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REVENUE CYCLE MANAGEMENT SERVICES- Billing & Practice Management
How It Works
The most basic expectation that a healthcare professional should have about any competent billing service is that it possesses the knowledge & ability to maximize potential reimbursement for services performed while concurrently minimizing the length of time that it takes to receive the reimbursement. PCMG Revenue Cycle Management Services exceeds this essential requirement because we have even higher expectations for our clients and ourselves.
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Our Billing & Practice Management Service is intended for practices that wish to outsource their billing and reimbursement requirements. PCMG provides services to clients based upon their intended level of involvement with the system. We offer many customizable add-on options to our standard service to provide each client with the flexibility and convenience that they need.
Service:
Standard Billing & Practice Management Service:
Each clients data is forwarded to PCMG via the clients preferred method (EMR, electronic superbill, scan, fax, courier) . All data is entered into our software and examined for appropriate CPT, ICD-9, HCPCS, and modifier code usage. Prior to claims submission, audits are performed to ensure that all data is complete and compliant with current regulations. Reimbursement is pursued. All payments and EOBs are forwarded to PCMG for reconciliation. Extensive follow-up steps are taken to assure maximum and correct reimbursement. Management reports detail all activity for proper practice analysis. Consulting is provided on an ongoing basis (including: coding/billing updates as they relate to your practice and employee training in PCMG procedures.
Includes:
Data entry of patient demographics & billing information Pended claims/Insurance requests processing
Data entry of charges, receipts, & adjustments Appeals on under/improper payments/denials
Production & submission of claims (both electronic & paper) Standardized A/R tracking & follow-up
Production & submission of capitated claims Refund processing
Production & submission of WC/NF claims & attachments Patient ledger requests
Production & mailing of patient statements H-P1 & NF Arbitration forms
Production & mailing of collection letters Insurance Commissioner Complaint forms
Account transfer processing to collection company Patient services support
Standardized claims tracking & follow-up Appropriate modifier usage edits
Bundling/unbundling edits CCI edits
Value-added Consulting :
Initial: Reimbursement Guide Creation (if necessary)
Initial: Fee Schedule Review & Analysis
Initial: Superbill Review/Proper Coding Analysis
Initial: Patient Registration Creation (if necessary)
Initial: Master Forms Booklet (if necessary)
Initial: Fee Schedule Creation (if necessary)
Initial: Superbill Creation (if necessary)
Ongoing: Billing/Reimbursement updates
Ongoing: Staff training
Annual: Fee Schedule Review & Analysis
Annual: Superbill Review/Proper Coding Analysis
Other Services:
Remote Viewing & Scheduler- Internet Access:
In addition to the standard service, PCMG will provide you with secure access to your patient database over the internet. You are able to utilize a computerized scheduling solution, view all of your patient data, print extensive management and analysis reports and print demand statements. There are no software installation concerns and you can view your data from wherever you are (not just the office.)
Electronic Document Storage Solution:
PCMG will provide you with secure access to all billing related documents over the internet. You are able to store, view, and print all of your eobs, superbills, and notices instead of keeping a paper copy for the several years that your state requires. There are no software installation concerns and you can view your data from wherever you are (not just the office.)
Verification of Benefits:
Proper verification of benefits often prevents large sums of write-offs and has a direct impact on your bottom-line. It is the first crucial step in obtaining payment for services. Aside from knowing the specifics of the patients insurance plan (copay, deductible, limits), proper verification of benefits gives you the information and justification needed to appeal a claim that is denied due to lack of coverage for the services provided. PCMG offers this service to all of our Billing & Practice Management clients as an Add-on option to their standard service. The new patient information obtained by the clients office is sent to us via fax or email. Proper verification of benefits will generally result in a noticeable revenue increase for the practice.
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