Behind robust contract management systems, strong front line PFS staff, and third-party vendors, PARAREV’s STAT Revenue team collects millions of underpaid commercial and government insurance dollars. We go account by account to find your unique underpayment issues that are often missed by technology-based vendors. We get you every dime you’re due.
In our experience 1% of contractually due revenue will go unpaid, which could be a million-dollar mistake.
Our nationwide revenue cycle expertise combined with our in-depth knowledge of payer and coding issues enables us to quickly recover lost revenue. Even when working behind robust contract management systems, strong front-line PFS, or other third-party vendors, we ALWAYS deliver results. We work on a full contingency basis so we only get paid if you do.
Our uniquely tailored independent payment audit does not rely on software on top of software to identify underpayments. Programs have intrinsic limitations when dealing with complex reimbursement methodologies. Our approach gives us the flexibility to address your hospital’s unique underpayment issues often missed by technology-based vendors. Our human-based approach, combined with our proprietary database, makes for an incredibly strong review that consistently outperforms even the best contract management systems.
Once underpayments are identified and researched, our highly skilled team works on your behalf to collect that revenue from your payers. Our proven follow-up, appeals, and denials approach consistently results in collections for even the most challenging underpayment issues.
ParaRev’s Underpayment Recovery service consists of Underpayment ParaRev’s STAT Revenue team applies nationwide revenue cycle expertise to recover underpayments from your payers. Our recommendations and trainings deliver customized and innovative solutions to your hospital. We enable your team to minimize future underpayment exposure, while recovering existing contractual underpayments to improve your bottom line. Our underpayment recovery service includes:
Behind robust contract management systems, strong front line PFS staff, and third party vendors, ParaRev’s STAT Revenue collects millions of underpaid commercial and government insurance dollars. We go account by account to find your unique underpayment issues that are often missed by technology-based vendors. We get you every dime you’re due.
Hospitals can lose millions in revenue when Medicare and Medicare Advantage patients’ discharge status codes do not reflect the post-acute care received. While receipt of services is outside of your control, we will ensure claims are in compliance and will recover unwarranted payment reductions.
Our process extends beyond underpayment recovery. We provide specialized trainings to bolster your team’s capabilities to resolve systemic errors and increase collection rates. Our best practice recommendations deliver customized and innovative solutions to your hospital to decrease future underpayment exposure.
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.
The ParaRev Revenue Integrity Program (PRIP) will allow your hospital to dedicate staff and resources to areas which will provide a greater return. The ParaRev Revenue Integrity Program deliverables include: Claim audit to review charge capture coding and compliance, Market-Based Pricing with a relationship to fee schedules or cost, Charge Master line-item review and maintenance, Compliance audit to review HIM/Business Office assigned codes and modifiers, Revenue Management Committee to provide oversight, governance and guidance.
Due to the current reduction in reimbursement and utilization, hospitals need to gain efficiencies; the PRIP will allow your hospital to dedicate staff and resources to areas which will provide a greater return. ParaRev’s Revenue Integrity Program audits your hospital’s revenue cycle to ensure appropriate charges are created, captured, coded, and priced correctly. The PRIP will also integrate your Department Managers into the revenue cycle to make them active participants in charge creation, capture and reimbursement.
Hospitals work continuously towards making sure their charge master is up-to date, compliant and priced appropriately. Many bring in outside vendors to perform detailed audits of their charge master to review pricing opportunities, coding/compliance issues and to identify missing charges. Having an outside vendor perform these reviews is helpful because it beings a fresh set of experienced eyes to the task of identifying hidden issues and reveal opportunities for additional revenue.
The goal of the ParaRev Revenue Integrity Program (PRIP) is to audit and enhance your Hospital’s revenue cycle to ensure appropriate charges are created, captured, coded and priced correctly.
Contract management and analysis is one of the most critical focus points of revenue cycle management to ensure effectiveness and better reimbursement. Hospital Financial Managers need a tool to manage, evaluate and optimize reimbursement to achieve the required returns.
There are three components to the process:
1. The Payer Scorecard – a high level snapshot of denials from your top ten payers
2. Remit Reconciliation – analysis of payments reconciled against contract rate sheet
3. Pro Forma Analysis – comparison of existing terms to proposed terms to analyze the impact
The Scorecard exports an Excel spreadsheet with a summary that displays information by payer including total charges, contractual adjustments, allowed amounts, patient responsibility amounts, and paid amounts. That is followed by the summary of denials, and an analysis of performance by patient type. 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. 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. Each remit is assigned a current contract parent and a Proforma contract, then settled side by side to see how the proposed terms will impact reimbursement. This will provide the hospital a basis for counter proposal to ensure revenue is not negatively impacted with a new contract.
ParaRev’s Lab PAMA Reporting Service offers an efficient and accurate method to meet a new Medicare reporting requirement due from certain hospitals in the first quarter of 2022. The reporting is extremely burdensome and labor-intensive, and penalties are high for failure to report timely, complete, and accurate data. Many hospitals are required to report, for the first time, “private payor” lab payment rates in detail during the first quarter of 2022. Medicare will use this data to set the Clinical Lab Fee Schedule rates for 2023-2025.
ParaRev’s Lab PAMA reporting service uses electronic claim and remittance files to efficiently prepare copious amounts of payment data into a consolidated spreadsheet that can be used to confidently report private payor lab payment rates to Medicare. Reports are due in the first quarter of 2022 for a six-month period in which payments were made (Jan-June 2019) by private payors for each laboratory service CPT® code.
Our powerful web-based platform efficiently matches line item payment data from electronic remittances to claims submitted to commercial payors on the 14x TOB. ParaRev’s technology and expertise produces a detailed, comprehensive spreadsheet which supplies verifiable data organized in a manner that is easily adapted for submission on a consolidated report to Medicare.
Hospitals are moving towards standardizing pharmacy pricing across all departments and services, thus improving compliance issues associated with inconsistent charging practices.
Although no standard methodology exists, it is ParaRev’s opinion that when creating pharmacy pricing methodologies, the following must be considered:
• Self-Administered Drugs (SAD) should have lower markups to comply with Medicare billing standards
• Pricing should be developed using a nationally recognized cost basis or actual acquisition cost
• Fixed Add-On and Minimum Charges should be utilized to compensate for any use of additional departmental resources for handling or compounding the medication
The ParaRev Pharmacy Pricing Process assists facilities in creating a rational, cost-based pharmacy markup that remains sensitive to self-administered drugs and uses a nationally recognized cost basis. The project focuses on reducing self-administered drugs while increasing injectable items to meet the revenue goals of the organization.
The ParaRev Pharmacy Pricing Process deliverables include a proposed markup, gross and net revenue projections, an item-specific detailed spreadsheet proposed changes, and a full write-up of techniques and findings.
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:
Grand Summary – Annualized summary of gross and net revenue impact including inflation cap, claim cap, and stop loss adjustments, and listing of iteration parameters
Peer Pricing Hospital – List of peer hospitals used in the analysis
Patient Type Summary – Unannualized summary of gross revenue difference by patient type
Department Summary – Unannualized summary of gross revenue difference by department and patient type
Payer Summary – Unannualized and annualized summary of gross and net revenue difference by payer including inflation cap, claim cap, and stop loss adjustments
Payer Detail – Unannualized and annualized summary of gross and net revenue difference by payer and patient type including inflation cap, claim cap, and stop loss adjustments
Contract Terms Summary – Listing of contract terms loaded into model by Contract and Patient Type including reimbursement methodology, values, inflation caps, claim caps, and stop loss thresholds
Procedure Detail – Unannualized summary of gross revenue differences by CDM line item including reimbursement and peer pricing data
Procedure Detail Less than Profee – Listing of CDM line items that have a current price less than the published Medicare professional fee schedule
Procedure Detail Less than Hospital – Listing of CDM line items that have a current price less than the published Medicare CLAB, DME, or APC fee schedules
Shoppable Services – Unannualized summary of gross revenue differences by CDM line for CMS Shoppable Services items including reimbursement and peer pricing data
Cost Settlement – Unannualized impact of contracts with Cost Settlement Terms by department and payer
Lessor Of – Summary of Lessor of Adjustments by Payor
DRG Cases – Unannualized summary of gross revenue by DRG