Client Profile
- South East US
- 2 Hospitals
- 300+ Beds
- 1000+ Physicians
- HIS System: Oracle – Cerner
The Challenge
The revenue recovery team at the client hospital system was tasked with hours of manual time to go back after the billing process was complete to find lost revenue and a way to recover more. The team was looking for a solution to combat significant claim denials and underpayments.
The need for customization to identify where to focus efforts was highlighted by the Moffitt team. When looking for a partner, the client wanted a partner that would provide a helpful customer experience and streamline their operations. “It’s like trying to find a needle in a haystack,” said the client’s Supervisor of Revenue Recovery Operations, “PMMC helped us see how payments were trending and shined a light on areas where our team should focus.”
The Solution
The client implemented PMMC’s contract management and analytics tools to discover revenue recovery opportunities in denied or appealed claims. This integration included detailed patient-level export tables in reports, specifically targeting underpayment and denial recovery, while adding functions to identify high variance accounts.
The flexibility of the software met the client’s unique needs and allowed them to exceed their goals. The PMMC team also developed custom reports for line-level CPT denial tracking and overturn success rates to prioritize workflow effectively. Their Supervisor of Revenue Recovery Operations shared that “the PMMC team worked with us to provide a full understanding of the depth of their software capabilities and helped build out custom views and custom reports to meet our needs.”
“PMMC’s custom solutions have transformed our approach, automating tasks that previously required manual effort. The analytics tools feel like having an extra team member, allowing us to track payments and generate insightful reports effortlessly,” she says. “This was extremely impactful when reporting at a higher level, with the ability to illustrate recovery efforts visually to via graphs and charts.”
The Results
The implementation of PMMC software at the client’s facilities has led to quantitative and qualitative improvements in identifying and prioritizing revenue recovery opportunities. “The support and advanced tools provided by PMMC have been instrumental in transforming our revenue recovery efforts,” says the Supervisor. “PMMC’s high level of communication and sense of urgency added to the success of our efforts.”
The integration of PMMC’s tools has provided long-term benefits, continuously advancing report functionalities, and operational insights. The PMMC team employed techniques to ensure that these tools were aligned with the client’s strategic goals and operational needs, facilitating a seamless adoption and sustained use of the software.
“The collaborative process between our Revenue Cycle Operations and PMMC has maximized the benefits of tools and analytics,” says their Supervisor. “PMMC’s focus on customer service and responsiveness has been incredibly helpful in attaining our annual revenue recovery goals and overall having a positive impact on the success of our revenue cycle.”
