Recovery+

Denial and Underpayment Recovery Services

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Increase Your Revenue with Reimbursement Services

Hospitals and health systems routinely lose significant revenue due to administrative complexities, payer errors, and the sheer volume of claims processing. You negotiated your rates, delivered the care, and deserve to be paid accurately according to those terms. 

PMMC’s Recovery+ operates with a singular mission: to identify and recover the revenue that your organization has rightfully earned but has not yet received. We provide leading underpayment recovery services designed to close the gap between your expected reimbursement and your actual deposits.  

We understand that you are operating in a high-pressure environment where margins are thin, and administrative resources are often stretched to their limit. Our services are built to alleviate that burden.  

  • Unlike standard recovery efforts that may only scratch the surface, our approach delves deep into the data, leveraging advanced technology and expert auditors to ensure no opportunity is overlooked. 
  • We act as an extension of your business, providing the manpower and the intellectual capital necessary to challenge payers and overturn incorrect adjudications.  
  • Don’t just fix past mistakes; secure the financial health of your organization for the future.  

By partnering with PMMC, you are choosing a recovery strategy that prioritizes accuracy, transparency, and results. The success of any recovery effort depends entirely on the quality of the baseline data. You cannot recover what you cannot identify, and you cannot identify a variance if your expected reimbursement calculation is flawed. This is where PMMC stands apart. Don’t be at the mercy of payers – let us equip you with the trends and the knowledge to not only combat denials and underpayments but also leverage yourself for more favorable contract terms.  

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Absolute Accuracy starts with the Xact EngineSM

Our recovery services are powered by the PMMC Xact EngineSM, a sophisticated calculation platform renowned for its precision. Before a single claim is audited, we ensure that the foundation is solid through our rigorous Contract Management protocols. 

  • Precision Modeling: We model your specific payer contracts with exacting detail, capturing every clause, carve-out, and unique term. 
  • The Power of Xact: The Xact EngineSM processes this contract data against your claims to generate an expected reimbursement amount that is accurate down to the penny. 
  • Accurate Variances: Because our expected reimbursement calculation is precise, when we flag a variance, it is a true discrepancy. This reduces false positives and ensures our team focuses only on claims where revenue is truly at risk. 

Many denial management solutions fail because they rely on generic logic or estimations. We do not guess. We know exactly what you are owed because we use the most accurate calculation engine in the industry. This foundational accuracy allows us to pursue underpayments with confidence, providing you with a clear, indisputable view of what your payers owe you. This includes complex scenarios like “lesser-of” charges and other intricate contract terms that are frequently miscalculated by less robust systems. 

Explore the Xact Engine℠

A Proven Process: From Data Ingestion to Variance Identification

We have refined our recovery process into a seamless, step-by-step workflow that minimizes disruption to your team while maximizing results. It begins with data integrity and moves quickly toward actionable insights. This strategic partnership transforms underpayment recovery services from a reactive fix into a proactive improvement tool. We provide the kind of reporting you need for accountability, both internally with your staff and externally with your payers. 

STEP 1: Comprehensive Contract Loading

The first step in our engagement is the complete digitization of your payer agreements. We load all negotiated payor contracts into our contract management software. This is a critical initialization phase where our experts translate your paper contracts into digital logic. We account for every nuance, payment hierarchy, bundle, exclusion, and detail of your agreements to ensure the system reflects the reality of your negotiations. 

STEP 2: Automated Data Streams

Once contracts are live, we establish a secure, nightly feed of your 837 (claims) and 835 (remittance) data directly into the Xact engine. This automation ensures that we are always looking at the most current data available. There is no need for your team to manually upload files or export spreadsheets. The data flows automatically, allowing our system to audit payments almost immediately after they are posted. 

STEP 3: Identify the Variances

With contracts loaded and data flowing, the system begins its work. Every night, the Xact Engine℠ compares the payments and adjustments file against the calculated expected reimbursement (based on the contract). When a discrepancy is found, it is flagged as a variance. This automated identification process is exhaustive. We look at every claim, regardless of size, ensuring that systematic small-dollar errors are caught just as effectively as large-dollar denials. This sets the stage for our recovery team to step in and take action. 

STEP 4: PMMC Collects

Our auditors and collectors do not just send automated letters; they actively work to collect the balance owed by following up directly with payers. They understand the nuances of payer logic and have the expertise to argue the technicalities of your contracts. Our team is constantly in contact with payers – saving your team the time, and emails, that resolving a denial or underpayment takes.  

  • No Cherry Picking: We are committed to a thorough recovery process. We collect as much as possible on every claim identified in our scope. We do not just skim the easy wins and leave the difficult, lower-value claims behind. If you earned it, we pursue it. 
  • US-Based Expertise: All of our recovery services are performed by experts located inside the US. This ensures a high level of communication quality and a deep understanding of the specific regulatory environment of the US healthcare system. 

STEP 5: Sharing Results and Strategy

Recovery is valuable, but prevention is ideal. That is why our process includes a robust feedback loop designed to make your internal operations stronger. We do not just hand you a check; we hand you intelligence. 

  • Trend Identification: We spot patterns that might be invisible during day-to-day processing. Then we work to correct them, our goal is to not see the same trend twice. 
  • Best Practices: We share specific strategies on how to leverage these trends and findings within your team. We teach your staff what we are seeing so they can fix issues upstream. 
  • Operational Improvement: By understanding why denials and underpayments are happening, you can adjust your front-end and mid-cycle processes to prevent them from occurring in the future. Your team can then take these insights to arm yourself for better negotiations with payers and more favorable contract terms.  

Working Smarter, Not Just Harder with RecoveryAI®

Volume can be overwhelming. Thousands of claims may show variances and tackling them in random order—or simply by highest dollar amount—is not always the most efficient strategy. PMMC solves this challenge with RecoveryAI®. RecoveryAI® is our proprietary technology that prioritizes claims based on collectability, not just face value. This technology allows us to offer superior denial management services compared to manual or linear workflows. While other approaches might waste weeks chasing high dollar claims that are effectively dead ends, our system directs us to the inventory that will convert to cash now. We focus on what’s most collectable and bringing in as much as possible. This ensures that our high-touch, high-communication recovery process is always focused on the most productive activities. 

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Speed to Revenue

By working the most collectable claims first, we accelerate cash flow. We get revenue back into your account more quickly because we focus our energy where it yields the fastest results. 

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Predictive Prioritization

RecoveryAI® analyzes historical data, payer behavior patterns, and denial codes to predict which claims are most likely to be overturned and paid. 

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Eliminating Guesswork

Your team—and ours—no longer needs to guess which accounts to work first. The system provides a prioritized roadmap for recovery. 

Flexible Terms for a Win-Win Partnership

We recognize that every healthcare organization has unique workflows and staffing capabilities. We are here to make this partnership work for you, which is why we offer engagement models with flexible terms. Every organization is unique, and every payer contract is unique. We are here to help with customized approaches for each hospital, system, and planWhether you need immediate intervention or a safety net for aged accounts, we have a model that fits and is flexible to fit the needs of your team now and in the future.  

Remit Date Recovery 

In this model, PMMC works accounts starting from the Day of Remittance.  

  • How it works: As soon as a payment is posted and a variance is detected, our team engages. 
  • Best for: Organizations that want immediate auditing and rapid cash acceleration. This ensures that underpayments are caught and contested while the claim is still fresh in the payer’s system. 

Aged Accounts Recovery 

Accounts are worked X days from bill date/payer payment date. The number of days is determined by your team, ensuring you have what you need for each payer and account. 

  • How it works: Your staff handles account follow-up for a set period after the bill date. PMMC auditors and collectors then begin working accounts based on a specific number of days after the bill date. 
  • Best for: Organizations with a robust internal team that want to handle initial collections but need a safety net for older, more stubborn claims that are aging out. 
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Why Choose PMMC for Recovery?

The benefits of partnering with PMMC extend beyond the dollars recovered. We provide a strategic advantage that stabilizes your revenue cycle operations. 

Risk-Free Financial Model: Our services are contingency based. You only pay a percentage of what we successfully recover. There is no upfront capital investment, making this a financially safe decision for your organization. 

Team Efficiency: We take back your team’s time. By outsourcing the labor-intensive work of appeal and follow-up, you improve efficiency and reduce the time your staff spends on inaccurate or manual claim reviews. 

Scalability: We provide instant scalability. Whether you are facing a temporary staffing shortage or a long-term increase in denial volume, we bridge the gap. 

Holistic Denial Management: We offer comprehensive denial management solutions that address the full spectrum of revenue leakage. From complex contractual underpayments to contract disputes, we have the expertise to handle it all. 

Transparency: You get an accurate view of underpayments based on your individual contract terms. Finally, you have a clear, unclouded view of exactly what you are owed. 

Measuring Performance and Results

Transparency is at the core of our client relationships. We believe you should never have to wonder about the status of your recovery project. Your team has access to PMMC Analytics+, a custom reporting and tracking tool to monitor results on your timeline. 

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During our monthly performance meetings, we present a comprehensive set of advanced analytics and reports. These offer deep insights into performance and highlight opportunities for improved contract management, payments, and collections. 

  • Executive Payments Dashboard: A high-level view of financial performance for leadership. 
  • Opportunities & Payments by Facility: Granular data breaking down recovery potential by location. 
  • Opportunities & Payments by Payer: Robust analytics showing how payers stack up against one another. This is the data you need for your next contract negotiation. 
  • Workflow Optimization Opportunities: Specific recommendations for process improvements. 
  • Auditor Scorecard: Transparency into the performance of the team working your accounts. 
  • Overall Submissions Recovery Rate: Tracking the effectiveness of our appeals. 
  • Denial & Reimbursement Trends: Long-term trending data to spot systemic payer issues. 
  • Underpayment & Reimbursement Trends: Detailed analysis of variance categories. 

We also offer customizable reporting based on your individual needs. We tailor the data to tell the story that matters most to your stakeholders. 

Don't let complex contracts and payer stalling tactics dictate your financial reality.

Through our denial management services, we not only recover lost cash but also provide the insights needed to stop future leakage. With the power of the Xact Engine and the intelligence of RecoveryAI®, we offer a recovery solution that is accurate, efficient, and transparent. Partner with PMMC to validate your payments, empower your team, and secure your bottom line. Contact us today to analyze your recovery potential. 

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