Customized Medical Billing Services for Chiropractors
A recent study by the Department of Health and Human Services found that Medicare inappropriately paid $178 Million for chiropractic billing claims on services determined to be miscoded. Additionally, CMS estimates that over 83% of chiropractic claims failed to meet one or more documentation requirements. Coding and medical billing errors such as the misuse of the acute treatment (AT) modifier to identify services, treatment or improper documentation frequently lead to denied and misadjudicated claims. Accuracy is essential for correct reimbursement and will help protect chiropractors from both malpractice and litigation.
PGM has over thirty years of experience in chiropractic billing. PGM will work side by side with your practice to help identify problem areas such as modifier application, and educate your practice on best-in-class chiropractic medical billing practices and procedures. Our team of certified medical coders and billing experts will manage all aspects of your chiropractic billing to help ensure your practice receives proper compensation for services provided. You’ll rest easy knowing that you’re not leaving money on the table or raising red flags for the RACs, MACs, MPICs, ZPICs, and private payer audit programs.
To learn more about PGM’s chiropractor medical billing services, request a free demo or contact us for more information.
Best-in-Class Medical Billing Software &
Services for Healthcare Professionals
Proof in Numbers
8% average improvement in collection, growth adjusted
$1 billion in gross claims billed annually
61 million accessions/visits processed annually
Up to a 50% reduction in denials
Two-time increase in successful appeals
100% payor reach
Reduced Billing costs based on collections not payroll
39 year track record
Over 30 specialties
Serving all 50 states
PGM Revenue Cycle Management
Payment Posting
Payments are received either hard copy or via electronic remittance advices (ERA). PGM clients are given the option to continue to receive payment at the practice or to have PGM manage all payments at one of our facilities.
Once payment is received, it is reviewed and line-item posted into our practice management system by one of our reimbursement specialists.
Claim Tracking
Once payments have been posted into our practice management system, they are run through our payer-specific rules software, which aggressively detects unpaid or misadjudicated claims.
Once an unpaid or misadjudicated claim is flagged, it is brought to the attention of one of our reimbursement specialists for further investigation and active follow-up.
Denial Management and Follow-up
Only 70% of the average medical practices insurance claims are ever paid by insurance providers. While a practice may submit a perfectly clean claim to a payer, there is no guarantee that it will get paid or, for that matter, get paid accurately.
It's no secret that payers continue to impose increasingly complex rules, systems and loopholes with the single goal of limiting payment. This frequently means that practices remain unpaid on the valuable service provided to patients.
PGM's incentive-based fee structure ensures that we work hard to make sure nothing gets left behind. Once an outstanding claim has been identified as past due, PGM's system alerts our account representative who then reviews the history and follows up on the claim accordingly.
Patient Balances Billing
At PGM, we understand that patients are the lifeblood of the practice. We work directly with the practice to custom tailor a patient billing profile to perform all patient billing functions on behalf of the practice.
The typical patient billing profile includes a series of easy to understand statements. Should a patient fail to make payment, additional letters and/or a call sequence is initiated. For questions regarding a bill, patients are provided a toll-free number to call where one of our patient billing specialists is ready to answer any questions.
PGM does not perform collection services, and therefore patient billing services are structured to encourage patients to resolve outstanding balances. For those patients who refuse or are unable to complete their obligation, PGM will work with the practice to structure a patient payment plan or transition the balance to a third-party collection agency for resolution.
Reporting
PGM provides advanced financial and practice analysis tools designed to give enhanced visibility into practice operations at the click of a button. Practices are provided access to PGM-online, our Internet-based reporting system, where they can access hundreds of practice analysis and performance reports. Should a practice require additional information, custom reports are also available upon request.
Additionally, PGM's reimbursement specialists provide frequent practice performance reviews offering additional insight into practice financial operations.
Medical Coding
According to the AMA, the average medical practice submits more than 50% of its claims with incorrect codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging and post-payment audit.
At PGM, all of our clients undergo a practice evaluation where our certified coders, in conjunction with our reimbursement specialists, analyze practice procedures and codes to make recommendations that ensure accurate and optimum reimbursement.
Patient Charge and Demographics Data Entry/Upload
Patient demographics and charges are collected from your office daily. Data can be scanned, faxed or couriered to any one of our locations. Once the data has been received, a dedicated PGM account representative will enter the information into our practice management system.
For PGM clients using an electronic medical record system (EMR/EHR), patient demographics and charge data can be electronically transferred in real-time to our practice management system though our EMR/EHR medical billing interface.
Claims Review
PGM's reimbursement specialists compile and review all client patient and charge data. Billing uploads and batches are balanced, and our medical claims process software is used to 'scrub' claims for errors and omissions. PGM's software performs thousands of checks, including CPT/ICD-9 validations, modifier checks, demographic comparisons and payer-specific edits.
The claims review process ensures that practice billing data is being accurately captured and that claims are clean prior to being submitted for payment. Clean claims greatly increase the rate of payment, helping to maximize the amount collected and reduce accounts receivable.
Claim Submission
Once the claims are reviewed and audited, they are transmitted to the various payers for reimbursement. PGM has the ability to electronically transmit claims to thousands of payers nationwide. For those payers that do not have the ability to receive electronic claims, PGM will generate and mail paper claims.
After submission, claims receive an additional level of "scrubbing' by our clearinghouse. Edits and errors are relayed back to PGM for correction.
Payment Posting
Payments are received either hard copy or via electronic remittance advices (ERA). PGM clients are given the option to continue to receive payment at the practice or to have PGM manage all payments at one of our facilities.
Once payment is received, it is reviewed and line-item posted into our practice management system by one of our reimbursement specialists.
Claim Tracking
Once payments have been posted into our practice management system, they are run through our payer-specific rules software, which aggressively detects unpaid or misadjudicated claims.
Once an unpaid or misadjudicated claim is flagged, it is brought to the attention of one of our reimbursement specialists for further investigation and active follow-up.
Denial Management and Follow-up
Only 70% of the average medical practices insurance claims are ever paid by insurance providers. While a practice may submit a perfectly clean claim to a payer, there is no guarantee that it will get paid or, for that matter, get paid accurately.
It's no secret that payers continue to impose increasingly complex rules, systems and loopholes with the single goal of limiting payment. This frequently means that practices remain unpaid on the valuable service provided to patients.
PGM's incentive-based fee structure ensures that we work hard to make sure nothing gets left behind. Once an outstanding claim has been identified as past due, PGM's system alerts our account representative who then reviews the history and follows up on the claim accordingly.
Patient Balances Billing
At PGM, we understand that patients are the lifeblood of the practice. We work directly with the practice to custom tailor a patient billing profile to perform all patient billing functions on behalf of the practice.
The typical patient billing profile includes a series of easy to understand statements. Should a patient fail to make payment, additional letters and/or a call sequence is initiated. For questions regarding a bill, patients are provided a toll-free number to call where one of our patient billing specialists is ready to answer any questions.
PGM does not perform collection services, and therefore patient billing services are structured to encourage patients to resolve outstanding balances. For those patients who refuse or are unable to complete their obligation, PGM will work with the practice to structure a patient payment plan or transition the balance to a third-party collection agency for resolution.
Reporting
PGM provides advanced financial and practice analysis tools designed to give enhanced visibility into practice operations at the click of a button. Practices are provided access to PGM-online, our Internet-based reporting system, where they can access hundreds of practice analysis and performance reports. Should a practice require additional information, custom reports are also available upon request.
Additionally, PGM's reimbursement specialists provide frequent practice performance reviews offering additional insight into practice financial operations.
Medical Coding
According to the AMA, the average medical practice submits more than 50% of its claims with incorrect codes. Inexact and inconsistent coding increases the risks of undercharging, overcharging and post-payment audit.
At PGM, all of our clients undergo a practice evaluation where our certified coders, in conjunction with our reimbursement specialists, analyze practice procedures and codes to make recommendations that ensure accurate and optimum reimbursement.
Patient Charge and Demographics Data Entry/Upload
Patient demographics and charges are collected from your office daily. Data can be scanned, faxed or couriered to any one of our locations. Once the data has been received, a dedicated PGM account representative will enter the information into our practice management system.
For PGM clients using an electronic medical record system (EMR/EHR), patient demographics and charge data can be electronically transferred in real-time to our practice management system though our EMR/EHR medical billing interface.
Claims Review
PGM's reimbursement specialists compile and review all client patient and charge data. Billing uploads and batches are balanced, and our medical claims process software is used to 'scrub' claims for errors and omissions. PGM's software performs thousands of checks, including CPT/ICD-9 validations, modifier checks, demographic comparisons and payer-specific edits.
The claims review process ensures that practice billing data is being accurately captured and that claims are clean prior to being submitted for payment. Clean claims greatly increase the rate of payment, helping to maximize the amount collected and reduce accounts receivable.
Claim Submission
Once the claims are reviewed and audited, they are transmitted to the various payers for reimbursement. PGM has the ability to electronically transmit claims to thousands of payers nationwide. For those payers that do not have the ability to receive electronic claims, PGM will generate and mail paper claims.
After submission, claims receive an additional level of "scrubbing' by our clearinghouse. Edits and errors are relayed back to PGM for correction.
Payment Posting
Payments are received either hard copy or via electronic remittance advices (ERA). PGM clients are given the option to continue to receive payment at the practice or to have PGM manage all payments at one of our facilities.
Once payment is received, it is reviewed and line-item posted into our practice management system by one of our reimbursement specialists.
PGM has a smooth and efficient approach to implementation. My dedicated account representative was extremely knowledgeable about everything from improving my fee schedule to developing a list of frequently used procedure codes that could improve my payer reimbursement. PGM guided my office staff and I through every step of the billing hand over.
PGM’s system tracks data so effectively that we can conduct detailed analyses to determine the health of each of our locations as well as the productivity of the providers.
PGM’s fully integrated practice management software combined with their back office billing solution gave our practice the resources to spend our time doing what we do best.
Office ManagerPrivate Physicians Medical Associates
When starting our laboratory we relied heavily on PGM for guidance on everything from credentialing and coding to managing insurance payments to patients. Their knowledge and expertise in anatomical pathology billing has greatly contributed to the success of our company. I highly recommend PGM to any lab, and we look forward to continuing our long term partnership with PGM.
PGM has been instrumental in helping us manage Acculab's billing and revenue cycle. They are a trusted partner, and have played a pivotal role in our continued growth and success.
PGM has a smooth and efficient approach to implementation. My dedicated account representative was extremely knowledgeable about everything from improving my fee schedule to developing a list of frequently used procedure codes that could improve my payer reimbursement. PGM guided my office staff and I through every step of the billing hand over.
PGM’s system tracks data so effectively that we can conduct detailed analyses to determine the health of each of our locations as well as the productivity of the providers.
PGM’s fully integrated practice management software combined with their back office billing solution gave our practice the resources to spend our time doing what we do best.
Office ManagerPrivate Physicians Medical Associates
When starting our laboratory we relied heavily on PGM for guidance on everything from credentialing and coding to managing insurance payments to patients. Their knowledge and expertise in anatomical pathology billing has greatly contributed to the success of our company. I highly recommend PGM to any lab, and we look forward to continuing our long term partnership with PGM.
PGM has been instrumental in helping us manage Acculab's billing and revenue cycle. They are a trusted partner, and have played a pivotal role in our continued growth and success.
PGM has a smooth and efficient approach to implementation. My dedicated account representative was extremely knowledgeable about everything from improving my fee schedule to developing a list of frequently used procedure codes that could improve my payer reimbursement. PGM guided my office staff and I through every step of the billing hand over.