Experts corner

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The primary benefit to the patient is that we help them navigate the myriad of obstacles set forth by auto insurance carriers. We never pursue patients for payment. Usually all it takes is a single interaction to get the information. Once we’ve received that information, we leverage our cutting-edge technologies and time-tested negotiation/settlement processes to address the patient’s bill while maximizing the hospital’s recoveries.

Medicare Secondary Payer (MSP) is designed to ensure that Medicare doesn’t pay when there are other, primary, sources of payments. When there is an auto accident, it must be ascertained that there is no liability insurance available as the primary insurance before Medicare can be billed. The same applies to Medicaid. Paratus has developed proprietary software customized to dealing with TPL situations and an experienced team that ensures the appropriate responsible parties are properly billed and settled, including the fully compliant billing of any remaining balance to Medicare where appropriate. We assist in accelerating the process so if the account is not true TPL it can be billed with the expectation that a denial will not prevail.

We differentiate ourselves based on our singular focus on TPL and the effort we apply to each recovery. This focus and effort can be seen in each of the components of our solution. 

• TPL is all we do. Just like you wouldn’t use a flathead screwdriver on a Philips screw, you shouldn’t use a general RCM vendor for TPL recoveries.
• When you outsource TPL recoveries to us, we’ll work each and every case sent to us. We quickly determine viability and start working those that are, and quickly return those which aren’t. There’s no cherry-picking high dollar cases while smaller cases sit idle.
• Paratus TPL workflow automation has processed over $4B in claims. We practice continuous integration in our software AND our processes as we strive to get better every day in all aspects of our business.
• Machine learning, automated distribution of calls, emails, and correspondence greatly increase the opportunity for success.

We’ve developed technology to simplify the tasks for all parties in the process. TPL Workflow Automation is at the center of our technology stack. From there, we’ve created easy ways to obtain or share real-time information for all parties. This includes a Client Portal so our clients have easy access to documents associated with the case or can see the status and progress of all the claims. We’ve developed a Patient Portal so patients can gather and upload their data at their convenience. Lastly, we have developed an Attorney Portal to expedite the process of working with the Plaintiff’s Bar to expedite settlements. Our software is cloud based and runs on one of the largest cloud providers in the business. 

At Paratus, we believe that in order to drive a singular focus on the clients’ success, companies should have “skin in the game”. This philosophy fits hand in glove with our overall approach to our clients – “we are in this together!”- we win when you win. 

There are several reasons for entrusting TPL to Paratus. TPL represents an overlooked % of a hospital’s net patient revenue and it is certainly an underserved revenue segment to drive additional net patient service revenue. And that usually means hospitals don’t dedicate their limited resources to maximize their recoveries or ensure compliance. We are dedicated to and built for MSP compliance and TPL recoveries. This segment of the business can result in the equivalent to 1.5 to 3% or more of a hospital’s net patient service revenue. Another reason is that until now, hospitals don’t have a software solution that combines a TPL specific workflow automation and a team of experts without which it would be difficult for any hospital to optimize the process internally. Frankly, that also applies to most third-party vendors! We are uniquely equipped to manage thousands of new potential TPL accounts each day. By having us work this overlooked portfolio, it allows the hospital to allocate their resources in a significantly more efficient manner on other areas of the business that need their attention while we maximize TPL Net Patient Service Revenue. We manage what we are prepared to do and you are free to manage the balance of your outstanding A/R.

A typical medical bill recovery will involve just the patient, health insurer, and hospital. A motor vehicle accident recovery could add up to four more interested parties! This includes the patient’s auto insurer, the other driver’s auto insurer, and possibly lawyers for each! Instead of your team dealing with just two other parties, your team is now sending emails, faxes, and making calls to up to six parties to get the bill paid on a patient population that approaches 60% of your mix. Imagine the staff and the legal support required to manage tens of thousands of TPL accounts at any given time.

Part of what we do, and we do it really well, is that we hyper-accelerate the securing of the information necessary to prosecute a successful recovery for the client. We are dedicated to identifying viable and non-viable accounts as efficiently and effectively as possible. Our average turn-around time for non-viable TPL accounts is 48 hours. This means those accounts are vetted for MSP compliance and returned for the NRP. Otherwise, we would be doing our clients a great disservice by not ensuring as quickly as possible that an account is directed to the appropriate source for the best source of recovery/reimbursement. It is not in our best interest or that of our clients for us to hold onto accounts indefinitely, hoping for a positive outcome. We develop a timely filing matrix for payers and then ensure that we return any accounts without a lien or claim at 180 days or 30 days prior to timely filing. 

Lift is the difference between the hospital’s estimated reimbursement rates and our performance on each account. Lift, and many other financial metrics are available in our monthly performance report.  We begin by developing a matrix, by payer source, of average reimbursement and match it up to our performance. You can readily see the value of our effort to your organization.

Many hospitals aren’t sure how much TPL recoveries they are missing out on. Lift is something we can estimate even before we start! Initially, we take a hospital’s data file to assess past financial performance of accident claims. We run your hospital’s prior financial results through our predictive proprietary algorithm toto project future financial performance if we are running the process.  

There are many questions, but I will boil them down to three. 

• First, does the current TPL Solution (external or internal) process every encounter and pursue settlement of the claims or do they only cherry-pick big dollar cases to manage their internal costs while leaving significant revenue dollars of their client on the table. Our analytics consistently show around 50% of the TPL recoveries coming from encounters under $20,000. 
• Second, instead of focusing on the rate quoted, what is your cost relative to recovery $ percentage. Which would you prefer to pay – 8% of $50,000,000, for net recovery of $42,000,000 or 12.5% of $100,000,000 for net recovery of $87,500,000? We have competitors that quote a low rate but are charging a flat rate of all ED visits, ostensibly to “vet” everything coming through the door. Our vetting algorithms are completely automated and close and return non-viable accounts without any charge. It seems to be counter-productive to pay someone to determine if a cardiac arrest happened at or shortly thereafter a motor vehicle accident. Wouldn’t you rather pay a percentage of actual recoveries?
• And finally, if your TPL vendor does not pursue every reasonable third-party source of recovery how is your hospital system in MSP compliance? And if you don’t, how much risk of exposure to denials are you willing to tolerate?