Growing financial pressures in higher education institutions have forced universities and colleges to seek additional methods to obtain funding for campus student health centers. Implementing a third party medical and behavioral health billing solution for services rendered on campus can assist with closing gaps in funding.
Public Consulting Group's (PCG's) intimate knowledge of third party reimbursement methodologies allows us to customize our approach to the needs and requirements of each university health center. We can help reduce costs, enhance and streamline workflows, and maximize revenues without sacrificing student care.
PCG implements best practice solutions for front-end, intermediate, and back-end revenue cycle processes. Our implementation services include
PCG will perform an on-site assessment of the revenue generation process in your health center operating environment, make recommendations, and implement solutions specific to the challenges facing student health centers. Key elements include front end workflow, encounter data capture methods, medical coding and compliance, back end workflow, and technology requirements. We will use the results of our assessment to create a customized third party billing solution for your health center.
Our technology development team has specific experience and expertise in health and human services-based systems. PCG offers complete technology solutions, including a practice management application for registration, scheduling, service documentation, coding, and billing and collections.
Significant amounts of third party revenue can hinge upon the successful credentialing of providers. PCG will manage the credentialing process by summarizing credentialing requirements by payer, collecting and submitting documentation and signatures, tracking progress towards approval, support renewal needs, and provide routine status reports.
Third party agreements with payers can significantly increase health center revenues. PCG can assist your institution in contracting with health insurance carriers to obtain reimbursement for services rendered. We will manage the entire process and act as a liaison between payers and the university management and legal departments.
PCG offers both administrative and clinical training programs for health center staff members and providers. Our programs cover key areas including patient registration, insurance verification, authorization and referrals, documentation of clinical visits, and CPT and diagnosis coding and compliance. Our compliance department and staff members adhere to the OIG's guidance for third-party medical billing companies in substance and principle. This includes coding & compliance training for every PCG employee, especially coders and others who highly impact the solvency of government and third party payers. The PCG compliance team can also assist providers with establishing, implementing, and managing a compliance auditing and reporting program.
PCG can assist with development and distribution of information to the campus community. Using newer communication channels such as e-mail and social media and with more traditional print collateral methods, PCG can facilitate the coordinated communication of student health center news and information to your target audiences.
PCG performs outsourced third party billing and collections for student health centers, public health clinics, behavioral health centers, state laboratories, and inpatient and outpatient practice settings. Our services allow clients to focus on student care while PCG manages revenue operations. Our outsourced billing and collection services include
PCG uses a blend of internal and commercial systems and claims clearinghouses to process third party claims. We submit claims electronically to third party payers including Medicare and Medicaid using the HIPAA compliant 837 format. Claims go through a scrubbing process and front end (payer pre-submission) rejections are routed to a billing specialist for review and correction. Claims passing pre-submission edits are submitted to payers. We also have the ability to generate paper HCFA 1500 and UB04 claims and Self Pay invoices and statements when necessary.
Payments are posted electronically using the HIPAA 835 format when possible and manually for payers sending paper checks and EOBs. Payer remit data is audited and reconciled to claim data to ensure payment and denial information is posted accurately. This data is then reconciled with bank deposit and daily check payment logs to ensure all received payments are posted accurately.
Effective denial management and claim follow-up procedures are critical to enhancing cash collection outcomes. Historically, PCG has found there is significant potential for improvement in most revenue operations' denial management processes. Our approach focuses on continued analysis of claim rejections and denial reasons. We monitor trends and implement corrective actions to help lower and prevent rejections and denials, leading to increased cash flow.
PCG has the technology to develop report solutions aimed at serving the business needs of our client management and staff.
PCG has vast experience and knowledge in creating reporting solutions to assist client management with analyzing several key areas of the revenue cycle. We produce several routine and customized A/R management reports covering key performance indicators, including project goals and objectives, performance results, operational status, volume and claim submission trends, and payment and denial trends. PCG also performs routine payer reimbursement reviews to monitor and track appropriate reimbursement levels to ensure we are maximizing health center revenues.
PCG submits more than 3,000,000 medical-related professional and institutional services annually to third party commercial insurance companies, including Medicare and Medicaid.
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For more information about PCG Health's University Health Third Party Billing Services please contact us at firstname.lastname@example.org or 1-800-210-6113.