Healthcare Revenue Cycle Management Solutions | Pararev
Partnering with Healthcare for Better Revenue Cycle Results
The ParaRev Supply Pricing Analysis deliverables include an identification of non-billable supply items and gross revenue impact, proposed markup, gross and net revenue projections, an item-specific detailed spreadsheet proposed changes, and a full write-up of techniques and findings. It assists you by standardizing supply pricing across all departments and services by providing a ration, cost-based supply markup.
Healthcare provider prices are being scrutinized more than ever now with the Affordable Care Act in place. The demand for rational pricing is a major component to transparency, price competitiveness and earned reimbursement. It is imperative to ensure that your rates are justifiable.
The ParaRev Market Based Pricing (MBP) Program is designed to improve profitability by creating rational pricing methodologies that ensure transparency, price competitiveness, and earned reimbursement. ParaRev assists hospitals and providers in creating a rational pricing methodology and best practice for developing prices based on cost, reimbursement, and peer pricing data. This is done through identifying line items in the charge master which have negative patient satisfaction due to high prices, identify gross margin improvement opportunities due to low prices and help establish a rational pricing methodology by setting prices based on fee schedule, APC, cost, or competitive market pricing data.
ParaRev’s seven step process ensures that client data is loaded and accurately modeled, market position is assessed, project goals and areas of sensitivity are considered, gross and net revenue impact is determined (including stop loss, claim cap, and annual inflation cap adjustments), all prices are quality reviewed and smoothed, accurately implemented, and impacted quarterly.
The ParaRev Market Based Pricing (MBP) Program deliverables include review of existing prices, price transparency, market/cost based pricing, market analysis, contract modeling, a series of pricing iterations with recommended prices and quarterly post-implementation progress reports.
As each iteration is developed, a series of reports are generated to assist in the quality review of the iteration parameters.
Comprehensive pricing reports include:
Historically EMR systems are built to store, summarize, and manage medical information, providing minimal guidance when working an account to resolution; ParaRev offers an add-on solution that builds in everything that someone needs—whether they are a brand-new hire or an experienced denials analyst—in order to work accurately and efficiently every time, on every claim
| Problems | Our Solutions |
| Keeping track of all the rules, regulations, and guidelines between different regions, carriers, and hospitals | With our technology-based approach, we build all rules and guidelines directly into our workflow system, we create a centralized location for information, eliminating the need to dig through emails and double-checking payor known-issue logs and other spreadsheets |
| Ensuring uniformity of work done by in-house staff and outside vendors can be a challenge | Since any specific preferences are built into our system, all workflows follow the same steps for any “like” issues/carriers Auto-notation creates a fast, structured history of accounts through uniform message choices |
| Quality across team members (in-house and vendors) can be hard to ensure | Human error significantly reduced since the system flags when hospital and insurance rules are not followed Automation also improves through the machine learning of the rules and of insurance behaviors |
| Targeting the right inventory to maximize collections is a time-consuming process | With machine-learning, our automation process optimally prioritizes what should be worked first—automatically, without time-consuming man hours Our system tailors worklists to specialized analysts, allowing greater efficiency as they work to their area of expertise, and easily guides them through all detailed processes |
| Vendors can be a huge additional cost | With your EDI data and access to your systems, HFRI’s tech-based hybrid approach to AR allows us to do more, to do it faster, and to do it at a lower price |
ParaPath is our proprietary AR follow-up decision software which guides our reps through the AR process with no deviation and auto-notates their actions within the program and is fully and utterly customizable to you and your needs and workflow—no more workarounds because our software is set up for you.
The program helps keep track of myriad of rules, regulations, & guidelines by storing everything in one place—our system—in a way that’s easy to follow and connect with. Our auto-notation creates a fast, structured history of accounts through uniform message choices to ensure uniformity of work. Unlike other software that can generate static “canned” notes tied to certain internal actions, ParaRev’s system builds notation from the answers and inputs of users on individual account actions, resulting in notation that is uniform, accurate, and—as with all aspects of the system—completely customizable.
By utilizing automated categorization when organizing worklists around the root issues, ParaRev eliminates the time and need to manually identify the problem, allowing our reps to start the account work immediately.
ParaPath allows you to monitor and guide your staff and vendors to make sure they work the exact way you want them to with the steps you need them to take. Through machine-learning, our automation process optimally prioritizes the accounts that should be worked first to make sure you are targeting the correct inventory and maximizing collections.
With your EDI data and access to your systems, our tech-based hybrid approach allows us to do more, faster, and at a lower price.
Huge budget cuts, cost saving initiatives and the uncertainty of not using the technology to its fullest has lead healthcare providers to consolidate to a single source platform in order to save time, money and resources.
The ParaRev Data Editor (PDE) is a robust web-based single source solution for pricing, coding, reimbursement and compliance for the hospital revenue cycle that is proven to improve reimbursement and compliance.
Comprehensive resources to support providers in analyzing, repairing, and improving the revenue cycle process all in one place:
The ParaRev Data Editor (PDE) system deliverables include providing a centralized, online, encyclopedic resource of current and historic regulatory information, code book subscriptions, charge master guidelines, and hospital specific revenue management data.
For a typical hospital with a 10,000-line chargemaster, seven patient types, and 20 payer contracts, this could mean 1.4M calculations needed to fulfill the mandate. According to an HFMA Article on the topic, this detailed approach could cost a hospital several hundred thousand dollars to contract with a consulting firm.
However, ParaRev’s Price Transparency Tool, which uses the actual payer contract language as outlined in the CMS requirements to make those millions of calculations, costs under $30,000 in the first year, with nominal (under $3,000) quarterly maintenance fees thereafter. It is the most cost-effective and comprehensive solution out there today.
Consumers expect to shop for healthcare the same way they shop for other goods and services and healthcare providers must be ready to meet that need. Therefore, ParaRev has partnered with hospitals across the nation to empower them in providing this required information in a consumer-friendly, intuitive manner.
The team at ParaRev believes that price transparency and Patient Price Estimators are a useful and important component of healthcare consumerism and have spent the past year preparing for the release of these requirements. In speaking with hospital associations, clients, and business vendor groups, we are finding that we are one of the only vendors who can completely satisfy, to the spirit and letter of the law, both CMS requirements in a fully customizable manner.
ParaRev will construct procedure categories and subcategories based on the facility-approved list of services and will provide the implementation instructions for deployment. Initial and ongoing training and support are provided for the duration of the agreement. ParaRev will review your current website design to create a Patient cost estimator tool. The ParaRev Price Transparency Tool provides the Patient an easy to use decision tree to select the required services.
ParaRev will provide your facility a web-based control panel to allow updates and changes to the estimator on an ongoing basis (i.e. update prices, change benefit plans, add services, etc.) ParaRev will provide an optional insurance and benefit plan allowing Patients to enter their own benefit information to calculate their cost.
ParaRev will provide Medicare and Medicaid terms (where applicable) allowing Patients to calculate their cost and will incorporate the Hospital’s self-pay discount to allow self-pay Patients to calculate their cost. ParaRev will provide an option for the price estimate to be printed and will provide links and referrals to financial counseling, charity care policies, quality ratings, Patient satisfaction scores, and other information deemed pertinent by the Hospital. ParaRev will provide an internal web-based tool to review all registrations, estimates, and eligibility checks created by Patients. The ParaRev Price Transparency Tool statistics are tracked in the ParaRev Data Editor (PDE) according to general use, visits by date, top estimates by service, estimates by insurance, and file downloads.
The ParaRev Price Transparency Tool provides facilities with a system for publishing the CMS mandated files to a public website and generating Patient quotes of the top procedures for the facility. The purpose of the ParaRev Price Transparency Tool is to create a web-based system that follows federal requirements regarding Price Transparency and allows the Patient to determine their share of cost for healthcare services.
ParaRev’s Contract Management Tool improves your revenue cycle by identifying the primary cause of denials, developing a work improvement process, and identifying short paid claims. With it you can manage, evaluate, and optimize reimbursement to achieve the required returns with access to our web-based tool for coding, reimbursement, and compliance.
Within each of the ParaRev standard patient types, the contract terms are defined, if the service is reimbursed based on a DRG, APC, fee schedule, ASC level or per diem, there is no relationship between pricing and reimbursement. The Pricing tab will only attribute additional net variable revenue to those contracts which have been specifically loaded into the Contracts tab and the reimbursement is based on a percentage of charges.
ParaRev’s Contract Settlement models can accommodate a variety of methodologies including MSDRG, APDRG, EAPG, OHAS, etc. The solution also incorporates adjustments due to Lessor Of, Stop Loss, and Claim Cap payer contract terms. The model identifies accounts/charges that are impacted by these adjustments and determines the net revenue impact of pricing changes.
