OPTUM360 vs AMA | Key Differences


Optum360® is one of the leading health services business organization formed by Optum. With over 25 years of experience, Optum 360 has been a leading source for top industry coding, billing and reimbursement solutions.

It offers services to the broad health market including physicians, health care organizations, payers, and government and thus it helps health systems reduce costs and achieve timely and accurate revenue.

Optum360 is devoted to changing the system of registration, documentation, billing, and payment so that it works better for hospitals, health systems, and other care providers; and thus it helps in delivering a better patient experience.

What OPTUM360 Offers:

  • It offers innovative online coding tools, coding books, and services
  • It offers intuitive solutions designed to streamline efficiency
  • It provides access to proprietary data that helps one to make informed business decisions
  • Optum360 offers a patient-centric approach from patient registration to the financial resolution of payments

The main motto of Optum360 is to simplify the health care business by providing the latest technology, services, and health information to hospitals, physicians, and health systems.

ICD-10-CM Expert for hospitals 2020 is one of the best selling references of Optum360 which is shown below.

It is supported by experts who, provide revenue cycle leadership, innovation, and operational excellence to eradicate the inefficiencies in health care and prepare it for value-based reimbursement.

Creating solutions that influence its resources, relationships and supreme industry perception, it partners with several providers to accomplish their planned vision and facilitates them to focus on care and healing.

American Medical Association (AMA)

The American Medical Association (AMA) is one of the most leading and influential organizations in the health care industry.

It is also the largest organization of physicians and medical students in the United States. The main goal of AMA is to promote medicine and to work for the improvement of public health.

Established in the year 1847, AMA has been an important organization ever since and has influenced the development of health care until date.

It promotes the improvement and betterment of the health care system in America as decided by the leadership of physicians.

The recent five-year plan of AMA encourages the advancements of health care as determined by the physicians.

It believes in promoting the development of the doctor-patient relationship.

Since its inception, it has taken both bold and controversial stances for the betterment of health care and is one of the most powerful lobbying forces in the country today. It has a political action committee AMPAC that directs its political influence.

AMA offers sponsorship and development of Current Procedural Terminology (CPT) and it has an immense impact on medical billing and coding professionals.

CPT is the standard terminology that is used in billing and coding to explain the specific medical services provided. While with private insurance companies, hospitals, physicians, or Medicare and Medicaid, billing and coding professionals are sure to encounter.

The AMA has a significant role in determining the figures used and rules that medical billing and coding professionals follow.

CPT determines the amount of reimbursement of medical providers by the Medicare and Medicaid programs.

However, it doesn’t determine the amount directly by through AMA’s Specialty Society Relative Value Update Committee (RUC) group.

This group makes recommendations on the value of the services provided by health care.

The RCU then makes their own recommendations to CMS- it is the agency that supervises the Medicare and Medicaid programs and these recommendations are accepted about 90 per cent of the time.

CMS then enters these suggestions from RCU into a formula that provides a dollar-value amount for medical services provided.

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