PMMC's Enhanced Solutions for Improved Financial Management and Patient Experience

One healthcare organization required a robust solution to regulatory reimbursement changes. PMMC's solutions supported the client's expansion and strengthened the partnership between the organizations, prompting further growth for the client along with recovery improvements using PMMC’s innovative products.

The Challenge

One of the pivotal shifts affecting the healthcare organization was the adoption of Enhanced Ambulatory Patient Groups (EAPGs), which redefined patient classification and brought about substantial changes in how hospitals manage their finances and patient experience tools. This new classification system necessitated a more accurate and functional approach to financial calculations and patient estimations, including changes in reimbursement submissions. PMMC stepped in to provide a solution.

The client's primary objectives were:

• To provide patients with a better estimation experience from start to finish.
• To enhance general denial management and focus on underpayments for improved net income.

The Solution

PMMC implemented a multi-faceted solution to address these challenges:

1. Advanced Payment Monitoring Systems: PMMC introduced advanced payment monitoring systems designed to proactively detect and address underpayments. This system ensured that all financial transactions were monitored in real-time, enabling immediate action through automatic notifications to rectify discrepancies. This let the internal team know where to start each day when they logged into the PMMC system.

2. Integrated Recovery Processes: To ensure accurate and complete reimbursements, PMMC fully integrated recovery processes into the client's existing systems. This integration streamlined the recovery efforts, making them more efficient and effective for the healthcare organization as they worked denials and underpayments.

3. Patient Estimates: The healthcare organization deployed PMMC’s sophisticated patient estimation tool, to provide patients with accurate and transparent pricing information. This tool was integrated with the organization's payment processor, which is designed to facilitate smooth patient payments. The integration ensured that patients had a seamless experience from receiving estimates to making payments.

4. Pricing Transparency Tools: PMMC leveraged pricing transparency tools to improve patient satisfaction and ensure compliance with regulatory requirements. These tools provided clear and concise pricing information, fostering trust and transparency between the healthcare provider and patients.

5. Modeling Integration: The healthcare organization utilized PMMC’s modeling software for streamlined integration and management of various hospital systems. This integration ensured that all hospital systems worked in harmony, reducing inefficiencies and improving overall operational effectiveness by having their team in the modeling software and analyzing the results internally to save time in the long run by looking at every option. The healthcare organization also predicted and mitigated the financial impact of payor litigations and regulatory changes through utilizing PMMC’s modeling software to prepare for every scenario.

6. Third-Party Integration: Estimates notifications were sent via a third-party text service to enhance the customer experience. By working with third-party tools, PMMC ensured a holistic approach to managing patient interactions and financial transactions and focused on flexibility to integrate with other tools based on the healthcare organization’s needs.

The Results

The implementation of PMMC's solutions yielded significant positive outcomes:

• Expansion and Integration: Over the past 10 years, the healthcare organization expanded, building new hospitals to grow from a single facility to a multi-hospital system while utilizing PMMC's products and services. This expansion included adding facilities with specialized needs, such as oncology centers.
• Increased Productivity: The seamless integration of PMMC products into daily operations led to increased productivity. PMMC's ability to integrate its products with third-party systems enhanced overall functionality and patient experience.
• Future Expansion: Given the results of PMMC’s efforts, the healthcare organization is now expanding the use of PMMC’s recovery software.