Go beyond basic coding with a mid-level research solution focused on claims processing, coding, payment and revenue

The Reimbursement Suite goes beyond basic coding to include payment calculators, edit-checking tools and everything you need to understand the claims processing system.

With additional guidance on claims processing, this level is the ideal solution for expert coders, revenue cycle, reimbursement & HIM/CDM professionals who need coding, revenue and payment tools and key regulatory content relevant to coding. The Reimbursement Suite will provide you with real-time updates that you need to ensure proper code assignment up front, minimizing your claim denials and increasing your bottom line.

Coding Tool Features

  • Code Explorer allows users to search across multiple code sets by code, description or key terms for instant coding instruction (Code Notes), outpatient and physician payment rates and coding guidance including local coverage determinations and critical coding guidance in one location.
  • ICD-10 Explorer provides keyword search functionality for ICD-10 codes and guidelines, as well as translation of ICD-9 to ICD-10 codes using GEMs mapping scenarios.
  • NCCI Code Pair Checking tool demystifies code bundling issues. Includes Medicare edits!
  • NEW and improved provider-specific MS-DRG Grouper and Calculator, powered by New Health Analytics, demonstrates MS-DRG grouping and payment logic under IPPS—now includes an integrated grouper, batch grouping capability, and ability to show/hide payment information!
  • E-Code Sets and e-books allow you to search by code, description or common terms. Integrate with the explorer tool and reduce your coding orders and subscriptions.
  • Includes complete electronic codebook content for HCPCS, CPT®, APC, ICD-9-CM, ICD-10-CM, ICD-10-PCS, GEMs, Physician Fee Schedule (RVU), MS-DRG, NCCI, E&M, and Drugs (NDC) in natural language.

Coding Guidance Resources

  • The 2023 HCPCS and CPT Codebooks are now available in MediRegs. Plus, Code Explorer, the OPPS and Professional Fee Claims Calculators and payment books will be updated with 2023 data for the January 1st effective date.
  • Includes a comprehensive Coding Guidance Library with more than three dozen coding supplements, including CPT® Assistant, CPT® Changes — An Insider's View archives and ASA Crosswalk®.
  • A medical dictionary, select CMS Manuals, and Medicare coding and billing guides further expand the list of reference material you can access before a code is assigned.
  • Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it.
  • Access the key CMS manuals used by coders, including full versions of the CMS Claims Processing Manual (Pub 100- 04), Benefit Policy Manual (Pub 100-02) and National Coverage Manual (Pub 100-03) provide you with detailed instructions to comply with Medicare. Learn Medicare’s stance on these codes, along with the common pitfalls behind them. Payment system final rule e-books including: inpatient PPS, outpatient PPS, physician fee schedule and ambulatory surgical centers make understanding changes simple.
  • WK Week In Review Newsletter keeps you abreast of regulatory, legislative and enforcement activities across Medicare.
  • CMS Transmittals, MLN Matters, Job Aids and CMS Frequently Asked Questions are updated daily to keep you apprised of real-time coding changes and discussions as they are released in one easily accessible place.
  • RAC Tracking tool helps you stay abreast of codes being investigated by government investigators.
  • A medical dictionary, CMS glossary, MLN Matters, Job Aids, fee schedule information, acronym tool and frequently asked questions further expand the list of reference material you can access before a code is assigned.
  • Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it.
  • Includes Wolters Kluwer Health Net Newsletter and MediRegs educational webinars.

Medical Necessity Resources

  • Instant access to LCDs and NCDs provide effective validation of the medical necessity of ordered outpatient and physician procedures and services. Additional access to Advanced Beneficiary Notification (ABN) forms and instructions, national coverage guidance (NCD), national coverage analyses (NCA).
  • Choose by contractor: All Medicare Administrative Contractor (MAC) LCDs and bulletins are included for specific local guidance

Inpatient Prospective Payment System

  • ICD-10 Grouper simulates inpatient claims, groups to the MS-DRG from ICD-10-CM code to help you understand and compare payment for different MS-DRGs or for the same MS-DRG over time.

Fee and Payment Tools

  • Easily reference the adjusted Medicare reimbursement rate for your region via the quick calculators for APC, RVU and MS-DRG.
  • Demystify bundled codes with the NCCI Code Pair checking tool, which is integrated automatically into the APC & RVU calculators

Training & Support

Wolters Kluwer offers a full range of training; from online videos to custom training.

customer support
We're Here to Help.
Call us at 1-800-808-6800
Need help finding the right solution?
HAVE QUESTIONS? Contact us and we'll put you in touch with one of our solutions specialists. Call us at 1-800-638-8437

Request a Demo

Missing the form below?

To see the form, you will need to change your cookie settings. Click the button below to update your preferences to accept all cookies. For more information, please review our Privacy & Cookie Notice.

Back To Top