Performance Medical Management

For successful operations, medical practices need to stay up-to-date on evolving healthcare programs and ensure that their clinical documentation complies with the latest regulatory mandates. When physicians fail to achieve this, their quality of care, billing, cash flow, and clinical and financial audit results deteriorate, leading to insurance claim denials. While efficient revenue cycle management (RCM) can help medical practices remain financially healthy, many clinics and hospitals need help to accomplish it, as the process is notoriously complex and rife with inefficiencies.

Enter Performance Medical Management (PMM), a medical management services company that assists medical practices in fostering a healthier revenue cycle through its practice management, revenue cycle management, and eClinicalWorks EHR services. It continuously improves and updates specific rules within a client’s practice management database based on specialized factors related to their practice, specialty, and location. Simultaneously, PMM ensures clinical data supports the ICD 10 and CPT codes, allowing insurance companies to accurately determine the severity of patient health issues and utilize that knowledge to forecast future healthcare costs. It also boosts a physician’s ability to satisfy patient needs without experiencing resistance from insurance carriers.

“We combine years of medical billing and healthcare reimbursement experience with cutting-edge technology to assist providers with selecting ICD-10 codes, managing denials, and financial reporting to help them precisely measure their success,” says Lanny Pauley, COO of PMM.

PMM’s systematic client engagement approach begins by supporting a physician in assessing their practice’s workflow and evaluating how much assistance they need from their medical assistants. It then creates templates, certified by a medical coder, in their medical records to enable the efficient processing of patient data.

This process of developing templates around a practice’s specifications eliminates the risk of disrupting existing workflows while consolidating critical information. Essentially, PMM acts as a concierge that helps clients understand how to accomplish their goals through timely and accurate coding and billing.

What sets PMM apart is its certified coders. They establish a solid rapport with the physicians and enable them to ask questions without inhibitions, which facilitates the generation of highly accurate and compliant electronic medical records. The coders use medical terminology to help physicians determine the appropriate vocabulary when communicating with insurance carriers and negotiating better coverage.

Leveraging its expertise, PMM’s built-in insurance company audits, down coding, and recoding resources allow physicians to consistently submit relevant documentation and gain better revenue. Unlike many physicians that struggle to process their insurance payouts even after multiple resubmissions, 98 percent of the claims submitted through PMM’s services are successfully adjudicated in the first submission.

PMM has spawned numerous success stories. In one instance, the income of a doctor’s group was boosted by 37 percent after the replacement of an office manager who was failing to provide the accurate feedback needed to improve their coding and billing processes. Flipping the script, PMM brought unmatched discipline to the process, which led to the delivery of precise feedback that let physicians take back control of their caregiving, claims-processing, and revenue-generation activities. At the end of this collaboration, the physicians made close to a million dollars in profit thanks to the added productivity offered by PMM.

The secret sauce behind successes like this is the emphasis PMM places on gathering and acting on client feedback. It continually performs internal audits and onboards third-party auditors to review the procedures and results it delivers, always staying up-to-date on the improvements it can make to offer better client outcomes.

A firm centered on constant improvement, PMM remains a leading player in the market for medical management services. Moving forward, it aims to continue providing its rule engine, claims dashboard, and provider training programs to enable medical practices to drastically reduce errors and boost their revenue cycle.