Billing
PMG's expansive billing services encompass a variety of offerings related to revenue cycle management. No other billing firm can match our CHC-exclusive focus and ever-improving process for maximizing payment possibilities for the CHC market.
Database Integrity & Practice Management Optimization
PMG works with a number of industry-leading practice management (PM) software products. A critical part of our initial work is to evaluate database structure, provider number linkage, 837 file output and other mission-critical indicators. Many of these indicators are often overlooked by revenue cycle experts who don't specialize in the CHC field.
State-Centric Research
PMG scours Medicaid and private payer resources to assure compliance with stated statutes and maximization of income. Our revenue cycle experts perform diligent research to assure your CHC receives every dollar to which it is entitled, legally and ethically.
Participation Status (Credentialing Verification)
Aside from basic compliance with federal and state requirements, PMG works with clients to identify and rectify potential pitfalls and confusion around the credentialing and determination of accurate participation status with governmental and commercial payers.
Charge & Sliding Fee Scale Analysis
We can summarize our approach to this work in one simple phrase: "Always charge more than what you expect to get paid." If you're not a revenue cycle "aficionado," this statement may seem controversial. However, by assuring clients set charges adequately, you will see impressive payment increases.
Charge Entry
Charge entry, one of the most challenging aspects of revenue cycle management, is also vulnerable to mismanagement. Whether a client transmits charges to PMG via an EMR/EHR or allows PMG to manage the entire process, we leverage thousands of pages of written rules created to mitigate delayed/denied claims.
Transmission
With v5010 changes, Medicare format requirements, Medicaid encounter-rate requirements and constantly changing commercial rules, most CHCs are vulnerable to common EDI pitfalls. By maintaining top-tier relations with clearinghouses and creating scores of rules to assure formats are exceptional, PMG promotes elevated clean claim rates.
Payment Posting & Denials
As with charge entry, PMG has written thousands of pages of rules to assure correct capture of optimal payment. Correction and resubmission of unpaid claims are part of these rules—and a key component to increase the speed with which PMG clients are paid.
Unpaid Claims
For those claims that are more difficult to get paid, ongoing, aggressive management is essential. PMG's net collection rate is in the upper 90 percentile due to dogged determination and attention to claims that payers deny on initial submission. In addition, our unpaid claims report categorizes denial reasons, thus improving CHC operational performance and avoiding ongoing denials where possible.
Data and System Interfacing
For PMG's Ntierprise clients, UDS reporting is practically standard. All other clients must be able to access unusual combinations of qualitative and quantitative indicators that are "non-standard" in terms of practice management software reporting. PMG works consistently with clients to manage a myriad of uni- or bi-directional interfaces for lab networks, PM to EMR/EHR, meaningful-use maximization and more.
