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Optum360 (Optum360)

230 products found

DRG Expert - (2 Volume set, shrink wrapped)

2-volume set, shrink wrapped

ISBN: 9781622545599
Optum360 (10/1/2020)

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DRG Expert - (2 Volume set, shrink wrapped)

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The DRG Expert has been a trusted and comprehensive reference to the DRG classification system for more than 25 years. Organized by major diagnostic category (MDC), the convenient and innovative book layout follows the logical MS-DRG decision process. This is a must-have reference for those who need to verify DRG information and accurately assign MS-DRGs concurrently or retrospectively based on ICD-10-CM methodology, which goes into effect October 1, 2020. Key Features and Benefits • Optum360 Edge — Visual indicators notify you of special alerts. Easily identify CC and MCC restrictions, special payment status, transfer DRG status, surgical/medical partitioning, and other requirements. • Optum360 Edge — Medicare CMS rate structure. Updated to provide current relative weight (RW), geometric mean length-of-stay (GMLOS), and arithmetic mean length-of-stay (AMLOS) for each MS-DRG under IPPS. • Optum360 Edge — MS-DRG structure. Every diagnosis and procedure code that defines each DRG is listed. • Optum360 Edge — LTC-DRG crosswalk and current rate structure. Know what the RW and length-of-stay data are for each MS-DRG under the LTCH prospective payment system. • Optum360 Edge — MDC diagnosis list. Complete list of mutually exclusive diagnoses defining each MDC. • Optum360 Edge — Transfer DRG symbol. Indicates a DRG selected as a qualified discharge that may be paid at the per diem rate. • Optum360 Edge — Average national payment. Listed for every MS-DRG as a quick benchmark comparison. • Easily locate the correct DRG. Use the numeric or alphabetic index to quickly identify a DRG based on its diagnosis or procedure code. • Surgical hierarchy table. Quickly find the DRG hierarchy for multiple procedure cases to help you assign the code that reflects the greatest resource utilization. • Alphabetic and numeric indexes. Search for DRGs by the numeric codes or by code titles for fast look-up. • Icons indicate which CC subclass the DRG belongs to based on the presence or absence of CCs or major CCs (MCCs). • Complete list of diagnoses considered CCs and MCCs. • List of those principal diagnoses that are their own CC and their own MCC. • Full titles for each MS-DRG. Selection of the correct DRG begins with knowing its accurate and complete description.

DRG Expert - eBook

e-Book

ISBN: 9781622545612
Optum360 (10/1/2020)

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DRG Expert - eBook

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ICD-10-CM Expert for Hospitals - (Spiral) with guidelines

Spiralbound

ISBN: 9781622545230
Optum360 (10/1/2020)

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ICD-10-CM Expert for Hospitals - (Spiral) with guidelines

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The 2021 ICD-10-CM Expert for Hospitals with Guidelines, with our hallmark features and format, makes facing the challenge of accurate diagnosis coding easier for acute care and longterm care hospitals (LTCH). This code book contains the complete ICD-10-CM code set, MCEs, and ICD-10 MS-DRG edits with symbols identifying codes for comorbidities/complications (CC) and major comorbidities/complications (MCC). Also identified are hospital acquired conditions (HAC) and CMS hierarchical condition categories (HCC). Delivery might be delayed beyond the October 1, 2020 effective date. Delivery is dependent on when the updated Official Guidelines for Coding and Reporting for 2021 are released from CMS. Key Features and Benefits • Optum360 Edge — Intuitive features and format. Visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, HCCs, QPP, and unspecified codes. • Coding tips. Coding tips are reviewed and updated and assist in appropriate code selection. • Clinical definitions. Clinical definitions help provide an understanding of complex ICD-10-CM diagnostic terms. • List of code changes and conversion table. A list of all 2021 new, revised, and deleted codes to identify at a glance code changes, plus an ICD-10-CM conversion table from the new and changed codes to the code previously used. • Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms • Guidelines with coding examples. Official Guidelines for Coding and Reporting including chapterspecific coding examples. • Detailed color anatomy illustration appendix. Many illustrations at the code level identifying specific code-related anatomy. • Downloadable files. CMS updates received after this ICD-10-CM Expert goes to print, including MCCs, CC Excludes PDx collection, and POA exempt codes. • Supplementary appendixes. Additional information provided for POA coding and reporting tutorial; code lists for CC, MCC, and other valuable appendixes.

ICD-10-CM Expert for Physicians - (Spiral) with guidelines

Spiralbound

ISBN: 9781622545117
Optum360 (10/1/2020)

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ICD-10-CM Expert for Physicians - (Spiral) with guidelines

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The 2021 ICD-10-CM Expert for Physicians with Guidelines, with our hallmark features and format, makes facing the challenge of accurate diagnosis coding easier. Developed specifically to meet the needs of physicians, the Optum360 codebook contains the complete ICD-10-CM code set, which is the cornerstone for establishing medical necessity, determining coverage, and ensuring appropriate reimbursement. Symbols in the tabular section identify codes associated with CMS quality payment program (QPP) measures and CMS hierarchical condition categories (HCC) used in risk adjustment (RA) coding. Supplementary appendixes available only in the expert edition include: pharmacology listings, Z codes for long-term use of drugs and associated drug names, and Z codes used only as primary diagnosis. Delivery might be delayed beyond the September 1, 2020 effective date. Delivery is dependent on when the updated Official Guidelines for Coding and Reporting for 2021 are released from CMS. Key Features and Benefits • Optum360 Edge — Intuitive features and format. Visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, HCCs, QPP, and unspecified codes. • Updated coding tips. Coding tips are reviewed and updated, and assist in appropriate code selection. • Clinical definitions. Clinical definitions have been added for a better understanding of complex ICD10-CM diagnostic terms. • List of code changes and conversion table. A list of all 2021 new, revised, and deleted codes to identify at a glance code changes for your specialty. Plus an ICD-10-CM conversion table from the new and changed codes to the code previously used. • Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms. • Guidelines with coding examples. Official Guidelines for Coding and Reporting including chapterspecific coding examples. • Helpful illustrations. Detailed color anatomy illustration appendix. Plus many illustrations at the code level identifying specific code-related anatomy.

ICD-10-CM Professional for Hospitals - (Softbound) with guidelines

Softbound

ISBN: 9781622545216
Optum360 (10/1/2020)

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ICD-10-CM Professional for Hospitals - (Softbound) with guidelines

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The ICD-10-CM Professional for Hospitals, with 2021 Guidelines, with our hallmark features and format, makes facing the challenge of accurate diagnosis coding easier for acute care and long-term care hospitals (LTCH). This code book contains the complete ICD-10-CM code set, MCEs, and ICD-10 MS-DRG edits with symbols identifying codes for comorbidities/complications (CC) and major comorbidities/complications (MCC). Also identified are hospital acquired conditions (HAC) and CMS hierarchical condition categories (HCC). Delivery might be delayed beyond the October 1, 2020 effective date. Delivery is dependent on when the updated Official Guidelines for Coding and Reporting for 2021 are released from CMS. Key Features and Benefits • Optum360 Edge — Intuitive features and format. Visual alerts, including color-coding and symbols, that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, HCCs, QPP, and unspecified codes. • Updated — Coding tips. Coding tips are reviewed and updated and assist in appropriate code selection. • Clinical definitions. Clinical definitions have been added for a better understanding of complex ICD10-CM diagnostic terms. • List of code changes and conversion table. A list of all 2021 new, revised, and deleted codes to identify at a glance code changes for your specialty. Plus an ICD-10-CM conversion table from the new and changed codes to the code previously used. • Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms.

ICD-10-CM Professional for Physicians - (Softbound) with guidelines

Softbound

ISBN: 9781622545094
Optum360 (10/1/2020)

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ICD-10-CM Professional for Physicians - (Softbound) with guidelines

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The 2021 ICD-10-CM Professional for Physicians with Guidelines, with our hallmark features and format, makes facing the challenge of accurate diagnosis coding easier. Developed specifically to meet the needs of physicians, the Optum360 codebook contains the complete ICD-10-CM code set, which is the cornerstone for establishing medical necessity, determining coverage, and ensuring appropriate reimbursement. Symbols in the tabular section identify codes associated with CMS quality payment program (QPP) measures and CMS hierarchical condition categories (HCC) used in risk adjustment (RA) coding. Delivery might be delayed beyond the October 1, 2020 effective date. Delivery is dependent on when the updated Official Guidelines for Coding and Reporting for 2021 are released from CMS. Key Features and Benefits • Optum360 Edge — Intuitive features and format. Visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, HCCs, QPP, and unspecified codes. • Updated coding tips. Coding tips are reviewed and updated, and assist in appropriate code selection. • Clinical definitions. Clinical definitions have been added for a better understanding of complex ICD10-CM diagnostic terms. • List of code changes and conversion table. A list of all 2021 new, revised, and deleted codes to identify at a glance code changes for your specialty. Plus an ICD-10-CM conversion table from the new and changed codes to the code previously used. • Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms. • Guidelines with coding examples. Official Guidelines for Coding and Reporting including chapterspecific coding examples. • Helpful illustrations. Detailed color anatomy illustration appendix. Plus many illustrations at the code level identifying specific code-related anatomy.

ICD-10-PCS Expert - (Spiral)

Spiralbound

ISBN: 9781622545452
Optum360 (9/1/2020)

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ICD-10-PCS Expert - (Spiral)

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The ICD-10-PCS Expert is our spiral bound version of ICD-10-PCS with snap tabs to allow faster referencing of procedural terms in the index and sections in the tabular. It contains the complete ICD-10-PCS code set and all of the supplementary appendixes required for reporting of inpatient procedures. In addition, you will find the familiar Optum360 coding and reimbursement alerts you have come to rely upon, including the Medicare Code Edits (MCE) and ICD-10 MS-DRG edits. Intuitively organized into 17 sections of code tables with supplementary definitions tables and device and body part keys, the Optum360 ICD-10-PCS codebook sets the standard for coding accuracy, which is the cornerstone of healthcare analytics and revenue cycle management. Key Features and Benefits • Optum360 Edge — Color-coding and symbols for Medicare Code Edits. Includes our hallmark color-coding and symbols identifying ICD-10 MS-DRG MCEs for non-covered procedures, limited coverage procedures, combination only procedures, non-operating room procedures affecting MSDRG assignment, non-operating room procedures NOT affecting MS-DRG assignment, and hospital acquired condition (HAC) related procedures. • Approach illustrations. The approach illustrations show components that determine the approach, including access location, method, and instrumentation. • Body part definitions included in root operation tables. All terms listed in the body part definition appendix are included in the root operation tables for the Medical/Surgical section eliminating the need to reference the appendixes when selecting the correct body part value. • Illustrations. Illustrations of body parts with body part values accompany the Character Meaning tables in the Medical/Surgical section.

Uniform Billing Editor - eBook

e-Book

ISBN: 9781601519849
Optum360 (every Mar, Jul, Sep)

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Uniform Billing Editor - eBook

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Uniform Billing Editor (Updateable Binder)

Updateable Binder

ISBN: 9781601519832
Optum360 (every Mar, Jul, Sep)

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Uniform Billing Editor (Updateable Binder)

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Facilities can use this reference tool daily to manage the constant changes to the Medicare billing and reimbursement process. The Uniform Billing Editor provides detailed, accurate, and timely information about Medicare and UB-04 billing rules and assists the user with 5010 data and UB-04 and 837i requirements. Key Features and Benefits • Quickly locate topics based on field locators, revenue codes, or coding structures. This easy-to-use format is fully indexed and tabbed with icons for quick reference. • Quickly link HCPCS and CPT® codes to applicable revenue codes. This crosswalk helps you to prevent the most common reasons for rejections: mismatched revenue codes and CPT® or HCPCS Level II codes. • Crosswalk to 837 institutional claims. Provides links to 837i 5010 data elements and any applicable billing rules, facilitating easier transition to the 837i. • Coding and billing tips with quick access to official sources. Submit claims to Medicare accurately the first time, which helps reduce claim delays and denials. • Includes 5010 standards and provides detailed, accurate, and timely information about Medicare billing and reimbursement. • OCE and MCE edits. Identify data inconsistencies, potential rejections, and denials through OCE and MCE edits. • Timely updates throughout the year. Stay current with changes to help you eliminate billing with outdated information.

2020 Relative Values for Physicians eBK

ISBN: 9781622546855
Optum360

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2020 Relative Values for Physicians eBK

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2021 Relative Values Physicians DataFile

ISBN: XRVP21
Optum360

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2021 Relative Values Physicians DataFile

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Additional Geozips for CFA.COM

ISBN: 1577
Optum360

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Additional Geozips for CFA.COM

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Anesthesia Cross Coder

ISBN: 9781622545780
Optum360

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Anesthesia Cross Coder

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Simplify and speed up the coding process with this one-stop, cross-coding resource developed for those who work for anesthesiologists, hospitals, or payers. Updated with the 2020 CPT, ICD-10-CM and HCPCS Level II codes, this easy-to-use manual provides essential links from CPT anesthesia codes to associated surgical CPT codes and crosswalks to ICD-10-CM and HCPCS Level II codes. The Anesthesia Cross Coder is sure to help you code it right—the first time!

Key Features and Benefits:

  • Numerical organization by CPT code.

Provides an all-in-one guide for coders who need diagnosis and surgical procedure code information.

 

  • Links surgical to anesthesia CPT codes.

Appendix provides quick reference, easily identifying the essential procedure-to-anesthesia code relationships.

 

 

  • Recognize when an ICD-10-CM code is gender-specific.

Icons indicate when the diagnosis code selected is appropriate for the sex of the patient.

 

 

  • Full code descriptions.

Easy-to-recognize full code descriptions for CPT, ICD-10-CM and HCPCS codes.

 

CPT is a registered trademark of the American Medical Association.

Anesthesia Cross Coder - eBook

ISBN: 9781622547012
Optum360

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Anesthesia Cross Coder - eBook

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ASCExpert.com

Software / Online Products

ISBN: 1373
Optum360 (Available Now)

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ASCExpert.com

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ASCExpert.com, created specifically for freestanding ASCs, brings together the billing, coding, and payment resources you need to achieve accurate reimbursement under the Medicare ASC payment system. Inaccurate billing and reporting can result in underpayments that your ASC can’t afford to lose! Key Features and Benefits • Optum360 Edge — Robust ASC medical necessity checker and ABN generation tool. Used to screen physician orders and generate an advance beneficiary notice (ABN) to get patient signature. This valuable tool can help hospitals decrease write-offs, improve and obtain revenue capture, decrease claim denials, automatically produce required forms for patients in advance of service, and help inform patients for point-of-care decision making. • Optum360 Edge — Physician compliance editor (with ClaimsManager rules). Check your work by running your selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses, and more prior to submittal to a clearinghouse/vendor/payer. Includes an 18-month historical content database for use during claim adjudication. • Complete medical code sets for ICD-9-CM/ICD-10, CPT® , and HCPCS Level II codes with intuitive functionality. Use the Optum CodeLogic™ search engine to search all codes set sets using acronyms, abbreviations, or medical terms. • Easily crosswalk from codes to NCCI, modifiers, revenue codes, coverage policies, and related procedures. Exclusive code crosswalks and coding tips provide quick links from clinical codes to CMS source documentation, billing, and reimbursement information. • Complete LCD policies, medical necessity data, and national coverage policies (NCDs). Improve medical necessity validation on the front-end and better manage the ABN process to reduce denials. • 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. • Tools to help reduce coding and billing errors. Revenue codes are linked to specific HCPCS and CPT® codes and HIPAA claim edits. • Wage-adjusted ASC payment calculator at the code or claim level. Validate expected reimbursement from Medicare, identify and resolve underpayments, and determine the patient’s copayment amount. • Physician Fee Schedule Information. Calculate the adjusted Medicare reimbursement rate for your area. Add-on Modules The price of ASCExpert.com does not include add-ons. Add-ons sold separately. Call for Pricing. AHA Coding Clinic for HCPCS Add-on (Item WA03) AHA Coding Clinic for ICD Add-on (Item WA02) Coders’ Dictionary Add-on (Item WA05) Coder’s Essential 3-Pack (Item WA22) CPT® Assistant Add-on (Item WA01) CPT® Changes: An Insider’s View (Item WA27) DrugReimbursement.com Add-on (Item WA08) Stedman’s Dictionary Add-on (Item WA04)

Auditors' Desk Reference - (Softbound)

ISBN: 9781622547074
Optum360

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Auditors' Desk Reference - (Softbound)

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"This unique manual shows what the medical record must contain for correct coding and billing of specific medical and diagnostic services and procedures. It provides coders and anyone concerned about coding with an auditor’s perspective on the clinical detail, regulatory instructions, and coding protocol needed for code assignment. Avoid the devastating effects of outside audits and reviews with this detailed coding tool.

Key Featuers and Benefits:

  • Optum360 Edge-Get online access to customizable audit worksheets.

Protect your revenue critical services and procedures.

 

  • Conduct skilled internal audits.

Ensure proper reimbursement.

 

 

  • Differentiate between similar procedures.

Compare and contrast seemingly similar, but different, procedures.

Auditors' Desk Reference - (Softbound)

Softbound

ISBN: 9781622547081
Optum360 (12/1/2020)

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Auditors' Desk Reference - (Softbound)

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This unique manual shows what the medical record must contain for correct coding and billing of specific medical and diagnostic services and procedures. It provides coders and anyone concerned about coding with an auditor’s perspective on the clinical detail, regulatory instructions, and coding protocol needed for code assignment. Avoid the devastating effects of outside audits and reviews with this detailed coding tool. Key Features and Benefits • Optum360 Edge—Get online access to customizable audit worksheets. Protect your revenue critical services and procedures. • Conduct skilled internal audits. Ensure proper reimbursement. • Differentiate between similar procedures. Compare and contrast seemingly similar, but different, procedures. • Completely updated for code set and regulatory changes. • Provides coders with an auditor’s perspective. Know the clinical detail, regulatory instructions, and coding protocol needed for code assignment, by individual code and code groupings. • Know what information needs to be in the medical record and on the claim form to capture appropriate reimbursement. • Know the key terms that need to be mentioned in the medical record. Support code assignment. • See the medical conditions that are indicated for diagnostic and therapeutic purposes. • Get valuable code intelligence. Confirm correct code assignment. • Train your staff. This resource is thorough and can easily be used to train staff how to code. It contains decision-making trees to assign correct modifiers and much more. Supports Best Practices.

Behavioral Health

ISBN: 19000
Optum360 (9/1/2020)

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Behavioral Health

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Behavioral Health 2020

ISBN: 18900
Optum360

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Behavioral Health 2020

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The Coding and Payment Guide for Behavioral Health Services is your one-stop coding, reimbursement, and documentation resource developed exclusively for behavioral health. This comprehensive and easy-to-use guide is updated for 2020 and organized by specialty-specific CPT® codes. Each code includes its official description and lay description, coding tip, documentation and reimbursement tips, Medicare edits, and is cross-coded to common ICD-10-CM diagnosis codes to complete the coding process. Getting to the code information you need has never been so easy.

Cardiology/Cardiothoracic/Vascular

ISBN: 19001
Optum360 (9/1/2020)

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Cardiology/Cardiothoracic/Vascular

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