PGM Logo Page

PRACTICE MEDICINE

NOT MANAGEMENT

Maximize your collections

Reduce your time to payment

Significantly improve your cashflow

Spend more time with your patients

Physicians Group Management

PGM Brochure Page

One of the biggest challenges for physicians today is balancing the role between physician and business person.

Physician practices all across America face similar challenges. With decreasing reimburse- ments and increasing denial rates, practices are seeing a serious impact on their bottom line. In addition, as insurance carrier and HIPAA re- quirements change, physicians are dedicating more of their time and resources to administra- tive tasks and red tape.

To meet these challenges, you need a partner who understands the complexities of healthcare management. Since 1981, PGM has been provid- ing practice management and billing services to physicians and healthcare facilities across the country. Our specialized medical billing service is focused on helping physicians not only get paid more, but get paid faster.

PGM’s technology plus service approach to prac- tice management maximizes the reimburse- ment process and helps streamline practice op- erations. You will see an improvement in day to day collections and cash flow and gain increased insight into practice performance. The end re- sult? Enhanced profitability and more time to deliver the highest level of patient care.

Have the most time-consuming work done for you.

Our complete practice management solution eliminates all charge entry, claim submission and follow-up, payment posting, advanced claim scrubbing to minimize denials, and much more.

Claims submission and tracking helping to ensure timely payment.

Remittance advice posting, including EOB scanning and payment verification.

New payer rule development helping to monitor changes and keep payments on track.

Extensive follow-up and appeals process where nothing gets left behind.

No-hassle, web based software that is easy to use, learn and implement.

Fully customizable reports available 24/7 in real-time, providing in-depth visibility into practice performance and trends.

A global dictionary of insurance package information, ensuring proper payer enroll- ment.

Periodic account reviews where we examine payer successes and opportunities for im- provement.

2

PGM Brochure Page

Maximize your collections, lower your expenses and reduce your time to payment with PGM.

Cost Effective

We get paid only once you get paid—PGM is 100% performance driven. With PGM, your costs are directly proportionate to your actual income. There are no dedicated staffing or administrative expenses related to in-house billing. In addition, there are no initial start up costs, no hidden or ongoing expenses, and no costly investments in hardware and software.

IN-HOUSE BILLING EXPENSE

Employee Salary

$38,000

Social Security, Medicare & Unemployment

5,000

Employee Healthcare

10,000

Hiring & Training

1,500

Office Space

2,400

IT Equipment & Software

3,000

Postage

3,000

Office Supplies & Telephone

1,800

Total Cost of In-house Billing

$64,700

OUTSOURCED BILLING EXPENSE

 

Gross Collections Internal Medicine (Average)

$310,000

PGM Performance Based Fee

6.0%

Total Cost of Outsourced Billing

$18,600

PRACTICE COST BENEFIT ANALYSIS

 

In-house Billing Expense

$64,700

PGM Billing Expense

$18,600

Annual Savings

$46,100

Improved Performance

Our comprehensive service is focused on maximizing your collections, getting you paid more and paid faster. Our clients typically see a 25–30% increase in net collections within six months.

Our advanced claim reviewer detects billing er- rors prior to entry, dramatically reducing denial rates. We aggressively follow-up and appeal de- nied and miss-adjudicated claims. In addition, we assume full responsibility for responding to all inquiries from patients and third party carri- ers, helping to increase your bottom line.

Improve

Your collection rate

Shorten

Your reimbursement cycle

Reduce

Your accounts receivable

Decrease

The rate of lost and denied claims

Gain

Improvedinsightintoyourpractice’sfinancial performance

3

PGM Brochure Page

Maintain your balance with Physicians Group Management.

Tailored to Your Needs

PGM understands that all medical practices are not the same. We provide physicians with a solu- tion tailor made to the individual needs of any practice. From full service medical billing, to ex- tending to you our proprietary software (where you retain full control), PGM offers the complete range of practice management services. We will work with you and your staff to design a program that best fits the needs of your practice.

U.S. Owned and Operated - At PGM we pride our- selves in our commitment to our U.S. based op- erations. It is our firm belief that the benefits of knowledgeable, experienced and accessible U.S.- based employees far outweigh any cost savings associated with off-shore practices.

Personalized Assistance

Our staff is 100% committed to serving you. All of our clients are assigned their own designated Account Executive, giving the security and comfort of working with a representative who is uniquely familiar with your practice.

From guiding you through the implementation process to frequent performance reviews and updates, our staff is there with you every step of the way.

 

 

Physician Billing Option Analysis

 

 

 

 

 

 

PGM

In-house

Third Party

Other

 

Billing

Billing

 

Billing

 

 

Software

Services

 

 

 

Cost Efficiency

High

Low

Low

High

 

 

 

 

 

Personalized Service

High

Mod-High

Low

Varies

 

 

 

 

 

Tailored Solutions

High

Varies

Low

Varies

 

 

 

 

 

Hardware & Software Requirements

Low

High

High

Low

 

 

 

 

 

Customized Reporting

High

Low

Varies

Varies

 

 

 

 

 

Payer Contract Negotiation

High

Varies

Low

Varies

 

 

 

 

 

Claim Follow-up & Adjudication

High

Varies

Low

Varies

 

 

 

 

 

Overall Benefit to Your Practice

High

Low-Mod

Low

Varies

 

 

 

 

 

5

PGM Brochure Page

Our financial management tools and reports help you monitor your practice’s performance.

Access to real-time, in-depth visibility and reporting.

Understanding your practice’s financial perfor- mance can be challenging. With data buried in patient charts, spreadsheets and antiquated systems, gathering the information necessary to optimize operations and plan for the future is often difficult and time consuming.

To help meet this challenge, PGM provides you with advanced financial and practice analysis tools, specifically designed to give enhanced vis- ibility of your operations at the click of a button.

PGM reporting is user friendly and grants instant access to data so you can instantly track perfor- mance and make qualified decisions. Qualitative assessment becomes easier, because you can review everything from which payers reimburse, and at what rates to which business lines are most successful.

Selected Finacnial Reports

Summary Report:

Overview of all charges, payments, and ad- justments.

Accounts Receivable Report:

Up to the minute, detailed or summarized aged receivable information that will give you 100% visibility over your uncollected claims.

Revenue and Production Reports:

Allows you to analyze your procedures by code, giving you better insight into how you allocate your time.

Payment and Charge Reports:

List of payments received and charges sub- mitted, helping you to categorize payments and charges by multiple variables including: location, physician, insurance carrier and more.

5

PGM Brochure Page

One of the best business decisions I made for our practice was to partner with PGM. The level of service is miles better than any system we previously had when we did our billing in-house. I am able to see every single aspect of our practice in minute detail.

--Bing C. Lee, M.D.

University of Medicine and Dentistry of

New Jersey, Newark, NJ

Our robust reporting tools show how to increase efficiency and improve revenue.

Selected Practice Analysis Reports

Frequency of Procedure / Diagnosis:

Examine the most common procedure, diag- nosis code, and other information recorded within you practice.

Payment Reimbursement:

Analyze the payment history by insurance carrier, helping you to determine if contract- ed carriers are meeting their negotiated fee schedules.

Denial Report:

Review claim denials by insurance carrier, helping you to identify areas of improvement and carrier abuses.

Benefit from no-hassle software, easy imple- mentation, and automatic updates.

From any internet enabled computer or mobile device, you can analyze payments by carrier, provider, location, procedure, diagnosis, time- frame and much, much more.

There are currently several hundred standard reports to choose from, as well as customizable reports that replace the static reports gener- ated by typical billing software. Many of PGM’s reports have been recommended and modified by PGM clients to provide the necessary infor- mation relevant to you.

With PGM reporting, you get clearer visibility into practice operations and claims’ status, all updated in real time. Reporting capabilities are focused on increasing your bottom line and giv- ing revenue control back to your practice.

6

PGM Brochure Page

Take your practice to the next level.

The PGM Process

1.Patient and charge data exports are collect- ed from your office daily.

2.Patient demographics and charges are keyed by our staff or electronically trans- ferred though our EMR/billing interface.

3.Medical claims process software is used to scrub claims for errors and submit claims electronically.

4.Insurance payments are received via paper or electronic remittance advices. Payments can be received at either the practice loca- tion or at PGM.

5. Payments are reviewed, line-item post- ed into the system, compared against fee schedules and then balanced. This per- formed at the time of payment posting to help ensure correct reimbursement.

6.Patient balances are billed and should the patient fail to respond, a letter and/or call sequence is initiated to obtain payment. It is important to note that patients are provid- ed with a toll-free number to call with any questions about their bill.

7.AR aging reports will be carefully processed and sent for your appraisal.

8.Once an outstanding claim has been iden- tified as past due, the PGM’s system alerts our Reimbursement Specialists who then review the history and follow-up on the claim accordingly

9.Reports are sent on a weekly/monthly basis and are available online 24/7 for client re- view.

7

PGM Brochure Page

Have the most time-consuming work done for you.

PGM’s practice management solutions allow your practice to eliminate all charge entry and patient demographic updates, as well as pay- ment posting. A dedicated team of Account Representatives will enter all charges, perform claims scrubbing, post payments, bill patients, and most importantly, follow-up on all denials.

Electronic and Paper Claims Filing

PGM manages all data entry, claims and claims tracking for you. We have the capa- bility to transmit claims electronically to thousands of insurance carriers.

Claim Follow-up

At PGM, claim follow-up is a priority. Our staff regularly follows-up on the progress of your claims to make sure you are receiving prompt, correct payments.

Advanced Claims Review System

PGM’s advanced claims scrubber identifies and corrects errors and omissions before claims are submitted. The results are re- duced denials and faster reimbursement.

EMR Compatibility

Our software has the capability to integrate with any existing EMR system.

Patient Invoicing, Collection and Inquiries

Monthly statements are sent to patients with remaining balances. Additionally, our dedicated staff handles all patient phone requests, billing inquiries, and necessary follow-up calls.

Financial Reporting

PGM provides your practice with financial and practice analysis reports available in the industry today.

Custom reports can be generated at your re- quest, and a wide range of standard reports are instantly available.

Remote Access

We provide internet access to all of your ac- count information, giving you direct visibility over patient data, current charges and bal- ances, as well as financial performance.

Claim Adjudication

Only 70% of the average medical practice’s insurance claims are ever paid by carriers. PGM aggressively monitors and accesses EOBs and payments to ensure the highest possible reimbursement rate.

8

PGM Logo Page

You can improve your collection rates and re- imbursement cycle, reduce your accounts re- ceivables, decrease the rate of lost and denied claims, and gain improved insight into your practice’s financials and performance.

Get Started

Learn more about why PGM’s Practice Man- agement Solution is the best way to streamline your practice, improve performance, and pa- tient care.

1050 Wall St West

Lyndhurst, NJ 07071

(877)-751-7515

www.pgmbilling.com