Optum Billing and Coding

[thegenius]

Any group use Optum's billing and coding division for their ED charts? If so, have they noticed conservative and improper coding of their ed charts? Like downcoding them from 99285 to 99284, saying something is low risk when you assert it's moderate risk, etc.

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[FlaminHotER]

 

[thegenius]

We always hear about how rigged the system is, how corrupt it is, about all the lobbying...and much of it is esoteric because we don't have examples. Hearing a concrete example is so infuriating!

 

[FlaminHotER]

 

[FlaminHotER]

 

[FlaminHotER]

The newest one ^^^^ is on point

 

[cyanide12345678]

Any group use Optum's billing and coding division for their ED charts? If so, have they noticed conservative and improper coding of their ed charts? Like downcoding them from 99285 to 99284, saying something is low risk when you assert it's moderate risk, etc.

Are they specifically under billing when someone has United healthcare as their insurance?

Brilliant move by an insurance company to become a billing company as well

 

[EctopicFetus]

Fox guarding the hen house. The leaders of this all left Optum. Your group should do the same.

 

[thegenius]

Fox guarding the hen house. The leaders of this all left Optum. Your group should do the same.

Oh we've been trying for over a year. It's not easy based on how the contract is written.
I'm wondering if other ER groups who use Optum have similar problems and thus we might have a course for a class action lawsuit.

 

[southerndoc]

We use AI and have had great success with it.

 

[EctopicFetus]

Oh we've been trying for over a year. It's not easy based on how the contract is written.
I'm wondering if other ER groups who use Optum have similar problems and thus we might have a course for a class action lawsuit.

There has to be some end to this contract. Whatever it is. Bail whenever that is.

 

[thegenius]

There has to be some end to this contract. Whatever it is. Bail whenever that is.

The hospital won't allow the ER group to read the contract, but I heard it was for 5 years and a 10M buyout of the contract. Just based on those terms, it's hard for the hospitlal to justify spending 10M to cancel the contract despite how vociferious we are. So freaking annoying and it's costing us (we estimate) prob like 10% more in revenue, as a ball park figure.

 

[thegenius]

We use AI and have had great success with it.

What AI company do you use? Do you happen to know the ratios of your 99292/3/4/5 charts? I konw you work at a higher acuity center as compared to me, just wondering about your ratios.

 

[southerndoc]

What AI company do you use? Do you happen to know the ratios of your 99292/3/4/5 charts? I konw you work at a higher acuity center as compared to me, just wondering about your ratios.

We use Fathom. We are doing well with 4's and 5's. In fact, most of our physicians have seen an increase in income with the new coding requirements.

 

[EctopicFetus]

The hospital won't allow the ER group to read the contract, but I heard it was for 5 years and a 10M buyout of the contract. Just based on those terms, it's hard for the hospitlal to justify spending 10M to cancel the contract despite how vociferious we are. So freaking annoying and it's costing us (we estimate) prob like 10% more in revenue, as a ball park figure.

Are you employed by the hospital?

 

[EctopicFetus]

We use Fathom. We are doing well with 4's and 5's. In fact, most of our physicians have seen an increase in income with the new coding requirements.

Do they just code or do they also collect the money? If they are collecting money how are they at that. U willing to give an estimate on the cost of their services?

 

[thegenius]

Are you employed by the hospital?

technically independent contractors of the hospital foundation, like many other services like IM, anesthesia, surgery, and a few others.

 

[TooMuchResearch]

We use AI and have had great success with it.

Can you send me info on this? We've had nothing but issues this year.

 

[TooMuchResearch]

Oh we've been trying for over a year. It's not easy based on how the contract is written.
I'm wondering if other ER groups who use Optum have similar problems and thus we might have a course for a class action lawsuit.

We don't use Optum but I've seen some BS down coding / claim denial from them.

 

[EctopicFetus]

Can you send me info on this? We've had nothing but issues this year.

Google fantom ai

 

[TooMuchResearch]

Google fantom ai

Thanks

 

[HemeOncHopeful19]

The hospital won't allow the ER group to read the contract, but I heard it was for 5 years and a 10M buyout of the contract. Just based on those terms, it's hard for the hospitlal to justify spending 10M to cancel the contract despite how vociferious we are. So freaking annoying and it's costing us (we estimate) prob like 10% more in revenue, as a ball park figure.

I’m sure there’s also an implication that dropping this contract will affect their next round of negotiations with UHC… this stuff is getting ridiculous.

 

[EctopicFetus]

I’m sure there’s also an implication that dropping this contract will affect their next round of negotiations with UHC… this stuff is getting ridiculous.

It is so bad how UNited has seeped into medicine. Optum.United employs 1/16 docs in america. Dont think that has serious implications? It is insanity.

 

[southerndoc]

Do they just code or do they also collect the money? If they are collecting money how are they at that. U willing to give an estimate on the cost of their services?

They just code and give our billers what suggested level to bill for. We audit them. I think we were their first major user, but I believe Yale-New Haven Health is now using them. Their medical director reached out asking about it.

We found that AI coded the charts better than human coders. Human coders get in a hurry and miss things. We've not found any major errors with AI.

 

[thegenius]

They just code and give our billers what suggested level to bill for. We audit them. I think we were their first major user, but I believe Yale-New Haven Health is now using them. Their medical director reached out asking about it.

We found that AI coded the charts better than human coders. Human coders get in a hurry and miss things. We've not found any major errors with AI.

You know what they charge? Is your billing inhouse? And does your entire hospital use it? or just the ER?

 

[EctopicFetus]

They just code and give our billers what suggested level to bill for. We audit them. I think we were their first major user, but I believe Yale-New Haven Health is now using them. Their medical director reached out asking about it.

We found that AI coded the charts better than human coders. Human coders get in a hurry and miss things. We've not found any major errors with AI.

The new system seemingly is very simple. I am glad it is working for you guys though. Must be very cheap since it costs them nothing and most of the RCM cost is collecting the money.

 

[TysonCook]

Fathom AI (and its competitors) might be worth a new thread.
I'd be really interested in how this works.

 

[TysonCook]

Bumping this:
I'm curious as to how the RCM is working...
Are the charts submitted to Fathom, who then send the codes to your own in-house billing, or do you use a 3rd party for billing and collections?