Author: EM Squared

Underpayment Recovery

Posted on by EM Squared
Revenue Capture

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.

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Underpayment Recovery

Posted on by EM Squared
Revenue Capture

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:

Underpayment Recovery

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.

Transfer DRG Review

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.

Staff Training & Education

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.

Contract Consulting

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.

Transfer DRG Review

Posted on by EM Squared
Revenue Capture

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, PARAREV’s STAT Revenue team will ensure claims are in compliance and will recover unwarranted payment reductions.

Nationally, the impact of incorrect post-acute transfer payment reductions amounts to hundreds of millions of dollars lost per year. Qualifying Medicare and Medicare Advantage claims receive a payment reduction when patients are transferred to another provider to continue treatment. Unfortunately, patients do not always comply with their discharge instructions and do not receive these post-acute services as planned. This results in improper payment reductions for your hospital.

Our thorough review of qualifying claims to ensure receipt of post-acute care as planned can provide your hospital with a significant boost in revenue. Our proven Transfer DRG Review service allows your hospital to recover unjustified payment reductions for claims with discharges in the last four years.

The review necessary to identify these claims is extremely time consuming and most hospitals don’t have the resources necessary to perform this review themselves.  Let us identify instances of non-transfer to capture this revenue for you, while also giving you the peace of mind your claims are accurately and compliantly reflecting the actual services received.

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Staff Training & Education

Posted on by EM Squared
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.

Contract Consulting

Posted on by EM Squared
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.

ParaRev Revenue Integrity Program

Posted on by EM Squared
RevTeg
Revenue Integrity

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.

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Managed Care Remit Reconciliation

Posted on by EM Squared
RevTeg
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.

Contract Analysis

Posted on by EM Squared
RevTeg
Revenue Integrity

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.

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ParaRev Data Maintenance

Posted on by EM Squared
RevTeg
Revenue Integrity

With all of the constant changes to coding and billing requirements, many organizations are overwhelmed with maintaining billing systems. Annual pricing updates are also a challenge for many facilities. ParaRev has the capability to assist the hospital in the implementation of updated CPT®/HCPCS codes and prices through ParaRev’s Data Maintenance Services which allows your hospital to maintain ongoing updates to your change master through remote access.

Hospital resources are finite, and with the constantly evolving environment of healthcare, codes and billing requirements can be hard to manage.  ParaRev’s Data team serves as a relief valve to ensure that the changes we are proposing our implemented in a timely and accurate fashion.

ParaRev can produce a custom upload file or ParaRev will process the price change manually and/or scripting changes directly into the billing system utilizing a secured remote connection.

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Lab PAMA

Posted on by EM Squared
RevTeg
Revenue Integrity

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.

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