average revenue gain for a 2% risk score increase
average revenue loss for as little as 1% in encounter data quality issues
average revenue loss for inaccurate status determinations
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.
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.
Our analytics are delivered on a flexible and easy-to-use platform that allows for customized outputs and reporting.
Read A Success Story
Oak Street Health Partners with Pareto Intelligence to Improve Revenue Accuracy
The partnership’s initial successes have led to a continuation and expansion of services focused on a holistic approach to achieving complete and accurate revenue capture.