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Is Your Value-Based Revenue Right?

In a delegated risk world, the financial outlook for payers and providers is inextricably tied together, with providers taking on most of the risk through reimbursement that is dependent on accurate documentation and reporting. This requires oversight into payer processes that have potential downstream impact on revenue.

Pareto’s Value-Based Reimbursement solution enables providers in risk-bearing contracts to review, analyze, oversee and improve key process that drive risk-based revenue performance.

$125-$150 PMPY

average revenue gain for a 2% risk score increase

$60-$80 PMPY

average revenue loss for as little as 1% in encounter data quality issues

$40-$50 PMPY

average revenue loss for inaccurate status determinations

$8.4M

in financial improvement potential for 30K attributed lives

Improve Risk-Based Revenue Accuracy

Oversight into the major factors contributing to revenue allows risk-bearing providers to ensure accurate reimbursement from private payers, CMS and/or state government. This starts with an assessment of data quality and value-based contracts to establish a baseline for subsequent analysis. Then we apply Pareto’s proprietary revenue integrity analytics to identify and prioritize gaps and recommend activities to improve performance.

The potential financial improvement opportunity identified by our Value-Based Reimbursement solution can be more than $8 million for 30K attributed lives.

How it Works

  • Risk Coding & Documentation: Identify & prioritize undocumented risk gaps to focus coding improvement efforts & ensure compliance.
  • Payer Data Validation: Verify data documented at encounter is completely & accurately transferred, submitted & accepted for regulatory reporting.
  • Capitated Payment Evaluation: Validate member status determinations (e.g., MSP, ESRD, Dual Eligibility) to ensure accurate premium payments.
  • Performance Improvement: Prioritized risk documentation improvement campaigns, actionable provider-level coding scorecards & proven payer-provider communication tools to improve risk, quality & clinical outcomes.

Why Pareto?

Payer Expertise

Our extensive experience working with payers on these activities gives us the insight necessary to facilitate data access and pinpoint issues contributing to lost revenue.

Root Cause Focus

We go beyond surface-level gap identification to uncover the root cause of revenue losses to resolve issues at the source.

User-Friendly Platform

Our analytics are delivered on a flexible and easy-to-use platform that allows for customized outputs and reporting.

Read A Success Story

See it and Believe it

Our demos say it all. Tell us about your challenges and we’ll show you how we can help you overcome them.

Schedule a Demo