FAQs
Does PMG bill for Community Health Centers (CHCs)?
Yes, PMG has been billing for CHCs since 2000. We are one of the nation's leading CHC-centric revenue cycle management (billing) firms and have difficulty finding other firms with a similar focus.
Why does PMG concentrate on the CHC market?
We respect the mission-oriented nature of CHCs' work, particularly in caring for the uninsured and underserved. Unfortunately, CHCs too often cannot achieve fiscal solvency, or even sustained surplus/profitability, due to competing priorities and/or a lack of in-house expertise. PMG is committed to helping CHCs make the necessary changes to address this shortcoming.
What is revenue cycle management (RCM) as opposed to outsourced billing?
RCM encompasses a much broader array of services than traditional "billing-only" firms offer. Many think of billing as simply the entry, transmission and payment posting of health care claims. RCM includes those key components of billing in addition to EOB analytics, sliding-fee scale review/development, coding training, chart auditing, coding optimization (e.g. modifier addition or ranking of items), claim enhancement (e.g. multiple encounters on a single DOS, CCI scrubbing), denial reason code management, returned item analysis/management and KPI reporting/enhancement. We work claims as if they were our own — and to some degree, they are because PMG is paid a percentage of what our clients get paid. And we don't get paid until our clients do.
Does PMG understand what makes CHCs unique?
Yes. Members of our billing staff are trained on the idiosyncrasies of the CHC business, such as sliding-fee scales, PPS vs. cost-based encounter rate, Title X, Ryan White, employed physician staff, a multilingual patient base and UDS reports. We also appreciate our clients' mission-oriented, nonprofit nature and recognize that they have different needs than hospitals, surgical centers and private practices.
Why should I outsource our organization's billing?
Outsourced health care billing companies have been around since the 1970s and process tens of millions of claims each year. CHCs choose to outsource billing services for a variety of reasons, including the inability to retain quality in-house staff, a knowledge deficit within the organization, the savings achieved by outsourcing and the revenue increases that typically come with incentive-based outsourcing contracts.
Generally speaking, CHCs report that outsourcing their billing needs produces superior results. PMG's clients, for example, carry on average less than half "days in A/R" than centers managing billing with in-house staff. Also, since starting with PMG, all of our billing clients have increased net revenue (i.e. payments) per patient while gross revenue (i.e. actual charges) have increased negligibly.
What services does PMG offer besides billing?
PMG billing/revenue cycle management clients may take advantage of other PMG services, such as chart auditing (including evaluation and management chart auditing and ICD-10 chart auditing), onsite and WebEx training (e.g. coding, CHC encounter rate, front desk and the revenue cycle), payer-related research, sliding-fee scale analysis and process assessments pertaining to operational areas impacting billing optimization.
What are the qualifications of the PMG staff?
Everyone on the PMG team — from certified coders to seasoned billing professionals to members of senior management — is an expert on CHC coding, billing and reimbursement. And with clients in more than 40 states, our knowledge of the CHC market is always expanding. Couple this tactical experience with the dozens of regional and national programs/events at which PMG presents, and you won't find a more talented and engaged group of CHC revenue cycle authorities.
On what billing or EMR platforms does PMG work?
PMG works on a range of practice management (PM) software that interacts with a variety of EMR/EHR products. Our experience includes AllScripts, NextGen, eClinicalWorks, eMedsys, Dentrix, EHS, HealthPort and others. Moving forward, we will maintain our commitment to working with the leading PM products to which the CHC market is committed.
