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PMB Quality |
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Emergency physicians who are clients of PMB can stay focused on patient care and feel confident that they are collecting appropriate revenue, while adhering diligently to the letter and spirit of compliance regulations. They find it comforting to know that once they complete the patient charge ticket, based on valuable training from PMB to optimize revenue and minimize compliance risk, the PMB system handles the rest, right up until their money shows up in their bank account.
A copy of each patient record is sent to PMB on a daily basis along with the physician's charge ticket. PMB's coding department compares the CPT procedure codes marked by the physician on each charge ticket with its companion chart for completeness and accuracy, and adds appropriate diagnosis and insurance codes. PMB staff also work with the client to take care of tasks such as patient complaints, physician credentialing, physician coding and documentation education, and audit report management of client performance to ensure optimized reimbursement.
After coding is completed, data entry specialists input the claims into PMB's billing software. Electronic downloading of hospital demographic information and dictation may also be possible. PMB provides verification of selected hospital demographic information. Claims are sent electronically on a daily basis to Medicare, Medicaid, Blue Shield and many commercial insurers. Patient statements and non-electronic insurance claims are sent daily to a laser printing company with a 24 hour guaranteed turn-around-time.
Payments are received at a bank lock box belonging to the client. This allows your money to start working for you immediately, and provides a highly accurate audit trail. The bank sends copies of all payment information and explanations of benefits to PMB's payments department. Payments are posted by line item and compared with the expected payments for contracted payers. This allows detailed tracking by payer of procedure reimbursement, and enables PMB to check that the payment received matches the expected payment. PMB's software provides timely cash flow by automatically billing secondary payers and guarantors once payment becomes their responsibility.
Claims which are denied, down coded, or inappropriately delayed are handled by PMB's Accounts Receivable Management department. PMB's depth and breadth of expertise and contacts is crucial in this area, since knowing who to call or how to correct the problem is often the difference between getting paid in full vs. getting paid in part or not at all. PMB's insurance specialists regularly work sophisticated accounts receivable and third party payer reports produced by PMB's software in order to identify claims which require appropriate follow-up.