Outpatient (OPPS) Module

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The OPPS auditing module of ReviewMate provides:

  • Accuracy rates for all elements including:

    • APC (Ambulatory Payment Classification)
    • CPT/HCPCS (Current Procedural Terminology/Healthcare Common Procedure Coding System)
    • E&M (CPT codes in the Evaluation and Management chapter)
    • Non-E&M (CPT codes not in the Evaluation and Management chapter)
    • Modifier(s)
    • Revenue Codes
    • Service Units
    • Diagnosis (ICD-10-CM or ICD-9-CM)
    • First-listed Diagnosis
    • Secondary Diagnosis
    • Procedure (ICD-10-PCS - optional)
    • Discharge Disposition (optional)
    • Procedure Provider
    • Procedure Date
    • CMS-HCC ( Hierarchal Condition Category)

  • APC and fee schedule grouping and pricing take place within the software eliminating the need for auditors to “toggle” between an encoder and ReviewMate. This also eliminates the need for auditors to re-enter codes and demographics into an encoder/grouper in order to make sequencing decisions.

  • Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, AHA Coding Handbook, Coders’ Desk Reference, Clinotes and code look-up eliminating the need for an outside product to perform research.

  • Identification on the screen of codes with CMS-HCC value.

  • Accuracy rates by Patient Types (observation, ED, clinic, etc).

  • Ability to assign responsibility on the line-item level to obtain individualized accuracy rates for the different contributors to the UB-04 (coder, charge team, radiology, etc).

  • Identification of line-items that were recalculated as a result of another line-item revision.

  • Full communication between auditors and coders within the software to discuss findings and recommendations.

  • Reconciliation of rebuttals occurs inside of ReviewMate.

  • Conversations between the auditor and coder are saved in a chronological manner and can be access by any user.

  • Accuracy rates are available real-time and can be “sliced and diced” to accommodate different situations and date patterns.

  • Extensive library of customizable and exportable reports from raw data to Executive Summaries.

  • Customizable dashboards to enhance the user experience.

  • Multiple user levels allow view-only access to any interested parties providing transparency within your organization.

  • “Audit the Auditor” available for a high-level quality check of any review in ReviewMate.

  • Support for Profee audit within the OPPS module.