State of the art software, management tools and reporting that has taken over 30 years to develop. Increase zero balance and billing income by ($500k to over $1.0+ million per payer contract audited), P2A loads your payer contacts and your zero-balance paper then automatically re-calculates each bill exactly as your contract states it should have been paid for each payer.
Every hospital or large physician group keeps their old data going back many, many years. However, this data is rarely ever used and if they put in a new operating system, they tend to look forward rather than backwards – and often walk away from the old data. P2A takes this old data and re-engineers it into a useful format that is used to increase recoveries, and more importantly generate reports that allow clients to make better decisions going forward.
The process truly is a 100% re-adjudication of every single claim that the client had, which can be millions of claims for certain facilities. The thorough process captures what actually happened with that claim, versus what should have happened with that claim. P2A loads the payer and provider contracts, the billing files (“837’s”), the payment files from the payers (“835’s”), and reconstructs the payment process of every claim with every payer that the client works with going back 5 years. This massive data exercise gives P2A a view that no one in the industry has.
When a hospital is able to see 5 years of billing, payment and contract history, all redone outside of their current systems in an independent environment, it provides a platform to really make better decisions.
The key reports that P2A produces are called Contract Value Analysis (CVA) reports. This is an analysis of each and every contract that that payer had with that hospital or physician group and it is a re-adjudication from the actual contract and then compared to what was actually paid. If there is a difference, then there has to be an explanation for that difference – this is where P2A drills down to figure out what is really going on.
It is now the hospital’s choice to decide how aggressively they will seek recovery of the lost payments. In some cases they will aggressively seek recovery of the short payments, in others they will use the past short-payments data to renegotiate more favorable contracts, in almost every case they can use the P2A data and reports to improve their internal processes.
