UPMC Offers Coding, Revenue Cycle Services

The University of Pittsburgh Medical Center has launched a coding and revenue cycle management outsource service for other hospitals and physician practices, bringing to the market capabilities it has developed in-house during the past eight years.

The service, called Ovation Revenue Cycle Solutions, is intended to streamline processes and improve the quality of revenue cycle lines, says April Langford, CEO at Ovation. Under the program, Ovation obtains discrete eligibility verification and claim status data that is available on health insurer websites that coders can use to improve claims submission/payment cycles. These include discrete eligibility data such as a patients’ progress toward meeting their deductibles and CPT code authorization that verifies that a service is authorized to be performed. To improve visibility into claims status, Ovation can deliver to clients proprietary codes needed to adjudicate a denied claim.

Ovation also offers three types of outsourced coding services that can be purchased separately or as a package. They include:

* Outsourced coding and quality assurance operations, with a minimum 48 hour turnaround time and at least a 95 percent accuracy rate.

* Run claims through 600 regulatory and risk edits to find the claims that need more work before submission and also identify missing edits to claims that Recovery Audit Contractors and other payer contractors regularly flag. The editing process also identifies issues of concern under value-based reimbursement arrangements, giving clients insight into certain matters such as patient falls and present-on-admission indicators to ensure claims are coded appropriately.

* Focus on audit reviews by having UPMC coders take another look at claims to identify deficiencies in claims or particular coders.

In developing Ovation in-house and with other hospitals, UPMC learned how to reduce “Discharge, Not Final Billed” incidents where a patient is discharged but not yet billed because of missing or incorrect information from the patient, physician or other sources. The organization also has reduced costs and now is better aware of where it needs to over-audit and where it can under-audit, Langford says. UPMC also learned that there is significant variation in the market on the quality and cost of outsourced coding.

Ovation exhibited at the HFMA ANI conference in Las Vegas in late June, which was its first trade show, and was pleased with the traffic to its booth, Langford adds. More information is available here.

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