PMMC Physician Contract Management.

Maximize revenue and get reimbursed accurately on all payer contracts with PMMC's physician contract management services. The physician contract management system uncovers the most critical underpayment and tracking errors, so your collections staff can work more efficiently and collect more revenue.

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PMMC delivers an innovative, process-driven approach that converts data to meaningful information to verify the accuracy of reimbursement from all payers.

Contract Clarity for Accurate Reimbursement Calculations

PMMC’s Physician Contract Management System correctly calculates all physician-oriented contractual rates and terms including multiple procedure/contiguous radiology reductions, global periods, modifiers, NCCI edits, various reimbursement methodologies for the same CPT® code for primary care, specialist or other ancillary providers, site of service differentials and payer rule changes. Beyond reimbursement scenarios, the system handles all payers including Medicare, Commercial and Managed Care payers. PMMC PHYSICIAN PRO pinpoints payment variances by accurately calculating the expected reimbursement at the time of billing and comparing it to the posted payments and adjustments.

Identify and Recover Underpayments

Payment variances are identified through a paperless, seamless, automated Account Management process. The system categorizes underpayment trends for improving the healthcare revenue cycle management process. PMMC PHYSICIAN PRO software identifies likely sources of variances including data issues, registration issues, calculation set-up issues, denials, contractual underpayments, etc. Variance trends are sorted into data views to streamline the analysis process. This provides the ability to focus on true collectable variances versus reoccurring process variances. Having more time for payer communications leads to a more productive appeal process and increased collections.  

Improve the Management Process of your Payor Contracts

From organizing your payer contracts to monitoring their performance, PMMC’s Contract Management services / applications deliver. Electronic versions of the payer contracts and rate schedules can be stored for easy access and retrieval. Payer contract performance monitoring allows users to track not only payer reimbursement variances but also monitor the overall financial performance and bottom line effects.

Negotiate Improved Contract Terms

Improved contract negotiations begin with accurate reimbursement modeling. Simulating and forecasting contractual reimbursement during, not after, the negotiation process provides this foundation. By modeling various rate and term scenarios, providers are better prepared for contract negotiations. PMMC PHYSICIAN PRO SIMULATOR provides the flexibility to model various rates and term scenarios using your historical claim data.  This helps ensure you fully understand the financial impact with your organization and its service and charge patterns, before you sign on the dotted line.

Flexible Implementation

PMMC leads the market with implementation options that match your IT/IS Department requirements, staffing needs and installation preferences whether through a local installation approach on the client’s network or a web-based/hosted solution with various support levels to best suit the client’s needs. PMMC PHYSICIAN PRO, like all PMMC software tools, is also designed with an open data exchange process in mind so it can easily work with other applications.