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.
Three components to the process:
- The Payer Scorecard – a high level snapshot of denials from your top ten payers
- ParaRev will load 835 remittance files at both the claim level and the line item level for the ParaRev Data Editor to identify and summarize denials, and settle the claims under the contract term details loaded in the PDE.
- Remit Reconciliation – analysis of payments reconciled against contract rate sheet
- Users can choose to examine the remittance denial codes within one or more individual remittances, or among all remittances within a date range. This review can be done within the tool, or a package of reports can be exported for analysis.
- Pro Forma Analysis – comparison of existing terms to proposed terms to analyze the impact
- Analysis can be performed on contracts under negotiation by comparing the proposed terms against the current terms, displaying the impact based on the remits received.
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.