A high volume of claims and complex hospital billing and reimbursement rules make it difficult to manage the medical coding and regulatory changes that have a direct impact on the revenue cycle.

• RevenueCyclePro.com is a comprehensive, up-to-date, online problem-solving tool that compiles content and data that hospitals depend on to answer questions about coding, billing, coverage and reimbursement into a single source.
• Easily identify values for different code sets. Organized by CPT® and HCPCS codes.
• New! UB-04 Claim Form. This feature provides a “clickable” UB-04 claim form, providing a visual cue and quick access to all UB-04 form locators and data elements.
• New! UB-04 Form Locators. This feature provides a listing of all official UB-04 claim form locators, their descriptions and usage guidelines. Coding and billing tips will be added to each data element throughout the transition period.
• New! Crosswalk from UB-92 to UB-04. The crosswalk tool provides users with an easy way to become familiar with the UB-04 FLs, data elements and content requirements needed to transition from the UB-92 to new UB-04 claim form.
• Quickly Access the Latest CPT® Codes, HCPCS Codes, ICD-9-CM Codes, DRGs, APCs, Fee Schedules, Wage Indexes, Code Crosswalks and Coverage Guidelines. Your facility will be up to date on all code sets and rules pertaining to inpatient and outpatient services.
• Reference Medicare Coverage Guidelines as They Apply to Medicare Part A. Includes hospital outpatient, APC and inpatient services. The Pub. 100 references, medical necessity rules (LCDs) and national coverage determinations (NCDs) provide coverage validation tools for hospital inpatient and outpatient services, supplies and drugs. These tools will help you manage the ABN process to reduce denials.
• Online Revenue Cycle and Coding Solution. Provides one-stop access to all referential tools related to CPT®/HCPCS codes, modifiers, coding guidelines and wage-adjusted APC tables. All codes, crosswalks and links help you reduce the time to code, the time to bill and the time to resolve rejections and denials.
• Search Tools and Calculators. Provide links from clinical code sets and information to billing and financial data. Get access to fully searchable CMS transmittals and regulatory documents, list lookups, clinical code sets, UB-04 data set, reimbursement tables and other reference data files and compliance documents. Help to reduce the need for multiple resources and improve productivity and problem solving.
• Easily Crosswalk from CPT® Codes to ICD-9-CM Procedure Codes. This crosswalk will help you link to systems and decision support tools that are based on ICD-9-CM procedure codes for outpatient services.
• Billing Tools. Includes complete library of the latest UB-04 data set and Medicare billing guidelines: revenue codes linked to CPT®/HCPCS codes; and HIPAA claim edits. These tools help you resolve mismatched CPT®/HCPCS Level II codes and revenue codes and other leading billing errors.
• Compliance Tools. Includes value-added references, including code-specific edits, Medicare Pub. 100 references, CMS transmittals and additional links to relevant cross codes. All of these tools are simply accessed from a medical terminology or code search.
• Reimbursement Tools. Provides national and hospital-specific payment rates for inpatient services paid under DRGs and outpatient procedures and services, drugs and tests reimbursed under APCs, fee schedules, cost or pass-through payments. The outpatient and DRG calculators help you validate expected reimbursement from Medicare, identify and resolve underpayments and determine the patient’s co-payment amount.
• Correct Coding of CPT®, HCPCS and ICD-9-CM Codes. Access the latest lay descriptions, code book annotations, images and exclusive Ingenix content. Make sure that the procedure and diagnosis codes submitted on UB-04 electronic claims are valid, accurately assigned and appropriately linked.
• Increase Efficiency Across Many Revenue Cycle Departments. Areas affected could include patient access, HIM, billing, CDM and revenue cycle management.
• CPT® is a registered trademark of the American Medical Association.