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.
Average Identified Lost Charges
Per 150 Bed Hospital
With Zero Upfront Fees
Omega will perform a no-cost assessment and review key elements of your revenue cycle.
The objectives are:
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.
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.
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.
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
If I were to go to another facility, I would bring them in there to assist me in a heartbeat
Large systems typically do a system look at charges on bills related to procedures codes. What none of these systems do is look at all the documentation which is on the chart as well as intervention.
I think Omega fits a niche that is currently not being performed. They have been looking at charts and the medical record that supports documented charges that are not on the bill and are billable. Missing charges identified and extrapolated to (the health system) could lift net revenue several million dollars annually.
They are bringing in millions of dollars in net revenue that we were due but...missed in billing.
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.