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
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.
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.
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
Historically EMR systems are built to store, summarize, and manage medical information, providing minimal guidance when working an account to resolution; ParaRev offers an add-on solution that builds in everything that someone needs—whether they are a brand-new hire or an experienced denials analyst—in order to work accurately and efficiently every time, on every claim
Problems
Our Solutions
Keeping track of all the rules, regulations, and guidelines between different regions, carriers, and hospitals
With our technology-based approach, we build all rules and guidelines directly into our workflow system, we create a centralized location for information, eliminating the need to dig through emails and double-checking payor known-issue logs and other spreadsheets
Ensuring uniformity of work done by in-house staff and outside vendors can be a challenge
Since any specific preferences are built into our system, all workflows follow the same steps for any “like” issues/carriers Auto-notation creates a fast, structured history of accounts through uniform message choices
Quality across team members (in-house and vendors) can be hard to ensure
Human error significantly reduced since the system flags when hospital and insurance rules are not followed Automation also improves through the machine learning of the rules and of insurance behaviors
Targeting the right inventory to maximize collections is a time-consuming process
With machine-learning, our automation process optimally prioritizes what should be worked first—automatically, without time-consuming man hours Our system tailors worklists to specialized analysts, allowing greater efficiency as they work to their area of expertise, and easily guides them through all detailed processes
Vendors can be a huge additional cost
With your EDI data and access to your systems, HFRI’s tech-based hybrid approach to AR allows us to do more, to do it faster, and to do it at a lower price
ParaPath is our proprietary AR follow-up decision software which guides our reps through the AR process with no deviation and auto-notates their actions within the program and is fully and utterly customizable to you and your needs and workflow—no more workarounds because our software is set up for you.
The program helps keep track of myriad of rules, regulations, & guidelines by storing everything in one place—our system—in a way that’s easy to follow and connect with. Our auto-notation creates a fast, structured history of accounts through uniform message choices to ensure uniformity of work. Unlike other software that can generate static “canned” notes tied to certain internal actions, ParaRev’s system builds notation from the answers and inputs of users on individual account actions, resulting in notation that is uniform, accurate, and—as with all aspects of the system—completely customizable.
By utilizing automated categorization when organizing worklists around the root issues, ParaRev eliminates the time and need to manually identify the problem, allowing our reps to start the account work immediately.
ParaPath allows you to monitor and guide your staff and vendors to make sure they work the exact way you want them to with the steps you need them to take. Through machine-learning, our automation process optimally prioritizes the accounts that should be worked first to make sure you are targeting the correct inventory and maximizing collections.
With your EDI data and access to your systems, our tech-based hybrid approach allows us to do more, faster, and at a lower price.
The benefits:
Reduce cost to collect
Single storage place for all your rules and guidelines—kept up-to-date for all staff in one uniform place
Ensures uniformity of work from your team & outside vendors, regardless of experience level
Ensures uniformity of notation and actions
Accelerates production from team members
Accelerates start up of new team members
ParaRev does all the heavy lifting requiring minimal client IT assistance
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.
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.
