Tag: Regulation/Compliance

Legacy system conversions

Posted on by EM Squared
Revenue Capture

For hospitals and health systems, replacing or upgrading an electronic health record (EHR) is a major undertaking fraught with operational and financial risk. Whether you’re upgrading your legacy system or integrating an acquisition into your current system, it’s essential that you ensure the smooth transition of clinical information, accurate coding, demographic, and financial data to sustain billing operations.

Supporting a seamless conversion requires extensive planning and training, along with laser-like focus on the operations and features of the new platform. Yet too often, billing personnel are pulled in multiple directions as they scramble to master the complexities of the new system while trying to wind down aging accounts receivable (AR) tied to the legacy platform. Attempting to juggle these competing duties can produce the worst of both worlds: The volume of outgoing claims submitted through the new system falls, while unresolved accounts in the old platform pile up. Cash flow erodes as days in AR and denials increase. And if unanticipated problems or delays emerge during the EHR implementation, the financial problems can quickly snowball.

ParaRev can help

  • Let us help you mitigate these risks and preserve cash flow by handling the legacy accounts, allowing internal staff to concentrate solely on handling new system billing activities. By focusing just on the new system, in-house personnel can more quickly develop the skills and knowledge necessary to assemble and submit claims in an accurate and expeditious manner.
  • Do you have times where you have a backlog of old accounts? ParaRev can help you here, too by deploying a team of experts to help you clean up these episodic backlogs.
  • With ParaRev as your partner you can be assured that all aging denials are worked methodically and completely to resolution. That means cash can be collected on accounts that otherwise would likely have been written off.

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.

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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Contract Management Tool

Posted on by EM Squared
Revenue Technology

ParaRev’s Contract Management Tool improves your revenue cycle by identifying the primary cause of denials, developing a work improvement process, and identifying short paid claims. With it you can manage, evaluate, and optimize reimbursement to achieve the required returns with access to our web-based tool for coding, reimbursement, and compliance.

Three components to the process:

  1. The Payer Scorecard – a high level snapshot of denials from your top ten payers
    • ParaRev will load 835 remittance files at both the claim level and the line item level for the ParaRev Data Editor to identify and summarize denials, and settle the claims under the contract term details loaded in the PDE.
  2. Remit Reconciliation – analysis of payments reconciled against contract rate sheet
    • 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.
  3. Pro Forma Analysis – comparison of existing terms to proposed terms to analyze the impact
    • 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.

Within each of the ParaRev standard patient types, the contract terms are defined, if the service is reimbursed based on a DRG, APC, fee schedule, ASC level or per diem, there is no relationship between pricing and reimbursement. The Pricing tab will only attribute additional net variable revenue to those contracts which have been specifically loaded into the Contracts tab and the reimbursement is based on a percentage of charges.  

ParaRev’s Contract Settlement models can accommodate a variety of methodologies including MSDRG, APDRG, EAPG, OHAS, etc. The solution also incorporates adjustments due to Lessor Of, Stop Loss, and Claim Cap payer contract terms.  The model identifies accounts/charges that are impacted by these adjustments and determines the net revenue impact of pricing changes.

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