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Physician Contract / Reimbursement Management |
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National statistics show that approximately 20% of all commercial claims are paid incorrectly according to the provider’s initial understanding of contractual reimbursement terms and provisions. Once all of the contractual provisions and reimbursement methodologies have been completely defined, denial issues addressed, posting / registration issues identified, this figure often translates to contractual underpayment variances of 1% – 5% of net revenue. PMMC’s revenue management solutions are designed to improve physician organization’s financial performance by accurately calculating contractual revenue for efficient collection of reimbursement. Click here for an electronic brochure on PMMC PHYSICIAN PRO
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Flexible Implementation |
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PMMC PHYSICIAN PRO utilizes Microsoft .NET and Microsoft SQL Server as its technology and database platform. This allows for flexible implementation solutions that can vary by client and flexible interfaces that can vary by situation. Implementation options include WEB-based hosting, LAN-based installation or specific project engagements. Interface options include extracting data from the patient billing system, data warehouse applications or the bill-edit module.
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Software Support Services |
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Regardless of the implementation approach, PMMC believes in strong project projection coordination. PMMC assigns a dedicated client support manager to develop a customized project plan for each hospital. PMMC support staff have prior experience with payors and/or providers, thus they understand business issues that each client is looking to solve.
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Revenue Cycle Management |
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Beyond underpayment recovery and settlement opportunities, there are other longer term benefits of automating the contract management process. A/R cycle time can be improved with a more accurate understanding of the contractual reimbursement terms and an automated underpayment appeals process. Patient registration can be improved as claims are audited and the insurance master is updated to reflect payor activity. Overall contract performance and profitability can be improved with more accurate contract modeling and re-negotiating proposed rates and terms. PMMC staff and support software can assist with all of these.
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Contract Negotiation |
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PMMC provides modeling and analytical tools for physician organizations to accurately forecast revenue and profitability of proposed payor contracts. Physician groups can model the impact of proposed reimbursement terms using their historical data to ensure accurate estimates of utilization and charge patterns and compare the projected effective discount rates for true side-by-side comparison between various contract terms including Medicare.
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PMMC PHYSICIAN PRO Standard Reports |
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Within PMMC PHYSICIAN PRO, there are more than 60 pre-defined audit/variance, financial summary, and other management/tracking reports. Users can also easily export data to a text file for use with other applications. Users can also attach to the data tables in order to create customized reports using Microsoft Access, Crystal Report Writer, etc.
For a detailed listing of current reports or to arrange a product demonstration, please contact PMMC.
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