PMG Insights Blog

December 3, 2018

Don’t Let Coding Errors Cost Your CHC Cash – “Decoding” Code Linkage and Medical Necessity

Without a doubt provider coding errors are a top reason for rejected claims at Community Health Centers (CHCs). This shouldn’t be surprising. We all ...

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October 3, 2018

E&M Code Level Consolidation On the Table… Again

Contributed by Ray Jorgensen Back in 1996 when I became the first CPC in RI and one of only seventeen in New England, we were ...

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June 25, 2018

Tactics to Boost CHC Front Desk Performance (and Your Bottom Line)

Your Community Health Center (CHC) front desk has many roles. It serves as a welcome face for those in need of care and must ...

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June 11, 2018

Choosing a CHC Provider Enrollment Vendor – Four Valuable Tips

Community Health Centers (CHCs) often struggle with credentialing and provider enrollment. Trying to keep the process in-house means finding (and keeping) experienced staff. Too ...

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March 6, 2018

Delegation and the CHC Revenue Cycle – Successful Leaders Set it and Forget it

The devil is in the details, and that is doubly true when it comes to the Community Health Center (CHC) revenue cycle. This complex ...

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February 19, 2018

Bigger than Billing… Exploring the Nuances of True Revenue Cycle Management

When we tell people that PMG offers Revenue Cycle Management services to Community Health Centers (CHCs), many people assume that we created a fancy ...

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February 8, 2018

Mission vs. Survival – The Community Health Center Battle

For the past several months, Community Health Centers (CHCs) have been faced with the uncertainty around continued funding by the federal government; funding which ...

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January 5, 2018

Provider Enrollment & Credentialing: Solving Enrollment Issues

We at PMG have never seen an FQHC that is not working tirelessly to obtain maximum reimbursement. You found the right staff, you finally ...

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September 11, 2017

Co-Sourcing Your CHC Billing Department – Have Your Revenue Cake and Keep Your Staff Too

Making the move to an outside vendor for your community health center’s (CHC’s) billing needs can be a difficult decision. CHCs are truly the ...

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July 12, 2017

Secrets for Winning the A/R Battle at Your CHC

At month’s close, Community Health Center (CHC) executives across the country brace themselves as they review the status of their accounts receivable (AR). Dollars ...

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April 17, 2017

Enrollment vs. Credentialing vs. Facility Privileges

To many in CHC leadership, these three topics can be confusing. To maximize reimbursement, while staying compliant with governmental regulations and payer contractual language, ...

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March 13, 2017

How the ACA Could Affect Your CHC

Congressional consternation continues in Washington D.C. Too many options from too many interest groups makes it difficult to find commonality to meet the needs ...

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January 17, 2017

Locum Tenens vs. “Incident to” Billing: Unraveling the Mystery

Too many CHCs are befuddled when it comes to understanding how to bill services under another provider’s National Provider Identifier (NPI). Some CHCs do ...

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January 3, 2017

PMG’s FQHC Funding Predictions for 2017

2016 was tumultuous to say the least, with the most divisive U.S. election in modern history topping the list. Despite the dire predictions of ...

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September 19, 2016

Top 5 Reasons PPS G Codes Need Code Expansion

Coding is a complex topic. So confusing is it that too many in CHC leadership fail to sometimes grasp nuances essential to broadly capturing ...

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August 15, 2016

CHC Credentialing… Great Opportunities and Frightening Liabilities

Many CHCs struggle to maximize reimbursement. Transition from cost based to PPS rates, understanding Medicare G codes, ACA programs advocating APM and expansion of ...

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July 18, 2016

What Does EDI Mean for Medical Billing?

I was asked to write a blog post about what I do as the Director of EDI and Business Systems at PMG. If you ...

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April 4, 2016

Improving Self-Pay is Not One Size Fits All for CHC’s

Is your self-pay AR continuing to grow and you just don’t know what to do about it? You are not alone.  Many of our ...

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January 25, 2016

Gross vs Net Collections: What Your CHC Needs to Know

At PMG, we encourage our community health center (CHC) clients to familiarize themselves with their financial numbers and to utilize the data reports we ...

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November 9, 2015

Claims Denial Reasons and How to Fix It

Are you in denial? Denials are claims that get processed by a payer but are not paid as expected. ‘Denial’ is a word that ...

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October 23, 2015

Culture of Confidentiality Part II

Your Health Center’s biggest information security threat is… your employees? Information Security Professionals are constantly on the watch for new threats. Technologists deliver strong ...

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June 22, 2015

Revenue Cycle Numbers: Day in Accounts Receivable (DAR)

A Key Performance Indicator (KPI), simply put, is a performance measurement. KPIs evaluate the success of a particular activity, in this case, the success ...

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June 12, 2015

How Medical Coding Training Could Help

CHC providers are notoriously bad at coding. Don’t believe me. Look at the data. CMS limited payment of multiple encounter rate payments at CHCs ...

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May 18, 2015

Numbers Don’t Lie: FQHC Key Performance Indicators

Reimbursement in the community health center (CHC) world has changed drastically over the program’s last 40 years. Gone are the grant dependent entities of ...

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March 30, 2015

Medicare PPS – are we having fun yet?

The Transition to PPS Payment Methodology The transition to the PPS payment methodology for Medicare has not been as seamless as some would’ve thought. ...

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February 17, 2015

What’s Your Average Number of Visits Per Hour?

Let’s face it. There are very few things that your CHC can do to immediately and profoundly increase income. Sadly you can’t magically increase ...

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November 6, 2014

Charge Setting at your CHC…Maximize Opportunities with Prudent Planning

New HRSA SFDS PIN, Medicare Rate Hike, & Medicare “G” Codes Create Perfect Storm Too often when we ask a CHC CEO or CFO about ...

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October 15, 2014

Elements of an Effective Payment Plan

Whether it’s the complexities in payment methodology, increase focus on outcomes, or the attention on health information technology, there is another common challenge among ...

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June 3, 2014

Time has not been wasted.

So everyone is really, and I mean really tired of hearing about ICD 10, and the latest onslaught of daily emails all addressing new ...

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May 13, 2014

Why Are We Scared of Auditors?

Want a sure fire way to send shivers up anyone’s back? Just tell them that they are going to be audited. Audit is a ...

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April 30, 2014

Find Inspiration in Constant Change…Or at least a reason to be willing to constantly change.

I write as I am crusing, according to our pilot, at 37,000 feet heading to Phoenix for work at the Region IX conference.  Most ...

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April 14, 2014

Time for Spring Cleaning!

Time for Spring Cleaning! Here in New England the weather has started to warm up.  It will be close to 60 today which for ...

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April 7, 2014

Adapting to Change

Groups like the American Medical Association which lobbied hard for another ICD-10 delay had their wish granted on Monday evening. The healthcare industry anxiously ...

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March 28, 2014

ICD-10 Delay… Again. Team Ready v. Team Tardy.

By now you have most likely heard about the probable delay of ICD-10, again.  H.R. 4302-Protecting Access to Medicare was passed by the House ...

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March 28, 2014

The ground is rumbling in Washington.

Well it’s been an interesting week in Washington.   On Thursday, the U.S. House of Representatives voted to approve H.R. 4302-Protecting Access to Medicare [1] ...

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March 11, 2014

ACA & ICD-10 Success… Make Your Own Luck.

“Be prepared, work hard, and hope for a little luck. Recognize that the harder you work and the better prepared you are, the more ...

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February 27, 2014

Benchmarking for Payment Expectations

Recently I was challenged by a CFO who was caught off guard when payments were significantly lower than expected.  After a slow couple of ...

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February 10, 2014

Medicare Sequestration Adjustment Codes Changed

The Budget Control Act of 2011 mandated across the board reductions in government spending.   In 2013 President Obama ordered a payment sequestration reducing Medicare ...

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