Hospital Software Solutions

Software Solutions 2017-09-12T11:48:54+00:00

Charge Capture Software Solution

Over 20 years of experience in performing hands-on lost charge recovery engagements has resulted in the development of truly unmatched revenue capture software. Our unique cloud based OCExaminer Charge Capture solution is designed to optimize your hospital's revenues by analyzing every claim to ensure that any potentially missing charges are identified prior to submitting the bill.

There are five core components of OCExaminer’s Lost Charge Recovery (LCR) edits:

Interventional Radiology
Drug Administration
Carve Outs
Proprietary LCR Edits
User-defined Edits

OCExaminer typically identifies between 8% and 15% potential error rate on previously scrubbed claims. It also helps you ensure compliance by automatically checking for:

Medicare and Medicaid coding issues
RAC alerts
NCDs and LCDs

OCExaminer is a web-based application and provides your users with a familiar UB-style interface for making corrections. This ensures rapid deployment and adoption by your team since there’s nothing to install or configure and training is minimized through superior design.

The result is a solution designed to work with your billing staff, allowing them to easily make corrections and identify opportunities. The ROI is almost immediate and capturing these additional revenues can significantly impact to your bottom line.
Interventional Radiology

OCExaminer analyzes your outpatient claims to identify any potentially missing or inappropriate companion codes. Robust edit logic helps you navigate through the complexities of interventional radiology by ensuring all appropriate procedures are reported.

Drug Administration

OCExaminer analyzes your outpatient claims to identify any coding issues and potentially missing charges for drug administration, including chemotherapy, for all payers. Our edits are based on the AMA's drug administration hierarchy and help ensure proper coding and reporting of these services.

Carve Outs

OCExaminer analyzes both outpatient and inpatient claims to identify potentially missing charges. Examples, include: Implants, Radiological contrast, High-cost drugs, and Blood transfusion components. If the claim has not been submitted to the payer, the facility can choose to either hold it for correction or send it on and subsequently create an adjusted claim after a review has been completed.
Proprietary Edits

OCExaminer analyzes your claims based on the common problems we find during our audits. Examples include: surgery without recovery time, conscious sedation without recovery time, and missing anesthesia charges.

User Defined Edits

OCExaminer provides the user with tremendous power and flexibility in creating user-defined edits. Your edits can be as simple or as complex as the scenarios that you need to evaluate. Edit criteria are "grouped" together and can be considered inclusively or exclusively with another group. Each group can have an unlimited number of criteria. It might sound complex - and that's because the logic and processing is - but considerable thought was given to the design to ensure that creating your own edits is simply selecting criteria from a list.

Rac Alerts

OCExaminer analyzes both your inpatient and outpatient claims to help you identify any claims that contain potential RAC issues. These alerts can be used to determine possible claim errors on the front end, allowing any necessary corrections to be made before the claims are processed. Some current RAC Alerts covered in this module are: POA / HAC Units of blood administration, High-risk one-day stays, Wound care / debridement. We continue to add a lerts and/or modify them as CMS contractors publish issues to review.

Invalid Data Elements

OCExaminer analyzes all claims to identify any items that would prevent them from being accepted and processed by the payer. Examples include the validation of data elements, such as: dates, HCPCS codes, required fields, and much more Many RAC issues are addressed in this module. Occurrences of MUE's (Medically Unlikely Edits) and age appropriate procedures are validated within this module. OCExaminer allows for the correction of reported issues prior to submission.

Managed Care Edits

More and more, managed care companies are requiring the same billing practices as CMS. OCExaminer analyzes your managed care claims based on the PPS and OPPS regulations from CMS. By applying those edits to managed care claims, cash is accelerated and optimized.

Medicare Edits

OCExaminer analyzes your claims based on the PPS and OPPS regulations from CMS. In addition, NCD's and LCD's are provided for outpatient claims. Edit Reference Information is provided when available and multiple issues per line, per claim are also provided.

OCExaminer is maintained to reflect the most up-to-date requirements from CMS and is version-based, so claims for services provided a year or older can be analyzed against relevant guidelines and regulations.
Medicaid Edits

OCExaminer analyzes your claims based on state-specific requirements for Medicaid, in addition to the federally required NCCI edits.

These edits are updated as changes are made to the rules.