specifically to help quickly and accurately determine appropriate wage-adjusted reimbursement for hospital OP claims before sending them out, and to audit reimbursement after the claim is paid.

Feel The Benefits

With Vitalware OPPS Calculator, your team will be able to proactively manage down your hospital’s AR queue. When your team is able to quickly determine expected reimbursement for outstanding claims and submit clean claims the first time, your facility gains some serious benefits.

INCREASED CASH FLOW

Calculating the expected reimbursement of your OPPS claims upfront gives your billing team the information they need to prepare and submit clean claims the first time, leading to timely reimbursement, and far less time spent reworking denied claims.

OPERATIONAL EFFICIENCY

With an easy-to-use interface and complete information, your team will work more efficiently, and you won't have to rely on outside resources to prepare or review your billing.

BETTER FORECASTING

If you're under pressure to reduce AR days, and your current process or clearinghouse has you treading water, let us show you how the Vitalware OPPS Calculator can help you quickly work through your backlog and dramatically reduce denials and AR days.

Vitalware's OPPS Calculator is an incredible, time-saving tool giving us immediate benefit. With the new OPPS Calculator, we are twice as productive, cutting our processing time in half. Consequently, we are also much more accurate at identifying underpayments, catching billing errors, and keeping our AR (Account Receivables) in balance.

Deana DeSalvatore Patient Account Analyst, Managed Care Hackensack Meridian Health

Pre-bill: Confident Claim Submission

Our OPPS Calculator determines reimbursement for hospital outpatient claims, and identifies line-items that will be rejected, denied, subject to payment reductions, or complexity adjustments, based on the CMS Integrated Outpatient Code Editor (I/OCE) specifications. OPPS Calculator also provides users with outlier reimbursement amounts for qualifying claims.

For claim preparation, OPPS Calculator identifies coding issues that might otherwise result in denials or line-item rejections, and provides a detailed explanation of the issue. This helps your team assure a clean claim is submitted the first time.

Post-bill: Accurate Reimbursement

It will help you make needed adjustments to denied claims, and guides users to the correct rule set based on the date of service. Overall, you'll see fewer denials, and be able to work this queue with greater speed and accuracy.

You’ll also be able to audit reimbursement once your claim has been paid to ensure that you received rightful reimbursement for procedures performed.

Validations

Vitalware’s OPPS Calculator also provides the following validations and calculations to help determine accurate net payment amounts.

OCE EDITS

Claim-level and line-item rejections and denials are identified, and an easy-to-understand explanation of the issue(s) triggering the edit is provided.

COMPLEXITY ADJUSTMENTS/PROCEDURE DISCOUNTS

Applicable complexity adjustments and procedure discounts are auto-calculated and explained on a line-item basis. The impact of additional procedure codes, modifiers, billing units, and revenue and condition codes affecting payment are all included in the final calculations.

Build A Better Revenue Cycle

OPPS Calculator will help you catch coding errors that can cause outright rejections or line-item denials. Post-bill, it will help you make any needed adjustments to denials, and audit reimbursements to make sure you're getting paid what you're owed.


OPPS Calculator will optimize your outpatient billing practice and the improvements will endure. Your team (and your bottom line) will love you for it.

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