Specialized payer resolution

Revenue Capture

ParaRev has experience handling all situations and all payers, and can take on any long-term or temporary AR projects you have in mind and will improve reimbursement, reduce denials, and decrease audits.

Our expertise ranges from:

  • Clinical denials (including prior authorization and medical necessity), handled by the expert RN staff of our utilization team
  • Coding and billing issues, resolved by our certified coders
  • Workers Comp/Personal Injury, handled by our specialized WC/PI team
  • COBs and patient denials
  • High- and low-balance account resolution
  • Aged problematic accounts and backlogs
  • Appeals
  • Corrected claims and rebills
  • Fiscal year-end collections

Staff Training & Education

Revenue Capture

Our process extends beyond underpayment recovery. We provide specialized trainings to bolster your team’s capabilities to resolve systemic errors and increase collection rates. PARAREV’s STAT Revenue team’s best practice recommendations deliver customized and innovative solutions to your hospital to decrease future underpayment exposure.

Our process extends beyond just underpayment recovery. Our goal is to bolster your team’s capabilities and controls to resolve systemic errors and increase collection rates.

Competitors see your hospital’s mistakes as their gain. STAT Revenue is different. We focus on reducing your underpayments year after year. We never withhold information from our clients. Reports detail exactly what we’re finding and how to prevent underpayments going forward.

From complex pricing instruction, contract analysis, appeal best-practices, and escalation tactics, our experience creating and delivering trainings for hospital teams spans all aspects of revenue recovery. Our trainings address significant issues directly and give your staff the tools we’ve used to resolve payment discrepancies.

Charge Master Review

Revenue Integrity

With the emergence of codes as the basis for almost all forms of reimbursement, charge master coding and maintenance has become a daily chore. Ensure your hospital’s Charge Master is up-to-date and compliant by having ParaRev identify and correct errors, compliance issues and missing charges.

The ParaRev HIM Staff will review Medicare, Medicaid and Workers Comp code changes on a monthly basis and update the charge master where required, any changes which impact the charge creation and capture process will be reviewed in the monthly RMC.

The ParaRev Charge Master Review deliverables include: Checking invalid HCPCS/CPT® and Revenue Codes, checking line items for charge compliance and modifiers, checking valid code assignment, checking pricing internally and against fee schedules and pricing data, reporting and implementing updates. The desk review can be expanded with an “on-site review” to meet with each of the Revenue Department Managers and complemented with a “Claim Review” and on-site visit.

One of the main goals of the program is to empower and unleash the entrepreneurial forces contained within each Department Manager. Managers are encouraged to update codes, prices and add services throughout the month, Managers are often frustrated by the slow pace of the current charge maintenance process. ParaRev’s services ensure that everyone is involved in the charge master maintenance process.

Purchase Item Master Review

Revenue Integrity

Many health care organizations experience difficulties capturing and billing supply charges due to inconsistencies between the purchase item master (PIM) and the Charge Description Master (CDM) billing system. Many times these systems are not linked; and therefore become unsynchronized resulting in lost revenue and other compliance concerns. ParaRev’s Purchase Item Master Review brings together the coding and financial analytic components of our services to create a link and a process to appropriately maintain the purchase item master (PIM) and Charge Description Master (CDM) systems simultaneously.

Determining which supply items are billable and maintaining consistency between the Purchase Item Master (PIM) and the Charge Description Master (CDM) can become a daunting task for revenue cycle and materials management personnel. 

The goal of the PIM review is to identify all billable items contained within the PIM and reconcile the PIM by line item to the CDM. The review also analyzes the HCPCS and revenue codes for the PIM/CDM items, to ensure compliant and appropriate supply billing practices.

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.

Price Transparency Tool

Revenue Technology

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.