Priority Management Group – CHC Billing Experts

Pawtucket, R.I., and Bradford, Vt. – May 26, 2009 — Priority Management Group, Inc. (PMG), a leading supplier of outsourced billing services for community health centers (CHCs), announced today it has entered into an agreement with Little Rivers Health Care to provide healthcare billing services.

Little Rivers Health Care is a 330-funded CHC with clinics in Bradford, East Corinth and Wells River, Vt. The organization began operations in June 2006 to address the health needs of the community and to promote the general wellness of its patients. It operates three clinics to deliver primary medical, behavioral and dental services for individuals of all ages. 

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Pawtucket, R.I. and Washington, D.C. – May 4, 2009 — Priority Management Group, Inc. (PMG), a leading supplier of outsourced billing services for Federally Qualified Community Health Centers (FQHCs), announced today it has reached an agreement with La Clínica del Pueblo to provide medical, behavioral, and interpreter billing services.

La Clínica del Pueblo is a 330-funded FQHC located in the heart of Washington, D.C. The organization was founded in 1983 to provide healthcare to uninsured and underinsured Latinos regardless of their ability to pay. More than twenty-five years later, the clinic continues to serve the healthcare needs of its patients in a newly renovated, state-of-the-art building. Last year, La Clínica provided over 55,000 health services to more than 7,500 individuals.

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Question: A Medicare patient comes into the health center with their own serum for an allergy shot. The shot was administered by an RN or LPN.  The appointment is not a face to face with a core provider (PA, NP, or MD) and the patient is not seen by anyone else but the RN/LPN giving the shot.  Can an FQHC encounter be charged?

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Question: May the therapeutic, prophylactic, and diagnostic injections and infusion codes be reported when these services are provided by the nursing staff employed by the hospital (ie, hospital outpatient department)? Can the facility report the infusion codes for the nursing staff providing these services and can the physician also report these codes for supervising the plan and treatment? If so, what are the documentation requirements for the physician to be able to report these codes in a hospital outpatient department?

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Question: An insurance company has refused to pay for an Evaluation and Management (E/M) Office or Other Outpatient Services code (eg, 99214) and procedure code 90765, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour, when they are both reported on the same date of service. They state the office visit is inclusive to the procedure. What is the appropriate way to report these services when the two (ie, the E/M visit and the intravenous infusion) are unrelated?

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Denials were rising, cash flow was up and down and staff turnover was increasing. What was the true problem, and could it be fixed?

In late 2002, Peter Gerondeau was appointed the senior vice president of finance & administration at Dimock Community Health Center (CHC) in Boston. After completing his initial round of staff meetings, he compiled a list of concerns. Heading the list was the billing department. Gerondeau’s over 20 years of experience in nonprofit health care was steeped with billing department and IT challenges. But while facing an issue in the billing department was no surprise, the pervasiveness of this problem was most unsettling.

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Pawtucket, RI and Washington, NC – May 22, 2007

PMG, the leading supplier of outsourced billing services for Federally Qualified Community Health Centers announced today that Metropolitan Health Centers entered into an agreement to provide medical and dental billing services.

Metropolitan is a 330-funded Community Health Center located at the heart of North Carolina’s Inner Banks in Washington, NC. The organization was incorporated in 1999 and provides healthcare to individuals regardless of their age, race or faith or ability to pay. The organization serves the health care needs of patients in Beaufort, Hyde, Pamlico and Martin Counties. The corporation recently celebrated the opening of its newest clinic offering family centered primary care medicine, diagnostic imaging, pharmaceutical and dental services to answer the needs of its rapidly expanding patient base. Metropolitan also provides chronic disease case management and outreach services to the regions Diabetic and HIV patients through grants from the State Office of Minority Health.

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