PMM handles the following procedures with efficiency and a dedication to service that guarantees improved patient billing and collection. Our services include:
Medical Coding
All coders have one or more of the following credentials: RCC(radiology certified coder), RN(registered nurse), or RHIT(registered health information technician). Continuing education credits are obtained on a yearly basis. PMM coders have over 20 years of experience ranging from emergency department, outpatient services, and radiology coding. Coders maintain current on coding issues by attending seminars, reading monthly bulletins, and networking. You can be assured your services are being assigned proper ICD-9-CM, CPT codes and modifiers. Coders will educate physicians on documentation in order to maximize reimbursement and ensure compliance with coding guidelines and standards set by the government.
Claim Submission
Electronic claim submission dramatically reduces the amount of time it takes to receive reimbursement and gives you comfort knowing your claims have been accepted and are ready for processing.
PMM utilizes a clearinghouse for all electronic claim submissions. This allows providers to submit claims electronically to Medicare, Medicaid, as well as any other commercial carrier set up to receive electronic claims. Our billing software also allows us to file secondary claims electronically to eligible carriers.
For insurance companies that do not accept electronic claims, we will file paper claims on a CMS-1500 claim form.
PMM follows the electronic claim submission process through until all claims are accepted by the carriers. With each electronic claim submission PMM receives an electronic confirmation report from our clearinghouse with all rejected claims. Claim rejections are then worked by the diligent staff at PMM to correct any issues and resubmit the claim for payment.
Insurance Follow-Up
We do not stop once a claim is submitted. Everyone on our staff is dedicated to tracking all your claims from the beginning through payment. We are able to identify problems with particular carriers and work with them to get your reimbursement in a timely manner. We have a state of the art computer system to track your claims, we make you aware of issues on a real time basis, not months after.
Payment Posting
Payments from carriers are received by a lockbox. The payments are picked up by the bank and deposited daily. Our office staff retrieves the deposits daily, and the transactions are posted to the patient’s accounts upon receipt. Medicare and Medicaid payments are received electronically. Our software also has the capability to post Medicare and Wellmark Blue Cross Blue Shield payments electronically to patient’s accounts.
Claim Denials
A coder reviews claims that are denied due to a coding issue. Reasons for denials include: modifiers, bundling procedures, procedures utilizing new technology, and medical necessity. Educating insurance companies is key to receiving reimbursement. Use of modifiers varies with each insurance company. We work with insurance companies and try to explain guidelines set by the American Medical Association and Centers for Medicare and Medicaid Services. Bundling of procedures is also a common reason for denials. Appeals are sent including a rationale of why procedures should not be bundled and documentation coding guidelines and/or dictation) are often all that is needed to resolve these denials. Procedures denied for new technology are usually handled with the involvement of a physician and many references (including medical journal articles) arguing the service is of benefit to the patient and to the insurance company. Medical necessity is often appealed with additional documentation. Educating referring physicians on local medical review policies is also done.
Refunds
We will identify all refunds and determine who the refund belongs to. We will provide you with a report indicating whom is owed the refund along with an amount and reason for the overpayment. In addition, we can process refunds for an additional fee.
Patient Interaction
How we deal with your patients is one of the most important parts of the service we provide to your organization. Your patients will be provided with a toll free number to inquire about their bill and will be treated with respect by all of our staff.