Primary & Secondary AR Recovery and Resolution

Revenue Capture

ParaRev pursues your aging, small-balance claims identified by your staff as problematic. If a claim has previously been worked internally, referring it to ParaRev’s dedicated, specialized teams can help ensure quicker cash conversion and a reduction of bad debt reserves.

Primary AR recovery and resolution

ParaRev helps ensure hospitals and health systems quicker cash conversions and a reduction of bad debt reserves through a team of dedicated specialists combined with intelligent automation, our proprietary, next generation technology. ParaRev supports your specific AR requirements by working claims based on your processes – both small and high-balance claims as well as highly-aged claims. Our flexibility and scalability allow us to work in partnership with your CBO to recover and resolve all outstanding insurance claims based on your balance and age criteria.

Improve your AR with our core competencies:

  • Provide a virtual extension to bolster your central billing office’s resources with a dedicated, knowledgeable and responsive team of experts who have specific experience with your payers
  • Integrate seamlessly with your systems and sits on the background for ease of working relationship
  • Decrease cycle time through transformative intelligent automation and advanced business process engineering expertise
  • Ensure all claims, no matter age or balance, are effectively worked to 100% resolution utilizing appropriate staffing
  • Prevent future AR issues through proactive denial management using root cause analytics to identify and address problems at the source
  • Ensure the security of your PHI with HITRUST CSF certification

Pre write-off (Secondary) AR recovery and resolution

Hospitals and health systems are realizing that the highly-aged claims they would have written off, present a potentially major, untapped revenue stream. Also known as secondary assigned accounts or second placement AR services, pre write-off insurance collections provide a critical safeguard to ensure no insurance payments legitimately due the hospital go uncollected, regardless of age. Through a team of dedicated specialists combined with intelligent automation– our proprietary, next generation technology, ParaRev can efficiently pursue these claims and maximize cash returns.

Benefits of enlisting a pre write-off recovery partner:

  • The establishment of an AR management process that offers a systematic approach to obtaining 100% claims resolution
  • A reduction in write-offs, a commensurate increase in cash flow and a decrease in bad debt reserves caused by aging accounts
  • The creation of incentives that push primary AR vendors to optimize their processes
  • Greater transparency to enable hospitals to evaluate performance across the entire revenue cycle
  • Let ParaRev focus on those claims that are approaching the end of the typical recovery cycle to help you collect more cash.

Spot/cleanup projects

Revenue Capture

ParaRev is available to assist you as relief valve in multiple scenarios:

  • EMR conversion projects—Assist with legacy platform to ensure staff has priority focus on new platform, or vice versa
  • Fiscal year-end projects—Assist with achieving aging and cash goals
  • Overall spot projects—ParaRev is available to assist for assorted project needs that are not necessarily ongoing in nature
  • Test trial projects—Let ParaRev prove ourselves with a one-time project to show you what we can do

As a vendor, our goal is to be flexible and assist our clients however needed. Our goal is to prove through our technology and experience that we can be a true partner for any healthcare provider.

Targeted denial resolution

Revenue Capture

ParaRev has over 20 years of AR and denial management resolution experience.

  • Our system and our processes are what sets us apart from other AR firms.
  • Our system is an automated decision tree, driven by our clients’ desk procedures and years of experienced industry-leading solution best practices. This platform is driven off EDI analytics, which starts an FTE at the appropriate initial step to expedite resolution.
    • Once a person is set at the correct initial starting point, the system guides them step-by-step through the resolution process of that issue, forcing the correct action to be taken.
    • Through this system, any type of issue or process can be streamlined for maximum efficiency.
  • Our workflow system keeps track of what needs to be done and when. Keeping our reimbursement specialists focused on what they need to accomplish and providing management the visibility into items that need action. Our system automatically sets reminders and ensures accounts get the required actions completed prior to timely filing.
  • ParaRev creates custom workflows for our individual clients based on their processes and procedures; our workflows will mirror your workflows. ParaRev creates these workflows for all major denials/issues; they are built into our software, ensuring your policies and best practices are followed. By guiding our staff through the best next steps within our software, we can ensure the highest levels of performance.
  • We have found that dedicated reps are far more productive than pooled staff. Working with a specific client not only gives them the ability to learn the client’s business & payer contracts, they also learn their culture and become experts on your specific collecting process, as every client is different. Along with dedicated team members performing follow up, ParaRev provides dedicated managers, supervisors, and team leads to your account—available whenever you need their expertise or insight.
  • Problem identification and communication is key. All of the above processes provide us with a tremendous amount of information. This information is then analyzed and provided to our clients in the form of dashboards, monthly reports, and quarterly meetings, including recurring deep-dive analytic presentations from subject-matter experts that will uncover root causes driving AR issues.  This information often results in helping our client strategically improve their revenue cycle by identifying front-end, system/edit, and payor-related opportunities.  By partnering with ParaRev your operation typically will see improved collections and reduced aging on the subset of the accounts outsourced. This is due to our process and the fact that we would be applying more attention to a targeted area of accounts that may not have historically seen as much focus. Our goal is to be a relief valve and allow your internal staff to target the younger inventory in other areas that need attention.

Contract Consulting

Revenue Capture

Complex reimbursement methodologies and ambiguous contract language are often the reason behind underpayments. Our review begins with a comprehensive analysis to identify the risks associated with each contract. We’ll collect the insurance revenue you’re due, and help you close contractual loopholes in future negotiations.

Our review begins with a comprehensive analysis of payer agreements, regulations, and legislation to identify the risks associated with each contract. We take special note of high risk contract language such as readmission clauses, coordination of benefits, and carve-outs for special services. We then utilize this analysis to complete an in-depth review of all related claims to identify underpayments.

Regular project updates are customized to inform your team of the top underpayment trends we uncover. We work directly with your team to ensure revenue integrity by implementing processes to strengthen controls, close payer loopholes, and provide contract language recommendations for future negotiations. In situations where the standard appeal process does not yield results, PARAREV can assist in escalating major underpayment issues to achieve resolution.

Managed Care Remit Reconciliation

Revenue Integrity

Available as part of the overall Contract Analysis or as a stand-alone service, the Managed Care Remit Reconciliation provides an analysis of payments reconciled against contract rate sheet.

In order to ensure claims are properly paid per contracted terms and improve your overall billing process, we will analyze your 835 remits with managed care settlement terms  to identify improperly paid claims, creating actual versus expected reimbursement. From there, we provide a report to review claims by payer to identify trends that can be addressed to maximize reimbursement or improve the billing process.

We will provide a comprehensive report package outlines charges, adjustments, allowed amounts, payment amounts, and projected payment amounts.

Claim Review

Revenue Integrity

ParaRev will review detailed itemized and UB04 outpatient claims to identify missing charges, compliance problems, and billing issues. The review will be completed by a certified coder with extensive experience in all areas of coding and auditing.

From the review, we will identify charge process capture issues, coding and compliance errors, billing errors, and identify documentation and system issues. We will then:

  • Provide detailed and summary reports identifying ParaRev recommendations and impact on reimbursement
  • Provide supporting authoritative references to support ParaRev recommendations
  • Review our findings and provide education in a meeting with the opportunity for the client to ask questions, provide comments and discuss recommendations
  • Analyze reimbursement impact
  • Provide ongoing support regarding coding/billing questions through our PDE software

ParaRev Data Editor

Revenue Technology

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:

  • Charge Quote/Price Transparency ‐ Provide accurate and timely price quotes. EDI interface to allow real‐time eligibility verification, fulfill the CMS Price Transparency requirements
  • Charge Process ‐ Streamlined process to add, change and inactivate items in your Charge Master, research databases to accurately add new services to the Charge Master
  • Claim/RA Evaluator ‐ Evaluate 835/837 EDA data to ensure proper billing and reimbursement, analyze denial trends for follow up
  • Payer Contract Analysis ‐ Manage and model all contracts for price transparency, pricing analysis, claim reconciliation and pro forma modeling of contract terms for improved reimbursement
  • Pricing Data ‐ Unlimited access to current detailed peer market data for four defined markets of your competition’s prices
  • Pricing Iterations ‐ Create pricing scenarios to determine the net and gross revenue impact to promote transparency and improve your competitive position
  • Pharmacy/Supplies Markup ‐ Manage all pharmacy and supply mark‐ups for price appropriateness in an easy-to-use interface
  • Filters/CDM ‐ Access to current/historic charge master files, to manage all coding and billing issues and ensure an up to date and compliant charge master
  • Calculator ‐ Query-based research tool that allows for access to current/historic billing and coding information, LCDs, NCDs, and Reimbursement
  • Advisor ‐ Educational repository for all supporting documentation on industry changes (MedLearn, OIG, RAC, and CMS transmittals, articles and bulletins)
  • CMS ‐ Data mine Inpatient and Outpatient Medicare claims data from 2006 to present to identify and correct compliance and reimbursement issues

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.

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