Case Study: Leading HealthCare Service Provider achieves $1.4M net ED revenue gain and accurate visit-level charging with Optum360

Medical center aligns visit-level determinations for accurate reimbursement

Leading HealthCare Service Provider, a 250‑bed Midwest medical center, faced a major shift in coding and documentation requirements and was relying on an internally built EMR charge capture system. The organization had already deployed an industry-leading EMR and Optum360’s Enterprise Computer‑Assisted Coding (CAC) and CDI 3D Platform, and engaged Optum360 to evaluate and improve its outpatient charge capture.

Optum360 implemented the Optum LYNX Emergency Department Charging Application, integrating its proprietary facility‑charging algorithms with the EMR to standardize visit‑level determination and coding. In year one the solution processed 38,155 ED patients and delivered a $1.4M net revenue gain (close to the $1.5M estimate), with an average incremental net increase of $36.84 per ED outpatient visit, while improving consistency and compliance.