For Provider Organizations

Healthcare Provider Organizations

In today’s complex and highly regulated health care environment, maintaining profitability and compliance while continuing to ensure that all patients get the best care is no easy task. At PCG, we can help your organization understand changes in state and national policy reform and more effectively manage state programs, including Medicaid and Medicare.

Services include


Cost Settlement and Supplemental Payment Strategies


Medicaid agencies and public providers are critical to the safety net system of care.  To ensure they have the resources needed to provide that safety net, PCG has worked with Medicaid agencies and public providers across the country to optimize Medicaid funding streams through cost settlement and supplemental payment strategies. Our work has covered a broad spectrum of institutional and community-based providers, as well as the introduction of proprietary web-based cost reporting tools to support millions of Medicaid supplemental payments each year. Our services include:

 

Cost Reporting and Cost Settlement


  • EMS Supplemental Payment Program
  • Public and Private Health Facilities
  • School-Based Health Medicaid Cost Reporting and Cost Settlement


Delivery System Reform, Performance Management, And Quality Improvement


PCG provides our health care customers with delivery system reform, quality and performance improvement, and other technical advisory services related to state health reform efforts.  Our clients range from Medicaid agencies, to hospital systems, to community based providers.

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DSH Payment Management



Health Information Technology (HIT)


Within the PCG Health practice area, the Health Information Technology (HIT) team works with state and government agencies, with a focus on Medicaid, Exchanges and health information technology, to help further the advancement of technology in the world of health care.

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Healthcare Access and Markets


States regulate their private insurance markets and operate Medicaid managed care and fee-for-service programs to assure healthcare access to residents. This includes access to both physical and behavioral healthcare. States turn to PCG to organize their commercial health insurance regulatory compliance.

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Integrated Health Plan Developments


Medicare Cost Reporting Services


Since our inception more than 30 years ago, PCG has worked with state agencies and public providers to complete Medicare cost reporting requirements. We will ensure that these important reports maximize revenue streams, provide information on the true cost of operations, and adhere to federal reporting requirements.

Revenue Cycle Management Services


PCG has been working with public and other providers to maximize revenue streams to ensure the sustainability of services and programs. Our work includes outsourced billing services, come-behind billing services to optimize revenue collections, coding services, compliance and review services, and revenue cycle management assessment and training services. We have a variety of billing solutions to process institutional, professional, and pharmaceutical claims.  


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Revenue Management


  • Public Hospital Revenue Management Services


Third Party Billing Services


  • University Health Care
  • Newborn Screening

 

Value-Based Purchasing


Value Based Purchasing Design and Implementations Services

Transform your Medicaid program’s payment model – save costs while improving the quality of care and enhancing patient experience. PCG can help. Value Based Purchasing (VBP) is a payment strategy to measure, report, and reward excellence in health care delivery. Simply put, it is an effort to reward value over volume. 

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For physician group practices, PCG provides a wide range of accounting and financial management services under the Financial and Business Solutions Schedule (FABS):


Charge Capture Development


Evaluating existing charge capture tools for completeness and comprehensiveness.

Billing and Collection Services


Full outsourcing and come-behind billing and collection services.

Coding and Documentation Improvement


Identifying potential coding errors that require training and education and/or opportunities for revenue improvement.

Compliance Reviews


Monitoring of operational risks related to billing, documentation, collection, and other compliance-related matters.

Financial Reporting


Obtaining relevant information and reports to help manage clinical and financial operations.

Rate Sensitivity Analysis


Managing your rate structure to ensure optimal results from your charges.

Revenue Cycle Review


Ensuring all procedures performed are captured and enter the revenue cycle.

Reimbursement Negotiations


Assistance with development and negotiations of reimbursement rates from federal and commercial payers.