Capturing all charges for patient services can be a difficult process. PMC will set up procedures to ensure the clinic or facility is accurately capturing all charges and claims are submitted efficiently. This can be done through work flow design and validation checks. With accurate and timely claim submission your office is able to collect the correct revenue associated with the patient visit in a shorter period of time.
Claims processing should be as simple and as automated as possible. Claims will be sent electronically each day allowing the organization to have constant cash flow. Daily claim submission is necessary to avoid common mistakes such as time filing limits and lost charges.
Batch verification procedures are in place to ensure submission of all charges.
Payment posting should be done through an automated process daily. Automated payment posting ensures the provider is being paid the exact contracted rate. Whenever possible, managed care contracts should be loaded into the organizations billing software. The billing software has the capability of alerting the “poster” of discrepancies at the time of posting. This verification process is important to avoid inaccurate and excessive write offs from being entered.
PMC offers a dependable solution for denial management. On a daily basis denied claims are monitored, reviewed, and corrected. All denied claims are submitted within 24-48 hours to ensure the claim is paid as quickly as possible. PMC monitors the denied claims to look for trends, coding errors, and registration issues. This allows PMC to review and update processes to avoid future denials. This hands-on process allows PMC to solve problems related to denied claims in a short amount of time, which in turn reduces the overall denial rate. If at any time an appeal is filed to the payer, PMC will facilitate this process to ensure the claim is processed by the payer.
PMC feels strongly about following up on claims that have not been paid within 20 days. PMC staff will follow up on any outstanding A/R every 20-30 days to ensure the claim is processed and paid.