Thirty Hospitals Implement OptumInsight Coding Solution for Accurate Hospital and Physician Reimbursement, Improved Financial Performance and ICD-10 Readiness

September 26, 2011
  • Actus computer-assisted coding supports ICD-10 readiness with consistent methodology for capturing billing codes from clinical documentation
  • The solution addresses financial pressures with improved revenue management
  • Natural language processing increases accuracy and improves coder productivity

OptumInsight (formerly Ingenix), a leading provider of health care information, technology and consulting services, announced that 30 leading U.S. hospitals will implement its Actus® computer-assisted coding (CAC) solution.

The Actus CAC software solution will enable the hospitals to quickly and accurately code medical charts for more consistent and complete reimbursement of medical claims and to prepare for the eight-fold increase in codes required for ICD-10 documentation.

The hospitals, as well as physician groups and some of the nation’s largest imaging and billing services centers will leverage Actus software - backed by OptumInsight’s consulting, training and support - to manage the growth and complexity of 155,000 ICD-10 codes, which directly affect these organizations’ financial health. Effectively capturing codes tied to each chart ensures accurate billing of medical procedures, tests and services, improves the productivity of coding teams and provides consistent, reliable reimbursement and revenue management.

“The addition of Actus CAC will help hospitals, physician groups and billing services improve financial performance – even while faced with today’s complex reimbursement requirements and clinical documentation,” said Ron Jones, senior vice president of hospital solutions at OptumInsight. “From smaller hospitals and physician groups to large and complex health systems, organizations are recognizing the impact that Natural Language Processing (NLP) technology provides to CAC by helping them deliver efficient and accurate reimbursement of patient care.”

OptumInsight’s CAC software and its patented LifeCode® NLP engine can precisely translate clinical documentation, generate billing codes, and ease coders’ workloads. As a result, health care organizations get faster, more accurate and consistent coding of treatment claims for reimbursement and become better prepared for ICD-10 compliance.

Billings Clinic in Billings, Mont., a multi-specialty physician group and 272-bed hospital that serve patients in Montana, Wyoming and the Western Dakotas, selected Actus to help coding experts validate and review clinical documentation to maintain a high degree of accuracy without expanding billing timelines.

“We were concerned with our ability to maintain best practices in the face of ever-expanding audits and the implementation of ICD-10. With Actus, we believe we will be able to increase coder productivity, enhance accuracy to improve case mix index, reduce our coding timeline and help prepare for ICD-10 changes,” said Connie Prewitt, Billings Clinic CFO. “Ultimately, I believe this will help us ensure the accuracy of the coding and billing of the medical services we provide."

More than 30 other organizations are implementing OptumInsight’s CAC solution.

  • Hartford HealthCare, an integrated health system consisting of six hospitals whose flagship site, Hartford Hospital, is one of the largest teaching and tertiary care hospitals in New England, will deploy CAC to prepare for the ICD-10 transition and help with its corporate coding standardization and efficiency management initiatives.
  • John Muir Health, an integrated system consisting of two medical centers ranked in the top three of the San Francisco area’s best hospitals by U.S. News & World Report, selected Actus to increase productivity, quality and compliance, while counteracting escalating pressures from a shortage of coders and the ICD-10 transition.
  • Mission Health, located in Western North Carolina, selected Actus to help improve coder productivity and deliver ICD-10 readiness in two of the health system’s hospitals.
  • Pacific Radiology Group, an expanding group of hospital-based radiologists in Honolulu, chose Actus to help address its coder shortage and ICD-10 compliance while providing a quick implementation and the interoperability needed with new vendors and legacy systems.

For more information, visit our resource page on CAC and read about the productivity gains of NLP use in healthcare organizations in a new white paper, “Advanced coding technology to advance the revenue cycle.”

About OptumInsight
OptumInsight provides health information, technology and consulting services. Commercial health plans, physicians, hospitals, life sciences companies, government agencies and other organizations that comprise the health care system depend on OptumInsight solutions and insights to improve their performance. OptumInsight is part of Optum, a leading information and technology-enabled health services company dedicated to making the health system work better for everyone. Visit or for more information.  

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