Priority Management Group – CHC Billing Experts

According to CMS regulations, under Chapter 13 in the Medicare Benefit Policy Manual, 60.1, would fetal non-stress tests performed in the office setting fall under Incidental and Integral part of physician’s professional services, making it necessary for the physician to be on site in order to bill for the service?

In short, don’t think so.   CMS recognizes three levels of supervision: general, direct, and personal. General supervision means the billing.provider does not even need to be on-site; e.g., lab, ultrasound.  Direct means the billing provider needs to be in the office suite “within shouting distance;” e.g., residency supervision or “incident to” billing. Personal supervision means in the exam room with the patient; e.g., personal oversight of surgical resident if wanting to bill as attending. Thinking fetal stress testing (like ultrasound) falls under “general supervision” not requiring physical presence of the billing doctor.  

With exception of SSI patients, questioning how many OB services are rendered to Medicare patients.  Can research whether fetal stress tests definitely fall under “general” supervision, or not, if desired.

By Robert Skeffington, Partner, PMG, Inc.

Now that the celebrations have ended and the confetti has been cleared, it’s time to consider how the Patient Protection and Affordable Care Act will impact Federally Qualified Health Centers (FQHCs).

As one of the most effective federal programs, FQHCs are poised to continue their prominence. Nearly everyone agrees that covering more individuals with health insurance is a positive step forward, as is substantially growing the FQHC program. But what, if anything, will change in the revenue and/or billing process as a result of the new law? Patient revenues from Medicaid, Medicare and other payers make up more than 50 percent of an FQHC’s revenue. As such, this question requires further examination.But what, if anything, will change in the revenue and/or billing process as a result of the new law? Billing is more than half of the average FQHC’s annual revenue, so this question requires a closer look.

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Pawtucket, R.I., May 19, 2010 — Priority Management Group, Inc. (PMG), a leading national supplier of revenue cycle management and consulting services to community health centers, announced today it has entered into an agreement to serve East Liberty Family Health Care (ELFHC) of Pittsburgh, Penn.

The contractual arrangement calls for PMG to deliver a comprehensive suite of services in the back-end billing staffing, denial management and clearinghouse areas. PMG also will provide consulting services, including a full onsite operational assessment, to improve the effectiveness and efficiency of front-end billing processes along with semi-annual in-service training sessions to ensure appropriate coding by physicians.

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Pawtucket, R.I., and Middletown, Ohio. – April 30, 2010 – Priority Management Group, Inc. (PMG), a leading supplier of outsourced billing services for community health centers (CHCs), is providing billing services for Primary Health Solutions Inc. (PHS), a federally qualified health center (FQHC) in Ohio.

Led by CEO Marc Bellisario and CFO Don Reimer, PHS management began exploring the need to outsource the billing process in 2009. The company needed help in addressing a number of concerns, including billing, accounts receivable, denial management and efficiency in collections. PHS selected PMG based on the excellent fit between the organizations and PMG’s significant experience with FQHCs.

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Pawtucket, R.I., and Anna, Ill. – Priority Management Group, Inc. (PMG), a leading supplier of outsourced billing services for community health centers (CHCs), announced today it will provide billing services for Rural Health Inc. (RHI), a federally qualified community health center in Illinois.

Led by CEO Cynthia Flamm, RHI leadership began exploring the need to outsource the billing process by interviewing five vendors. The company needed help in addressing a number of concerns, including billing, accounts receivable, compliance and efficient receipt collection. RHI selected PMG based on the excellent fit between the two organizations.

Under the agreement, PMG will deliver a comprehensive suite of services (e.g. UDS reports, cost-based reimbursement, sliding fee scales, etc.) beginning Nov. 16. Consulting services will include a full on-site operational assessment to improve the effectiveness and efficiency of the front-end billing process along with semiannual training sessions to ensure appropriate coding by staff and physicians.

“While investigating the possibility of outsourcing the billing process, we researched five vendors with extensive business experience and asked them to submit a bid for this service,” said Flamm. “We determined there would be a significant cost savings and financial gain to the organization by entering into an agreement with PMG. We are excited to take advantage of PMG’s unique back-end billing process and focus on community health centers, which we are certain will result in increased revenues for us.”

“My partners and I are proud to have been selected by RHI, a key provider of health care services to the Southern Illinois community” said Robert Skeffington, PMG co-founder and partner. “With PMG’s proven track record in the CHC billing environment, RHI staff will be able to focus on their mission of serving patients while leaving the business of increasing their revenues to us — a core competency of ours.”

About Priority Management Group

PMG is an industry-leading third-party medical billing company offering services to CHCs and look-alike organizations since 2000. We speak the CHC language and have dramatically increased revenues at each of our CHC clients. For more information, please visit www.chcbilling.com or call Robert Skeffington (401-616-2020) or Ray Jorgensen (401-616-2099).

About Rural Health

Rural Health Inc. is a private non-profit community health center located in Southern Illinois. We provide primary care services to individuals and families throughout their lives, including obstetrics, gynecology, pediatrics, adolescent, adult and geriatric medicine. We have four primary care sites, a school-based center at AJ High School and a dental clinic. Our mission is to provide quality health care to patients, regardless of their ability to pay. More at www.ruralhealthinc.org

Providence, R.I. –  Priority Management Group, Inc. (PMG) is proud to announce it has been selected to present at the 2010 National Association of Community Health Centers (NACHC) Policy & Issues (P&I) Forum. The conference will take place in Washington, D.C. from February 24-28, 2010.

This will be the second time PMG has presented at the P&I Forum. The session attracts the nation’s elite administrators and board members of community health center (CHC) organizations across the country. An annual event, it is a premiere showcase of both the issues facing CHCs in these challenging times and policy focus for the CHC market as a whole.

After a thorough search and vetting process, the NACHC selection committee chose PMG to present on one of the most significant changes to the billing process in the last decade. “ICD-10 – Are You Ready?” will examine the changeover to new diagnoses coding, departments affected in the health center and how to plan for the event. The implementation of ICD-10 will impact diverse areas such as front desk, billing software, provider training and reporting.

“PMG is thrilled to speak again at the P&I Forum,” said Robert Skeffington, Executive Vice President of the firm.  “We look forward to expanding our work within the CHC market by assisting organizations with the ICD-10 change and its significant effect on the entire revenue cycle process.”

“Diagnosis coding, an integral part of the reimbursement process, is one of PMG’s core competencies and a focus of our firm for the past decade. We hope this session will assist CHC organizations in understanding the magnitude of the ICD-10 change and in starting to plan for its inception. It will have a direct financial impact on all health centers nationwide.”

With the primary and secondary conference hotels already sold out, this year’s event is highly anticipated — and should be one to remember.

About Priority Management Group

PMG is an industry-leading third-party medical billing company offering services to CHCs and look-alike organizations since 2000. PMG speaks the CHC language (e.g. UDS reports, cost-based reimbursement, sliding fee scales, etc.) and has dramatically increased revenues at each of its CHC clients. For more information, please visit www.chcbilling.com or call Robert Skeffington (401-616-2020) or Ray Jorgensen (401-616-2099).

About the Policy & Issues Forum

The National Association of Community Health Center’s Policy &Issues Forum is the largest gathering of health center clinicians, executive directors, state and regional primary care partners, board members and advocates on record. This is the conference to participate in as the nation launches an historic effort to restructure the health delivery system and expand the reach of health centers from 20 to 40 million Americans. 

Priority Management Group, Inc. (PMG), a leading supplier of revenue cycle management and consulting services for community health centers (CHCs), announced today it will provide billing services for Kent Community Health Center, an organization comprising medical, dental and behavioral health providers.

Delmarva Rural Ministries (DRM) runs Kent Community Health Center, the only not-for-profit Federally Qualified Community Health Center (FQHC) serving Delaware’s Kent County. Founded in 1972, DRM is committed to helping the uninsured and underinsured of the region.

The need for Kent Community Health Center’s services is strong and growing daily. Its comprehensive staff includes board-certified physicians, dentists and mid-level providers offering adult, geriatric, pediatric, women’s health, behavioral, dental and case-management services.

“From our initial interaction, PMG has been professional, patient and extremely knowledgeable. These types of transitions can be difficult; the transition with PMG has been everything but,” said Shannon Backus, Kent Community Health Center chief operating officer. “The transition has been educational and pleasant, with goal-oriented staff. I look forward to continued work with PMG.”

“My partners and I are excited to be working with such an important organization as Kent Community Health Center,” said Robert Skeffington, PMG co-founder and partner. “With PMG’s track record of increasing revenues for its CHC clients, this relationship should allow Kent to focus on its patients’ needs and expanding on its mission.”

About Priority Management Group

PMG is an industry-leading third-party medical billing company offering services to CHCs and look-alike organizations since 2000. PMG speaks the CHC language (e.g. UDS reports, cost-based reimbursement, sliding fee scales, etc.) and has dramatically increased revenues at each of its CHC clients. For more information, please visit www.chcbilling.com or call Robert Skeffington (401-616-2020) or Ray Jorgensen (401-616-2099).

About Delmarva Rural Ministries & Kent Community Health Centers

DRM is a private not-for-profit organization serving those with modest incomes, including seasonal and migrant farm workers, and other underserved populations on the Delmarva Peninsula. Kent Community Health Center aims to provide high-quality, compassionate and culturally sensitive primary and preventive health care services to its community. For more information, please visit www.drminc.org.

Priority Management Group, Inc. (PMG), a leading national supplier of revenue cycle management and consulting services to non-profit health centers, announced today it has entered into an agreement to serve Neighborhood Health Clinics, Inc. (NHCI) of Fort Wayne, Ind.

The contractual arrangement calls for PMG to deliver a comprehensive suite of services in the back-end billing staffing, denial management and clearinghouse areas. PMG also will provide consulting services, including a full onsite operational assessment to improve the effectiveness and efficiency of front-end billing processes along with semi-annual in-service training sessions to ensure appropriate coding by physicians.

NHCI, a Federally Qualified Community Health Center (FQHC), offers a wide range of health care services, such as full family medical and dental care, pediatric care, women’s health care, pregnancy care and the Women, Infants & Children (WIC) nutritional supplement program. Since its founding in 1968, NHCI has grown steadily in terms of patients served, unduplicated encounters and programs offered to residents of Fort Wayne and surrounding areas.

A 330-funded grantee, NHCI serves clients regardless of their ability to pay. The organization needed assistance to address a number of concerns, including wraparound claims, turnover of billing staff, decreased revenue, lag time related to cash flow, inadequate reporting and the overall headaches associated with managing a complex billing process.

NHCI initially engaged PMG to assess its billing department via a mini assessment. After reviewing the results of this financial and billing benchmark evaluation, the organization selected PMG for its revenue cycle and billing needs.

“PMG is proud to welcome Neighborhood Health Clinics to its growing roster of Community Health Center [CHC] clients. We are pleased to have the opportunity to afford NHCI the ability to focus on their core competency of well serving the healthcare needs of the Fort Wayne community” said PMG President Ray Jorgensen.   “PMG hopes to create financial security and additional funds through which NHCI may further expand its community outreach. We look forward to a long, mutually rewarding relationship.”

For more information about NHCI, please call 1-260-458-2641.

About PMG

PMG is an industry-leading third-party medical billing company offering services to FQHCs and look-alike organizations since 2000. PMG speaks the CHC language (e.g. UDS reports, cost-based reimbursement, sliding fee scales, etc.) and has dramatically increased revenues, with flat patient growth, at each of its CHC clients. For more information, please visit www.chcbilling.com or call Robert Skeffington (401-616-2020).

Since its founding in 1976, Optimus Health Care has been serving the health care needs of the community. The organization has been true to its mission of improving the overall health of the many communities it serves by providing culturally sensitive services regardless of ones ability to pay.  The community health center offers a wide range of services including medical, dental, behavioral health care as well as HIV, OB/GYN and Health care for the Homeless.  Optimus has experienced significant growth in the past few years resulting in over 2000,000 annual patient encounters generated at over 12 clinics.  

Several months ago, administrators of the organization realized the need for an outside view of their revenue cycle to assess its health and ways to improve efficiency with a focus on increasing revenue.  Thomas Hill, Chief Operating Officer of Optimus was tasked to find a firm with solid CHC experience and a track record of helping organizations in similar situations.  After researching the market and contacting NACHC and the Connecticut Primary Care Association for ideas, Mr. Hill talked to several firms.  Finally, Optimus decided PMG Consulting was the best choice.  PMG has been helping community health centers and look-a-like organizations for more than 10 years. Its PMG’s core business.  

The review occurred over several days both in the health centers and in meeting at the CHCs administrative offices.  PMG consultants interviewed staff across the organization, from front desk staff through the C level staff.  Upon the completion of this phase, PMG staff conducted an in-depth review of the revenue cycle including benchmarks of both staffing levels and financial results.  The project culminated in a comprehensive written report and project plan offering a step by step improvement plan for Optimus.  The results were well received by the organization. 

Ludwig Spinelli, Chief Executive Officer of Optimus offered the following to summarize the project:  “As a veteran FQHC CEO, I was pleased with the depth and method used by PMG to complete a revenue analysis. I believe every FQHC should undertake one as we face mounting numbers of uninsured and wish to serve as many patients while keeping a positive bottom line. PMG knew what to look for and produced as meaningful report that can be tied with action steps leading to enhanced revenue.”

About Optimus Health Care

Optimus Health Care, formerly Bridgeport Community Health Center, Inc., is the largest provider of primary health care services in Southwestern CT. With 12 service delivery sites located in the Cities of Bridgeport and Stamford, and the Town of Stratford, we provide comprehensive health care services to everyone, regardless of race, income and insurance status. We will provide you and your family the best quality of care.  For more information please visit http://www.optimushealthcare.org/.

About PMG

PMG is an industry-leading third-party medical billing company offering services to Federally Qualified Community Health Centers and look-alike organizations since 2000.  PMG speaks the CHC language (e.g., UDS reports, cost-based reimbursement, sliding fee scales, etc.) and has dramatically increased revenues, with flat patient growth, at each of its CHC clients.  For more info please visit www.chcbilling.com or call Robert Skeffington (401-616-2020).

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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