How We Help Hospitals Thrive

As healthcare evolves to value-based care, the average hospital revenue cycle is losing roughly $22 million due to missed revenue capture. An October 2018 survey of more than 100 leaders in finance, revenue cycle, reimbursement and health information management (HIM) departments at hospitals and acute-care facilities uncovered that 84% of respondents believed clinical documentation and coding presented medium-to-high revenue cycle risk for their organizations. Hospital finance leaders were the most adamant with nearly half choosing clinical documentation and coding as their greatest revenue cycle vulnerability.

At Paramount Health Solutions, our highly experienced team of physicians and coding auditors work together with the hospital physicians and staff to improve CDI and coding, improve compliance, increase revenue, and reduce payer denials.

The Services We Provide

For more information about each of our services, click the links provided below.

  • Clinical Documentation Improvement (CDI) is critical to capturing the true clinical picture of a patient’s stay. Proper and accurate documentation is essential for several reasons, including patient safety, accurately recording population health, and claim submission.
  • DRG Validation service bridges the gap between CDI and Coding by auditing the coded data with the correlation of clinical validation of the diagnosis in the patient’s medical record.
  • To obtain proper reimbursement for services rendered, drugs administered and other billable items, clinical documentation is paramount. The primary focus of clinicians is patient care. More time spent on documentation takes a physician’s attention away from patient care. Our team of expert credentialed auditors is ready to help.
  • The Paramount Health Solutions team is comprised of physicians and highly trained individuals who focus on the details in every patient chart. They review charts for information indicating exactly what was included in the patient encounter.
  • The Paramount Health Solutions denials management team of industry expert physicians, coding auditors and UR/Case Management professionals look at all types of denials.
  • Expert coding ensures compliance with both the Centers for Medicare and Medicaid Services (CMS) regulations and commercial insurance regulations regarding quality and reimbursement.
  • PHS’s coding team brings a unique perspective to coding denials. With the belief that each record stands alone, only a thorough review of the medical record will determine the correct coding for each claim. Rather than simply rebilling the claim, our team conducts a comprehensive analysis of the medical record and writes a detailed appeal to defend the codes and support the DRG billed.
  • Our team of industry expert physicians are highly experienced and effective in conducting provider, staff, and coding education.
  • Our approach is to use the client’s previous documentation data as case study examples to stress the importance of complete and accurate information.
  • Paramount Health Solutions conducts monthly calls with clients’ coding, CDI and other relevant departments to create a feedback loop, essential for the success of every Health Information Management Department.
  • Paramount physicians will provide guidance on Level of Care/ Medical Necessity cases referred by the Case Management Department based off InterQual and Milliman criteria on prospective, concurrent, and retrospective reviews.
  • Ask us how our Utilization Review services and Peer to Peer Appeals can help your facilities stay ahead of fighting denials.
  • The rapidly changing coding guidelines during the COVID-19 pandemic have caused confusion and uncertainty among hospital coding professionals. In addition, the government is stepping up audits.
  • Paramount can provide support services to hospitals that self-report billing issues and face a potential billing penalty.
  • Call us to discuss how we can assist your team and potentially reduce your penalty when facing these stressful auditing situations.