Financial Compliance and Audit Management

Stay financially on track with federal and payer-specific requirements

Optum360™ can help your hospital achieve the transparency, visibility and consistency needed to comply with federal and payer-specific requirements and, when necessary, manage the audit process. Through technology solutions and outsourced services, we can help you strengthen claims integrity to avoid disruptions to your revenue cycle.


Compliance Checking

Financial Compliance and Audit Management

OptumTM Compliance Checking helps you demonstrate your intent to fully comply with all guidelines from the Centers for Medicare & Medicaid Services and Office of Inspector General, as well as your commitment to achieving accurate and proper documentation for full and appropriate reimbursement.

Transfer DRG Service

Identify Medicare underpayments

Optum™ Transfer DRG Service helps providers identify and re-bill for Medicare underpayments resulting from patient transfers to post-acute care. After analyzing and identifying claims with potential for additional reimbursement, we follow up with payers and post-acute care providers to determine each patient’s real subsequent level of care and quantify any additional payments due.

Audit Management

Maximize workflow, minimize future audit risk

OptumTM Audit Management provides all the tools needed to effectively handle Recovery Audit Contractor (RAC) and other Medicare audits and prevent future take backs. Designed specifically to meet Medicare and other payer audit requirements, this solution allows you to predict financial impact of claims audits, as well as identify and resolve the sources of claims errors.