Provider Advocacy Services

Assisting Providers as they face a complex array of legal issues and payment challenges.

PARA draws on its expertise in the healthcare financial process, charge and payment information, to work with providers and attorneys to preserve and enhance the payment rights of providers.

PARA's Provider Advocacy Services eliminates the unnecessary time, expense, and resources spent on preparing your case, due to our many years of performing these services.

PARA acts in defense of a rate increase, transparent pricing challenges, pricing, contracting and charge policies to payers, or RAC audits and subpoenas by Government agencies, working with PARA creates efficiency and results.

PARA assists in the successful preparation of the case; PARA's Staff has experience in expert witness presentation for all types of conflicts, (mediation and trial).

PARA's financial analysis tools, utilizing proprietary relational databases, facilitate the abstraction, analysis, and concise reporting of data, which wins cases.

Working with PARA will provide you and your Counsel confidence that your case is complete and accurate.

Pharmacy Mark Up Standardization

Assisting Providers in the pricing of drugs based on cost.

With the recent legal settlement ending the average wholesale price AWP publication, Providers are moving to cost based markup pricing.

The PARA service combines several sources of data into a financial model to project net and gross revenue impact.

The PARA process will also audit NDC’s and assist in the correction and updates.

PARA continues to assist the Provider with quarterly and annual updates to the cost basis, with continuing refinement of the markup to meet the financial requirements of the Provider.

Materials Management Pricing Audit

Correct Pricing of medical supplies creates correct and appropriate reimbursement

Many Providers have cost reimbursement provisions in their managed care contracts for implants, pacemakers and other high cost supplies.

PARA has developed a financial model to identify items that are not priced correctly, and therefore not reimbursed correctly.

PARA will link the purchasing cost system to the financial model to process a series of markup algorithms, calculating gross and net revenue impact to allow the Provider the ability to choose the “correct” markup to meet its financial requirements.

PARA also updates the cost and revenue impact tables quarterly to track the accuracy of the projections.

PARA will code the purchasing system items with their Universal Product Number (UPN) to increase the accuracy of the coding, ordering and charging of medical/surgical products in the supply chain.

Managed Care Contract Maintenance, Audits and “what if” Projections

Negotiate fair contracts, audit collections, and project the financial impact of changes to existing contracts

Utilizing the Contract Management Tab in the PDE, PARA provides the ability to track an unlimited number of contracts.

The PARA system allows the User to develop reimbursement terms for any type of agreement.

Using the reimbursement terms the User can audit payments to collect “short” pays and project “what if” changes to the contracts.

Procedure Pricing

Fair, equitable and transparent pricing of all services

Link provider specific market data to each line of your price book.

Price services using cost, fee schedule and market data.

Price all type of providers, Physicians, ASCs, Independent Testing Facilities, and Hospitals.

Determine the net revenue impact of price changes to all payers, with any type of contract and level of complexity.

Charge Master Outsource Program

Utilize the PARA Staff to maintain all data elements contained in the charge master

Depend on the PARA Staff to implement all data changes within 48 hours of request.

Utilize the PARA secure web based email system to create, transmit and approve all charge master changes.

Depend on PARA’s coding and pricing expertise to review and approve all charge master changes

Look to PARA to update all codes on a quarterly basis, and advise and educate all interested Users

Utilizing the PARA system will bring your cost accounting, staffing RVUs, purchasing, billing and order entry tables into one convenient always accessible system viewable with any browser anytime anywhere.

Claims Audit and Analysis

Identify compliance concerns and specific areas of lost reimbursement

PARA will audit claims to completely trace the creation of charges, the supporting documentation, and the representation of the charges on the claim forms.

PARA will identify services which should not be billed or billed in conjunction with associated or integral services.

PARA will identify services which have not been billed which are separately reimbursable.

PARA will identify services which expose the Provider to revenue or reimbursement recapture

Payer Defense Audit Services

Outsource the confirmation audit of insurance claims, to an independent auditor, for which the only focus is making the claim correct

Utilizing Registered Nurse Auditors, PARA will review all proposed adjustments to a claim as a result of an “outside” audit to verify the adjustments are correct.

PARA will recommend changes to the charge capture process and the documentation contained in the medical record to reduce the financial impact of future audits.

PARA will recommend changes to the charge master to reduce recapture for revenue from future audits and enhance the net revenue of the Provider.

Operating Room Charge Structure and Pricing Analysis

Develop a resource based charge system which can be replicated by any person on the O.R. Staff

Improve charge capture, reimbursement and resource allocation utilizing PARA's proprietary OR charging methodology.

PARA will create a revenue positive resource based charge schedule and process which allows the consistent charging of all services, for any type of surgical procedure.

The PARA charge system tracks the O.R. Staff payroll hours and converts them to billable charges.

Develop a relationship between payroll hours, outside services, set-up time, and capital equipment and charges.

Emergency Department Analysis

Develop and implement a complete web based system to determine E&M levels, process charges and audit for correct reimbursement

Utilize PARA to develop and implement an E&M level assignment process which reflects the resources expended on Patients.

PARA will work with your ED Staff to improve the charge capture process for drugs and supplies.

The PARA system will also guarantee the capture of all billable hospital based physician charges.

Increase reimbursement by charging all separately billable nursing services.

Look to PARA to be sure that all services billed are compliant and correct.

Charge Master Maintenance

Quarterly, annual and as required updates, to keep your charge master correct

PARA shall continuously review the charge master for any coding or compliance issue and produce a quarterly report to the Hospital.

PARA will determine the financial impact of any compliance issue, and assist in rebasing the charges or processes to correct any problems.

Providers utilizing the PARA PDE system can track an unlimited number of codes within each charge line, for Medicare, Medicaid, Blue Cross and Worker’s Comp Payers.

Utilizing the PARA PDE system all Staff will be able to create audit reports to identify reimbursement opportunities for any diagnostic or therapeutic procedure.

Provider Staff will be able to map provider specific market data on any HCPCS coded item, to be sure of correct pricing of items.

Revenue Integrity Program

Outsource your revenue cycle charge process

The PARA team will chair the monthly Revenue Cycle Committee meeting

PARA will audit the complete charge and billing process for each department, to meet the requirements of an internal audit Staff.

Identify losses in the charge capture and charge documentation process.

Educate Department Managers on all billable reimbursable items.

Implement / update all facets of the revenue cycle to decrease billing costs, increase cash receipts, increase Patient satisfaction and decrease accounts receivable.