Pam Petz, Vice President Optum360 Commercial Coding Division Cyndi Thomas, Vice President Optum360 HIM Solutions
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1 Pam Petz, Vice President Optum360 Commercial Coding Division Cyndi Thomas, Vice President Optum360 HIM Solutions
2 Our approach Coding Auditing Coder Knowledge 30 years of service 2.7M encounters coded thru Q Audit program through Compliance Division Comprehensive staff training domestic and global 2
3 Optum360 Commercial Coding Team Workforce Designated Team Coding Director Coding managers Consistent coder assignment Shared Service Team Coding supervisor/bench Coding monitors Education support based on monitor feedback Technical support 2 Domestic Directors 12 Domestic Managers 207 Domestic Coders 206 Global Coders 40 Auditor/Educators Coding Audit & Compliance Advisory council and education Separate reporting structure Supports Optum360 compliance plan 3
4 Our Coding Team Qualifications Our coders are employees of Optum360 (domestic and global) All coders are held to the same compliance and performance standards Active certification & membership through AHIMA and/or AAPC RHIA, RHIT, CCS, CCS-P, CPC, CPC-H, RNs with coding credential Proficient with Optum and Commercial encoders and CDI technology 4
5 Workforce Each client engagement includes: Coding Operations Manager Consistent Coder Assignment for Continuity Technical Support Team Quality Management Program 5
6 Balancing Coding Services and Client Expectations Chart Types OP Clinics Leveraging our Talent 100% certified coders servicing 60+ clients Facility Coding = 40 clients, Professional Coding = 30 clients Global teams operating out of India and Philippines Quality focused Experience with multiple coding systems/platforms Electronic Records Behavorial Health Inpatient & Observation Security/HIPAA Compliant Secure VPN (Citrix Log-in), Web Access View data no ability to save, copy or print data Physical segregated area with access controls for global coding Anesthesia Medical Coding Specialty Technology Agnostic Platforms: Experience with over 30 different coding software applications Experienced on CAC, 3M, Webstrat, Encoderpro, Revcyclepro, Lynx, E-code, etc Ambulatory Surgery (Pro and Facility) ED (Pro & Facility) Industry Changes/Client Requests OIG Work Plan Value Based Purchasing-shifts from volume to value Quality Measures (PQRS, PSI, HAC) Payment Models (MSSP, MACRA) Payer Denials/Appeals 6 6
7 Optum360 Revenue Cycle Management (RCM) Foot Print Front Office (Patient Access) Preregistration Scheduling Admitting and Patient Check in Insurance Verification, Authorization and Eligibility POS Collection Financial Counseling Medical Necessity Determination Middle Office (HIM Services) Charge Description Master (CDM) Contracting and Pricing Medical Records Clinical Documentation Transcription Coding/Auditing Release of Information Concurrent Review Extended Business Office (Patient Financial Services) Physician and Insurance Billing Cash Posting Insurance Follow-up Patient Calls Denial Management and Appeals Compliance and Risk Management Executive Health Resources (EHR), The Physician Advisor Company Denial Management and Appeals through to ALJ Concurrent Review Contracting and Pricing Scheduling Reporting/Analytics Letter Posting 7 7
8 Client Support and Collaboration turning coders into Super Heros 40% 35% 30% 25% 20% 15% Pre Lynx Apr-16 May-16 Jun-16 10% 5% 0% Level 1 Level 2 Level 3 Level 4 Level 5 8
9
10 Joining the Super Hero Team 10
11 Key takeaways: Our Differentiators Proprietary technology Competitive pricing Domestic and global scalability Dedicated client oversight, staffing & Compliance Program Optum Advantage 11
12 Thank you Pam Petz, Vice President Optum360 Commercial Coding Services Office Cyndi Thomas, Vice President HIM Solutions Mobile:
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