Ambulatory Revenue Manager™
The Ambulatory Revenue Manager™ identifies claims with lost APC payments resulting from uncoded, unbilled and inappropriately coded services. The software has been used to recover millions of dollars for hospitals nationwide. Now your hospital can use the software on a daily basis to prevent lost APC payments.
The software analyzes each claim by day of service using hundreds of edits based on CPT®/HCPCS guidelines, program memoranda and the results from thousands of chart reviews. Date-specific versions of each edit reflect the codes in effect during each time period. The edits are updated quarterly by our clinical staff of coders and nurses.

The edits identify claims with possible lost APC payments by checking for coding inconsistencies. The software indicates the line that triggered the edit as well as what to look for. Based on the edit description, the user reviews the medical record and/or itemized bill for the potential missing service, verifies the accuracy of the edit, adds a line if the service was not originally reported and assigns the appropriate CPT®/HCPCS code. The revised claim can then be submitted to ensure that the hospital receives the full reimbursement it is entitled to, based on the documentation. The chart review and correction process can be performed prior to or after the initial claim submission.

The edits fall into several categories. The first consists of services that are typically performed together, but where only one is present on the claim (e.g., a chemotherapy drug without an administration code). Another consists of drugs where the reported units are below the minimum expected number of units. A third class consists of inappropriate codes (e.g., deleted codes). The major groups of edits include:

• Surgical procedures
• Interventional radiology
• Nuclear medicine
• Blood
• Visits
• Observation
• Modifiers
• Drugs
• Units
• Devices
• Inappropriate codes

The edits are also prioritized based on the likelihood of additional payment.
In addition to reducing lost APC payments, clients also use the software to identify and resolve CDM, coding and compliance issues. The software also serves as an early warning system to quickly detect changes or breakdowns in charge capture and coding processes. The result is improved coding, billing, compliance and financial performance. Contact us for a free analysis of your hospital’s potential lost APC payments.

CPT is a registered trademark of the American Medical Association.