Healthcare Revenue Integrity Solutions
PMMC identifies, tracks, and collects revenue short falls, ensuring complete payment for the provided services.
Many healthcare providers continue to write off millions of dollars in contractual adjustments that are a direct result of third-party underpayments , even though they are confident their contract management systems and payer reimbursement audit procedure
A retrospective underpayment review identifies and collects accurate payment on underpaid and denied accounts.
A primary account review evaluates and collects on all identified accounts where underpayments and/or denials exist.
PMMC provides a retrospective service that identifies, appeals, and collects denied charges and denied reimbursement.
Under current CMS reimbursement guidelines, hospitals receive less reimbursement when a patient is discharged to another facility for additional ‘skilled-care’ versus discharging the patient to their home. The lesser payment is dictated by the discharge status. Occasionally, the transfer patient does not receive the Medicare-approved follow-up care. When this event occurs, the hospital is underpaid because they should have received the full Medicare DRG payment.
Teaching hospitals are required to create a “shadow bill” in order to receive the Indirect Medical Education (IME) payment from CMS when the patient is enrolled in a Medicare Advantage plan. The issue of ‘Shadow Billing’ is a consistent problem for teaching hospitals with the burden of the provider having to identify the IME claims and coding the affected claim correctly before processing.