Omega | Lost Charge Recovery | Revenue Integrity Analytics for Hospitals
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Slide Revenue Cycle Assesment Lost Charge
Recovery Services
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Integrity Analytics™
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Reimbursement models become more complex as healthcare payers accommodate new markets and business lines. Advancements in medical care exponentially increase testing and treatment options available. As reimbursement models grow more complex, and healthcare coverage increases, the complexity, and number of claims will also increase, impacting the demand for payment accuracy solutions.

Risk and opportunity. Your hospital balances these every day.

Understanding where risks and opportunities lie within your revenue cycle requires mining vast amounts of data.

Omega Technology Solutions has helped hospitals analyze their claims data for over 25 years. By combining powerful analytical software with investigative expertise we identify revenue cycle risks and opportunities for our clients.

Omega’s Revenue Integrity Analytics Platform™ is a unique blend of data science and clinical expertise that enables every identified lost charge to be manually compared to its medical record, verifying charge accuracy.


Working remotely, Omega will identify, verify, bill, and collect missed charges, provide root cause analysis to prevent future missed revenue and address potential compliance issues, all with minimal impact on your operations. Your hospital will increase cash while only paying for results.

On average Omega discovers over $500 in unbilled charges per outpatient surgery. We are able to recover up to two years of historical unbilled revenue for our clients and then continue to find lost revenue month after month after month.
$5,000,000

Average Identified Lost Charges

150

Per 150 Bed Hospital

$0

With Zero Upfront Fees

What To Expect | Omega’s Typical Project Process

Assessment

The First Step in a Lost Charge Recovery Project

Omega will perform a no-cost assessment and review key elements of your revenue cycle.  

The objectives are: 

  • Assessment of the CDM using our proprietary software, ChargeMASTER.
  • Assessment of claims using our proprietary software, OCExaminer.
  • Manual validation that those charges on the claim are supported by appropriate documentation in the medical record.
  • Validation that those services rendered were captured and charged appropriately.

Overview of Recommendations

OTS reviews the CDM using our proprietary software, ChargeMASTER. Our philosophy is that if the CDM is complete and compliant with the most current regulations, clean bills can be produced with very little manual intervention required by the hospital or the Omega staff.

OTS reviews combined batches of claims using our proprietary software, OCExaminer. OCExaminer has all of the edits for Medicare and Medicaid, as well as edits we have created from our experience with Lost Charge Recovery projects across the nation. Other modules include: RAC alerts, managed care edits, and lost charge edits. We focus on Emergency Department, drug administration, carve-outs, OR, and user-defined edits. This processing identifies issues that cannot be hard-coded in the CDM, so that your claims are clean and complete when they are submitted for payment.

Finally, we manually review a sample of outpatient medical records, corresponding charge detail, and UB-04’s to evaluate the current charging practices at the facility.

We sample from the following departments: 

  • Cardiac Catheterization 
  • OR
  • Emergency Room 
  • Endoscopy 

  • Chemotherapy
  • Observation 
  • Interventional Radiology

The assessment provides detailed findings, a Management Action Plan to address known issues, and a summary of the potential financial impact on your hospital from a formal Lost Charge Recovery project.  

In almost every case, Omega finds significant enough missing charges to warrant going forward with a Lost Charge Recovery Project with the hospital.

Lost Charge Recovery Project

Complete support from identification to recovery

Omega facilitates a formal project kick-off with the client to ensure alignment on the project phases and deliverables. This step is key to a successful program and client satisfaction.

The hospital then provides a data download of its patient bill along with remote access to your patient accounting and medical records system.

A retrospective review is then performed which can go back as far as two years depending upon the terms of the payer contracts. Omega initially screens the individual files through its proprietary software process to sort out types of procedures that have historically produced missing charges in the billing process. At that point the sorted files are manually reviewed by auditors; auditors are usually nurses and other health professionals with years of experience in the clinical specialties where most missing charges are found.

The missed charges are identified and documented. A revised bill is prepared and submitted to the respective payer for payment. Omega does not bill the patient for additional charges. Omega answers any questions or objections from the payer. The additional funds are received by the hospital and a contingency fee is then paid to Omega.

Omega’s Clear Value To Hospitals

Adds Revenue to Your Bottom Line

Supporting Documentation of Proposed Billing Practice Changes

Charges Verified by Manual Comparison to Medical Record

Claim Accuracy and Compliance

Root Cause Analysis and Management Action Plan to Avoid Future Missed Charges

Zero Increase in Cost, Collaborative Process

Our results speak for themselves. Schedule a no-cost assessment or phone call to learn more about how
Omega can uncover lost charges and add revenue to your bottom line.

Results That Hospitals Trust

Our President, Ann Fierro,

Explains Our Process

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What Charges Have Been Missed?

On average Omega discovers over $500 in unbilled charges per outpatient. We are able to recover up to two years of historical unbilled revenue for our clients and then continue to find lost revenue month after month after month.

How Much Are We Talking About?

For a quick estimate, please use our Lost Charge calculator.

      1. Enter the number of outpatients you have per year, then
      2. Slide the month scale to see how much we could recover monthly, or historically, all the way to two years.
Every Hospital is unique. In order to get a highly accurate estimate, along with a detailed review by one of our senior analysts, click below to set up a no-cost assessment.

 

That’s right, zero assessment cost.

What Can You Recover?

11000
24
Gross Recovery Estimate

This is an estimate based on 25+ years of historical findings. Depending upon how your hospital classifies patients, we may be able to find significant revenue from non OP patient visits. Please request a no-cost assessment so that we can deliver an accurate revenue expectation.