Evaluate the major factors contributing to revenue and identify activities to improve performance, as well as potentially offset losses from COVID-19.
Gaps in risk documentation can have a material impact on your overall revenue. Pareto identifies and prioritizes undocumented risk gaps to focus point-of-care efforts and ensure regulatory compliance.
From encounter to regulatory submission, both the health plan and provider are responsible for maintaining the integrity of encounter data. Pareto verifies that data generated at point-of-care is completely and accurately transferred and submitted without data leakage.
The capitated payment you receive depends on the Medicare Secondary Payer (MSP) and entitlement status of your patients. Pareto verifies the accuracy of status determinations to ensure accurate payments and appropriate commercial insurance billings.
Using Pareto’s solution, Oak Street Health identified issues within encounter data submissions that were impacting risk adjustment payments and evaluated discrepancies specific to End-Stage Renal Disease (ESRD) entitlement determinations.
If you're a provider that is not currently taking on risk, there has never been a more important time than now to begin that journey. Between the sharp decline in elective procedures, restrictions on face-to-face visits and general apprehension towards seeking any non-emergent or nonessential medical care, providers relying exclusively on a fee-for-service (FFS) model will struggle to combat and recover from COVID-19's impacts.
Leveraging Pareto's data and analytics empowered by the deep healthcare expertise from Gorman Health Group advisors, we can accelerate your transition to value-based care to prevent revenue interruption, create more predictable capitated reimbursement and bring certainty to your bottom line. Contact us to start the conversation.
