ReviewMate

Outpatient - OPPS

The Outpatient Prospective Payment System (OPPS) is the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care provided to patients with Medicare. Reimbursement is based on Ambulatory Payment Classification (APC) assignment.

Correct APC assignment is critical to the health of your organization. Coding audits, as well as using the proper tools will, allow financial and compliant stability.

The ReviewMate platform assists medical coding auditors analyze specific elements affecting APC assignment and reimbursement.

In addition to ReviewMate's standard features for auditing, our OPPS module features:

  • Accuracy rates by Patient Types (observation, ED, clinic, etc).
  • Ability to assign responsibility on the line-item level to obtain individualized accuracy rates for the different contributors to the UB-04 (coder, charge team, radiology, etc).
  • Identification of line-items that were recalculated as a result of another line-item revision.
  • Support for Profee audit within the OPPS module.

All auditing account types are considered part of the core of ReviewMate's auditing system that covers many features such as:

  • Customizable settings for analyzing overall accuracy rates. Adjust for particular coders, tasks or firms.
  • Built-in code look-up for performing research intuitively.
  • Conversations between the auditor and coder are saved in a chronological manner and can be accessed by any user.
  • Customizable dashboards to enhance the user experience.
  • Identification on the screen of codes with CMS-HCC values.
  • Grouping and pricing take place within the software eliminating the need for auditor to "toggle" between an encoder and ReviewMate for better resequencing decisions.
  • Full suite of edits/warnings including gender and age conflicts, MCE edits, critical error and TruCode warnings.
  • Accuracy rates available real-time and can be sliced and diced to accommodate different situations and date patterns.
  • Multiple user levels allow view-only access to any interested parties providing transparency within your organization.
  • Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, Clinotes, Principal Diagnosis Analysis, DRG Analysis, and AHA Coding Handbook
  • Reconciliation of rebuttals occurs inside of ReviewMate.
  • Extensive library of customizable and exportable reports from raw data to Executive Summaries.
  • "Audit the Auditor" available for a higher-level quality check of any audit in ReviewMate.

Any particular questions or inquiries? We'd like to hear from you.

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