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Publisher: Optum360
Experts: Denise Smith
Sample Pages:  View PDF

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RevenueCyclePro.com is an up-to-date, online coding referential tool hospitals can use to access data and medical code sets; answer questions about coding, billing, coverage, and reimbursement; and resolve edits, problems and issues to minimize non-compliance exposure.

This comprehensive tool includes access to ICD-10 code sets, ICD-9 to ICD-10 mapping information, crosswalks, updated Medicare LCD and NCD policies, revenue codes, UB-04 billing tips and an enhanced APC calculator. 

See all the available add-on modules for RevenueCyclePro.com.

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Features and benefits

  • Optum360 Edge The robust compliance editor and ABN generator tool. Powered by claims manager, scrubs at the claim level for Medicare, Medicaid and commercial compliance, enabling you to capture and correct errors before submittal for fewer denials and provides official LCD, NCD and CCI source material based on date of service, which can assist in the denial resolution process. Additionally, this tool can be used to generate an advanced beneficiary notice (ABN) for patient signature.
  • Optum360 Edge DRG Grouper Calculator Add-on Available. Group diagnosis and procedure codes to DRGs using the same EasyGroupTM  logic that many major industry systems are using. Obtain provider-specific reimbursement, including outliers, for the DRG using the powerful add-on tool.
  • Optum360 Edge — APC Calculator. Sophisticated outpatient calculator helps you validate and manage outpatient APC and composite APC reimbursement under Medicare, identify and resolve underpayments, and determine the patient’s copayment amount.
  • Access a complete library of medical code sets, UB-04 billing and coding tips, and reimbursement information. Address problems that are core to hospital revenue cycle processes.
  • Simplify research processes and boost productivity. Use the robust search engine to quickly find codes you are looking for—using acronyms, abbreviations, or medical terms. Plus, exclusive code crosswalks and coding tips provide quick links from clinical codes to CMS source documentation, billing, and reimbursement information.
  • Historical data organized by quarter. Nine quarters of historical data enables you to resolve older claim problems using the codes, billing, coverage, and reimbursement rules in effect at the time the service was provided.
  • Resolve leading coding and billing errors and prevent rejections. Use the latest UB-04 data set and Medicare billing guidelines as well as revenue codes linked to CPT®/HCPCS codes.
  • Complete, updated Part A LCD policies and medical necessity data and national coverage determinations (NCD) with crosswalks to CPT®/HCPCS, ICD-10/ICD-9-CM, revenue codes, and type of bill codes.
  • Access information from top-selling Optum360 DRG products, such as the DRG Expert and DRG Desk Reference. With a click of your mouse, you will be able to identify new ICD-10/ICD-9-CM codes, the DRGs they group to, all ICD-10/ICD-9-CM codes associated with each MDC and DRG, detailed DRG, RW and length of stay information, transfer DRGs, and DRGs that may be optimized. Guidelines are designed specifically for improving hospital reimbursement and financial forecasting and alerting the facility to possible coding problems.
  • Comprehensive DRG data and documentation guidelines guide your coders to better and more compliant code assignment. Identify what generates a CC, which DRGs have the potential to be optimized, and which codes group to targeted DRGs.
  • Make sure you are using CPT®, HCPCS Level II, and ICD-10/ICD-9-CM codes correctly. Lay descriptions, code book annotations, images, and Optum360 proprietary content will help you make sure that the procedure, drug, item, and diagnosis codes submitted on claims are valid, accurately assigned, and appropriately linked.
  • Easily find and resolve inpatient and outpatient edits using one source. Edit icons identify facility PPS edits—outpatient OCE, MUEs, device code edits, hospital CCI edits, and all inpatient MCE edits. Plus, clear edit explanations and edit resolution tips help you resolve them. Understanding how to resolve claim edits is one of the keys to improving your denial management process.
  • Link clinical code sets to billing and payment information. Help your staff make the correct coding decisions and increase the efficiency across every revenue cycle department.
  • Improve coordination and problem-solving among key revenue cycle departments such as HIM, CDM, PFS, and admitting. This will help improve revenue capture and accelerate cash flow.
  • Cross-coding relationships. Quickly link to codes that are unique to hospital billing, codes used with specific revenue codes, interventional radiology codes, and related surgical procedures.
  • Exclusive code crosswalks, links and coding tips simplify the research process and increase productivity. Crosswalk from ICD-10/ICD-9-CM procedure codes to CPT® or HCPCS Level II procedure codes; ICD-10/ICD-9-CM, CPT®, and HCPCS Level II codes to Medicare inpatient, outpatient, and device code edits; clinical codes to CCI, OCE and MCE edits, modifiers, revenue codes, coverage and related procedures, and CPT® or HCPCS Level II codes to revenue codes.
  • ICD-10-PCS Code Builder. Learn the complexities of the new coding system while you identify codes. This intuitive electronic format helps you understand the relationships between root operation, body system, and section. Definitions and guidelines provide insight to help you get you up to speed and ready for the new coding system.
  • Uniform Billing Editor eBook. Directly access the comprehensive Uniform Billing Editor eBook for definition of and requirements for each Field Locator. Understand billing structures such as Type of Bill Codes and Revenue Codes, and access proprietary UB-04 billing and coding tips that address problems that are core to hospital revenue cycle processes

The price of RevenueCyclePro.com does not include add-ons. Add-ons sold separately:

Click here to view all the available add-on modules

  • AHA Coding Clinic® for HCPCS Add-on (Item WA03 & WA03C)
  • AHA Coding Clinic® for ICD Add-on (Item WA02 & WA02C)
  • AMA CPT® Assistant Add-on (Item WA01)
  • AMA CPT® Changes: An Insider's View Add-on (Item WA27)
  • The AMA CPT® Content Module Add-on (Item WA34)
  • Total CPT® Add-on (Item WA37)
  • The ASA CROSSWALK® Add-on (Item WA24)
  • Claim Appeal and Denial Support Add-on (Item WA32)
  • Clinical Documentation Improvement Add-on (WA35)
  • Coders' Dictionary Add-on (Item WA05)
  • Dental Codes Add-On (Item WA23)
  • Dr. Z’s Medical Coding Series: Interventional Radiology Add-on (Items WA30 & WA31)
  • DRG Grouper Calculator Add-on (Item WA33)
  • DrugReimbursement.com Add-on (Item WA08)  
  • ICD-10 Essentials: Operation PCS Add-on (Item WA39)
  • Post-acute Care Add-on (Item WA38) 
  • Stedman's Medical Dictionary Add-on (Item WA04)

CPT is a registered trademark of the American Medical Association.


Start a Free Trial > Click here

Schedule A Demo > Click here

For a video demo of RevenueCyclePro.com, Click here.

Content Experts

Denise  Smith - Denise is the product manager for eFacility Solutions and has been with Optum360 for 24 years. During that time, she spent 10 years working closely with the chargemaster consulting team, and, prior to accepting her most recent position, was training as a junior consultant. She earned a Bachelor of Science degree in nursing from the University of Utah and is a certified coding professional.

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