For nearly a decade, Priority Management Group (PMG) has made Community Health Center (CHC) billing a Priority. Our company has been laser focused on a few, carefully selected criteria: increasing revenues while decreasing Days in A/R, compliance and collecting receipts as efficiently and as fast as possible. Our narrow focus produces big results for our Clients.

Results PMG's CHC Clients carry roughly half of the outstanding receivables of organizations billing with in-house staff. In most cases, PMG’s CHC Clients carry roughly one month of outstanding charges or 30 Days in A/R (DAR). Our perfected billing process covers the full life of a claim. From charge entry to CPT/ICD/CCI claim scrubbing to electronic claims submission to payment posting to denial and unpaid claims management; it is this process that ultimately separates us from the pack. Every PMG Client receives medical coding training for their providers to ensure their organization is reimbursed properly. In addition, PMG Clients utilize a variety of industry leading Clinic Management Systems including AllScripts’ Ntierprise and Eclinical Works.

CHC Vocabulary PMG staff members know what Sliding Fee Scales are and why CHCs utilize them. We know UDS Reporting, cost based Medicaid reimbursement , school based health centers, dental claims, Substance Abuse/Detox billing and CHC Centric specialties as well as UGS/NGS Medicare. We know the mission of CHCs and take a unique approach to collections by applying proven billing processes while not restricting access due to inability to pay.

Focus PMG grew similarly to countless other billing companies; we took all potential accounts, regardless of their specialty. Over the following 7 years, PMG ballooned to over 17 medical specialties and sub-specialties, including CHCs. However, maintaining industry leading expertise in so many varied specialties is simply unsustainable. We at PMG have realized this, and have since reduced the number of specialties served by intentionally paring the existing account base to focus on CHC billing.

Core Competency CHC billing is the heart of PMG. It is our core competency. This is not to say PMG staff are experts at cost reports, risk management or clinical recruitment and retention. We are billing experts. However, do not believe us: ask our Clients about the financial results they have experienced during their tenure with PMG. For example, three of PMG’s largest CHC Clients have seen their encounter rate increase more than $20/per patient encounter. These same Clients saw an average payment increase of more than 40% while charges increased, on average, less than 5%. These are not sales tactics but empirical data.

An argument for PMG as the FQHC billing experts…

• PMG is a nation-leading outsourced revenue cycle management firm with more than eight years in the CHC market.
• PMG staff worked over 150,000 denials and unpaid claims in 2007.
• PMG staff has extensive experience in medical, dental and behavioral health revenue cycles.
• PMG’s understands the language- PPS, Encounter rate, Sliding Fee Scale, UDS reports. We understand the CHC language and mission.
• PMG has experience on multiple management information system platforms (e.g., eClinicalWorks, AllScripts) and willingness to work on national “tier one” products.
• PMG has reduced outstanding A/R for all Clients compared to prior billing structure. Some CHCs have seen a 55% reduction in Days in A/R with PMG.
• Every CHC client benefits from increased revenues after signing with PMG, some more than 30%.

PMG’s maximizes CHC compensation during revenue cycle management via:

• Medicare compensation blending legal mix of UGS versus Medicare Part B billing
• Encounter rate billing and wrap around claims o Extensive commercial payer experience
• Understanding of Medicare Advantage and Managed Medicaid.

CHC clients benefit from unusual mix of services, including but not limited to:

• Encounter Form Review/Creation
• Electronic charge capture (EMR)
• Sliding Fee Scale Development/Management
• FQHC Centric Coding and Reimbursement Training
• Medical Record Review (Chart Audits for compliance and education)
• Operational Assessment around revenue cycle management (including front desk review, historic EOB review, revenue/coding enhancement, etc.)

Contact Us
Feel free to contact us and discuss if PMG is a good fit for your organization. A five minute conversation may help your organization immeasurably.

Download the capabilities PDF here.