Outpatient Claim Analysis & Rebilling Solutions

The Outpatient Prospective Payment System ("OPPS"), implemented in 2000, significantly changed the method by which hospitals are paid for services to Medicare outpatients. Unfortunately, the transition to OPPS has been confusing and difficult, and most hospitals have opportunities to correct historical claims. The daunting challenge, however, is to analyze thousands of claims to find the rebilling opportunities.

We can help. The "Outpatient Claims Analyzer", our proprietary software tool, will allow our consultants to review all of your Medicare claims and identify rebilling opportunities. Our edits are far more comprehensive than Medicare's "Outpatient Code Editor" since our software is based on our extensive technical and clinical experience.

Getting started is easy and begins with processing your available electronic claim files through our software to identify potential rebilling opportunities.

Once your claim files have been processed, we will:

• Provide a prioritized list of claims for gathering associated medical records and detailed bills.
• Analyze the information to determine any changes required for an adjustment claim. Please note that we will identify any changes that may have either a positive or negative impact to reimbursement. This is important for compliance purposes.
• Provide specific changes in HCPCS/CPT codes, UB-92 revenue codes and units for each claim. This can serve as supporting documentation for generating the adjustment claims.
• Assist with filing the adjustment claims to your fiscal intermediary.
• Quantify the expected reimbursement from our recommended changes.

For more information regarding SunStone Consulting Outpatient Solutions, please contact Tim Mosco at 717-469-0386, or via email at timmosco@sunstoneconsulting.com.