PAYMENT COMPLIANCE

Our team turns over rocks to resolve reimbursement discrepancies, improving forecasts and collections.

About 1% to 3% of net hospital revenue is commonly lost due to insurance underpayments and invalid denials. Our seasoned team works with you to develop a payment compliance monitoring system that relies on robust contract modeling to identify the true value of the services you provide based on your contracts and the care provided. Precise reimbursement modeling enhances net revenue accuracy, identifies lost revenue and provides visibility into adverse reimbursement trends. By identifying and resolving inappropriately underpaid claims and denials, we work collaboratively with you to improve collections and cash flow–and your overall financial health.


A Track Record of Success

Increase cash collections

We recover more than $650+ million annually for clients through real-time management and resolution of payment discrepancies and denials.

Improve forecast accuracy

Our effective protocols and technology give you the ability to better predict revenue because you know what you can expect.

Identify opportunities to change out-of-date processes

Improve your awareness of outdated protocols causing payment discrepancies through analysis that’s benchmarked with 250+ top-performing hospitals.


CASE STUDY: Service in Action

The Issue

A 15-hospital system faced a high percentage of denied and underpaid claims, as well as aging technology and outdated protocols, resulting in consistent revenue shortfalls.

The Action

Parallon partnered with the client to develop a new payment compliance system, update technology, leverage best practices and establish proven resolution protocols. Parallon conducted a root cause analysis to identify internal process refinement opportunities and hold payers accountable for actions that violate the agreed upon terms of the provider contract. In addition our experts pursued underpayment recoveries and overturned denials.

The Result

$20M in incremental net revenue

Parallon Results

How it Works

1

Discrepancy capture and triage

Our systematic comparisons identify issues in real-time to facilitate timely action and resolution. Discrepancies are triaged and coded to assist with measuring large volume issues across payers, contract language, facilities, or states.

2

Root cause analysis

Accounts are analyzed to determine the root cause of the payment discrepancy. This leads to minimizing incoming volume as a result of internal process opportunities.

3

Payment resolution

Pursue valid underpayments, routing denials to specialized appeals teams. Defined escalation paths and established relationships with major payers pave the way for faster and increased payment discrepancy resolution.

Improve Reimbursement Accuracy

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