Based on its recent analysis of the revenue cycle management (RCM) coding and clinical documentation market, Frost & Sullivan recognizes Optum360, a leader in revenue management solutions for health care providers, with its 2017 U.S. Market Leadership Award. The award recognizes proven leadership by Optum360 for Optum® Enterprise CAC and Optum® CDI 3D solutions, powered by its proprietary natural language processing (NLP) technology.
The U.S. healthcare industry is in need of revenue cycle solutions that support healthcare organizations in the transition to various reimbursement models. Prevalent financial solutions often fail to effectively capture appropriate reimbursement from health plans for a wide variety of patient services commonly rendered by hospitals and physician practices. Many services are related to complex chronic conditions and associated complications that require advanced clinical documentation and coding.
“The transition from ICD-9 to ICD-10 codes helped care providers realize that their underlying health information management (HIM) encoders were not adequately equipped to manage the increased coding specificities of ICD-10, which includes 28times as many procedure codes and 5 times as many diagnosis codes. ICD-10, payer-specific coding requirements, and higher scrutiny for coding compliance are driving care providers to opt for more efficient coding products that primarily include CDI and CAC solutions,” said Koustav Chatterjee, Industry Analyst - Digital Health.
Optum360 has developed technologically advanced products that foster seamless interoperability between CDI and coding departments. Powered by Optum NLP, these solutions help improve revenue cycle performance and can:
Review clinical documentation in real time. The CDI 3D case-finding feature identifies gaps in documentation and potential quality events at point of care to address as they occur. Seamless workflow between CDI and coding teams ensures more complete and accurate documentation leading to more complete and accurate coding and reimbursement.
Capture appropriate codes. Optum NLP technology applies both basic terminology matching skills and advanced artificial-intelligence capabilities to auto-identify current procedural terminology and diagnostic codes within clinical documentation for coding staff review. Assigned codes are connected to documentation supporting the code assignment.
Increase staff productivity. Automated clinical documentation review and code attribution ensure coders spend less time searching for the right codes to assign.
“The driving force of Optum Enterprise CAC and Optum CDI 3D is the unique capability of the company’s patented NLP, which helps customers accelerate clinical documentation improvement and accurate code assignment, contributing to revenue integrity and operational efficiency. Optum360 consultants, trainers, IT implementers and performance management experts ensure that every care provider can achieve measurable results and receive support throughout the engagement to manage the transition toward accountable financial management,” said Chatterjee.
"Optum360 enables our clients to achieve better financial and operational performance in support of their mission to deliver quality care for their patients and communities," said Optum360 CEO Tom Boehning. "We are grateful to receive this award from Frost & Sullivan and to be recognized as the industry leader for CAC and CDI innovation."
Frost & Sullivan’s independent market analysis confirms Optum360 as the proven market leader in the important RCM IT segment of CAC and CDI. The Optum360 corporate culture of innovation promotes continual product improvements and fortifies the company’s visionary technological capabilities. Patented technologies, coupled with an experienced support staff, ensure that customers thrive with better financial outcomes. For its strong overall performance in the RCM coding and clinical documentation market, Optum360 has earned the 2017 U.S. Market Leadership Award.
Frost & Sullivan presents this award to the company that has developed an innovative element in a product by leveraging leading-edge technologies. The award recognizes the value-added features/benefits of the product, which in turn raise customer acquisition and overall market penetration potential.
Frost & Sullivan Best Practices Awards recognize companies in a variety of regional and global markets for demonstrating outstanding achievement and superior performance in areas such as leadership, technological innovation, customer service, and strategic product development. Industry analysts compare market participants and measure performance through in-depth interviews, analysis and extensive secondary research to identify best practices in the industry.
Optum360 (optum360.com) simplifies the business of health care by delivering health information, services and technology to hospitals, physicians and health systems. Our 7,700 performance experts provide revenue cycle leadership, innovation and operational excellence to eliminate the inefficiencies in health care and prepare for value-based reimbursement. By creating solutions that leverage our resources, relationships and unparalleled industry perspective, we partner with care providers to fulfill their strategic vision and enable them to focus on care and healing.
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