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Payer Reimbursements

Healthcare Revenue Recovery and Reimbursement

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Maximize Reimbursement & Drive Revenue Opportunities

Healthcare organizations are empowered to master the complexities of the reimbursement cycle through a powerful combination of advanced technology and deep industry expertise.  

  • Leverage Precise Data Analytics: Identify hidden underpayments, enforce contract compliance, and maximize revenue recovery.  
  • Sophisticated Solutions: Ensure every payment aligns with negotiated terms while streamlining the auditing process to improve overall cash flow.  
  • Gain a Competitive Edge: Protect your financial integrity and minimize avoidable losses. 

Payer Reimbursement

PMMC provides comprehensive solutions designed to optimize payer reimbursements for both hospitals and physician practices. Our services leverage advanced technology, including RecoveryAI®, to identify underpayments and recover lost revenue efficiently. Whether you prefer managing the process internally using our tools, require full-service assistance, or something in between, our expert team can handle collections on your behalf. With PMMC, healthcare providers can ensure accurate reimbursements and a streamlined recovery process to increase revenue quickly.

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Recovery+

PMMC’s Recovery+ services offer a comprehensive payer collection service tailored to client needs, utilizing a contingency-based payment model that ensures clients only pay for performance. The service involves skilled auditors and collectors who manage accounts through a high-touch process. By leveraging PMMC’s advanced software, the team maximizes payer collections on behalf of your organization. With options of Remit Date Recovery and Aged Accounts Recovery, our team jumps in where you need us. Our flexible approach allows you to customize our partnership and rules of engagement to align with the unique requirements of your organization, ensuring optimal results and revenue.  

Payer Collection Services
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Reimbursement Software

Hospital teams gain comprehensive insight into how payer variances are affecting their revenue cycle allowing you to address variances to achieve better financial outcomes.  This allows you to compare charges against allowable amounts, prioritize the most collectable variances with RecoveryAI®, and allocate more time to payer communication to improve appeals outcomes and boost collections. PMMCs analytics provides reporting, and our team will provide insights to help you identify and correct errors in registration, coding, and billing, improving accuracy and efficiency universally.   

Denial Management Software
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Physician Reimbursements

Physicians can gain a clear understanding of their underpayments and denials and tackle variances to achieve optimal financial performance. Physician Reimbursements provides tools to monitor reimbursements, rank the most collectable variances with RecoveryAI®, and prioritize more time to communicating with payers to improve collections outcomes. PMMC’s analytics provides reporting to identify errors in registration, coding, and billing, improving accuracy and efficiency across the board. With our innovative, data-focused solutions, physicians can streamline workflows, enhance payer interactions, identify trends and unlock the full revenue potential for their practice.  

Physician Reimbursements
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Excel with RecoveryAI®

RecoveryAI® is an artificial intelligence solution designed to transform the collections process for organizations by leveraging pioneering AI technology and advanced data-driven insights. RecoveryAI® streamlines resource allocation and task prioritization, reduces manual effort and increases submission rates and success rate of appeals. Ultimately, RecoveryAI® empowers organizations to drive superior recovery outcomes and maximize overall operational efficiency.  

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Best Practices for an Efficient Reimbursements Process

  • Staying Current on Policy Changes
    Regularly review insurance policies and guidelines to remain informed about updates. This reduces the risk of retroactive denials and ensures compliance. 
  • Analyzing Root Causes
    Identify the underlying reasons for denials, including eligibility issues, coding errors, or data entry mistakes. Understanding these causes allows for targeted improvements. 
  • Implementing Preventive Strategies
    Leverage technology to automate processes like pre-authorization, eligibility verification, and workflows. These proactive measures help minimize errors and streamline operations. 
  • Prioritized Workflow
    Establish a clear priority list for tasks, involving initial cash collectors, appeal specialists, and external vendors where necessary. Outsourcing can complement internal staff and optimize resource allocation. 
  • Streamline Operations
    Simplify and standardize processes to allow your team to address most variances effectively. Consider utilizing external vendors to handle complex and slow-to-resolve issues, such as contractual underpayments and specific denial categories. 

Frequently Asked Questions (FAQs)

  1. How does PMMC’s recovery solution ensure accuracy?
    PMMC leverages the advanced capabilities of the Xact EngineSM and RecoveryAI® to deliver precise recovery outcomes. These tools utilize data intelligence and automation to identify discrepancies and recover lost revenue efficiently while reducing human error. 
  2. What types of payment discrepancies can PMMC address?
    PMMC specializes in tackling a wide range of payment discrepancies, incorrect bundling, exclusions. This includes contract underpayments, denied claims, and delayed reimbursements. Our solution is designed to uncover and address these issues, securing maximum revenue for healthcare organizations. 
  3. What is RecoveryAI® and how does it work?
    RecoveryAI® is an advanced artificial intelligence solution designed to revolutionize the collections process for organizations. It utilizes cutting-edge AI technology and data-driven insights to optimize resource allocation, task prioritization, and overall recovery outcomes. 
  4. What specific benefits can organizations expect from using RecoveryAI®?
    By implementing RecoveryAI®, organizations can significantly reduce manual workload, improve submission rates, increase the success rate of appeals, and enhance overall operational efficiency. It streamlines processes and ensures optimal resource utilization. 
  5. How does PMMC ensure its solutions integrate seamlessly into existing processes?
    Our dedicated team of experts collaborates closely with healthcare providers to customize and implement our solutions. We assess current processes and provide tailored support and training to ensure a smooth transition and maximum efficiency. With client-provided resources we establish feeds from your 835/837s, your contracts, your CDM, and implement a custom timeline to get you the solutions you need.  
  6. What kind of training and support does PMMC offer?
    PMMC offers continuous training and guidance to physician teams and healthcare professionals. This ensures users can fully utilize our tools and insights to drive efficiency, recover revenue, and achieve sustainable financial success. 

Testimonials

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Physician Reimbursement Client

We think using PMMC will help us to achieve several objectives, including recouping revenue that is being underpaid, responding more quickly to variances that the system identifies, and providing up-to-date analysis of contract profitability and payer performance. In addition, the system will provide a sense of security to the physicians in our group that we are actively pursuing proper reimbursement and that we are always seeking to improve our internal processes.

Asst. Director of Contracts & Billing Systems
Location: Southeast US, 450+ Beds, 1300+ Physicians
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Recovery+ Client

After implementing process changes and a new contract management system we immediately began uncovering contractual underpayments as well as billing, coding and registration process changes that generated tangible results.

Contract Compliance Analyst
Location: Southeast US, 200+ Beds, 100+ Physicians
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Reimbursement Software Implementation Client

As the new Cost & Reimbursement Manager at my hospital, I wanted give you some positive feedback. I’ve worked here for almost a month, following the position being vacant for quite some time.  As you can imagine I have a lot of clean-up work to do; as well as meeting new expectations from a new Director.  So far, I feel very accomplished in such a short time…. much of my success I can attribute directly to the excellent support.

Cost & Reimbursement Manager
Location: Southeast US, 150+ Beds, 400+ Physicians