PCG Health consulting services help state and local governments interact more effectively with the Centers for Medicare & Medicaid Services (CMS) in order to better meet the needs of families and children they serve.

PCG Health's Medicaid-Medicare services include

Cost Allocation Plans (CAP)

PCG Health can maximize the recovery of funds and assess structural and fiscal issues that impede your agency or county’s ability to maximize its revenue. .

Learn more about PCG Health's Cost Allocation Plan Services

 

 

Disability Determination & Medicaid Enrollment Consulting

PCG Health's Disability Determination & Medicare Enrollment (DDME) consulting services assist health plans in managing these economic and demographic changes. Our knowledgeable team can help identify individuals who have disabling conditions that may make them eligible for Social Security Disability Insurance (SSDI) benefits and ultimately eligible for the federal Medicare program..

Learn more about PCG Health's Cost Allocation Plan Services

 

 

 

Health Benefits Advisor

PCG Health understands our clients’ goals to reduce Medicaid spending without reducing or jeopardizing the recipient's quality of care. PCG Health's Medicaid managed care team is dedicated to helping states accomplish this mission.

Learn more about PCG Health's Health Benefits Advisor Services

 

 

 

Medicaid Administrative Claiming (MAC)

PCG Health has experience helping clients design and implement Quality Management Programs in the major behavioral health domains of mental health, substance use, and mental retardation/ developmental disabilities. We understand the unique nature of each of these areas, and the importance of creating connections across them.

Learn more about PCG Health's Medicaid Administrative Claiming (MAC) Services

 

 

Medicaid Rate Setting Audit and Validation

PCG Health has more than 20 years of experience working with publicly operated facilities and other provider reimbursement cost report data. PCG Health™ has detailed knowledge of cost reporting and rate setting practices of Medicaid agencies across the nation.

Learn more about PCG Health's Medicaid Rate Setting Audit and Validation Services

 

 

Medicaid Targeted Case Management (TMC)

PCG Health has successfully guided and supported a number of agencies through the implementation of Medicaid Targeted Case Management (TCM) service billing. We have also reviewed rate setting methodologies and existing programs.

Learn more about PCG Health's Medicaid Targeted Case Management (TMC) Services

 

 

Medicare Part D Claiming and Recovery Services

PCG Health’s experience in state-run facilities, as well as with the complex Medicare Part D system, allows us to help states successfully navigate the network enrollment process and maximize reimbursement for prescription drugs, efficiently and compliantly.

Learn more about PCG Health's Medicare Part D Claiming and Recovery Services

 

 

Medicare Part D and SPAP

PCG Health worked extensively with many SPAPS during the initial implementation of Medicare Part D. We continue to offer comprehensive management, financial, and operations improvement services ranging from an initial complimentary operations assessment to the facilitation of claims adjudication from PDPs.

Learn more about PCG Health's Medicare Part D and SPAP Services

 

 

Medicaid Program Analysis and PERM Assistance

PCG Health can assist states in reviewing and enhancing the integrity of your MMIS operations as well as preparing for and responding to PERM audits as prescribed by CMS. Our consultants have more than 20 years of experience in all facets of the Medicaid operation, including MMIS edits and audits, program policies and procedures, recipient eligibility, quality controls, and best practices.

Learn more about PCG Health's Medicaid Program Analysis and PERM Assistance Services

 

 

Program Integrity Consulting and Outsourcing

PCG Health can review your current system of care, help you better define the quality and system goals, and assist in the development of outcomes measures that change the way your home and community based service delivery system works.

 

Learn more about PCG Health's Medicaid Program Analysis and PERM Assistance Services

 

 

Revenue Enhancement

PCG Health will conduct a thorough analysis of your policies and procedures to pinpoint valid revenue enhancement opportunities and put into place a program to help you achieve optimum results. Our goal is to develop strategies and procedures that produce sustainable funding streams to responsibly recover the revenue to which you are entitled, in compliance with all federal and state regulations.

Learn more about PCG Health's Revenue Enhancement Services

 

 

State Plan Design

PCG Health consultants have extensive experience with CMS requirements and provide clients with unmatched consulting services on state plan design.

Learn more about PCG Health's State Plan Design Services

 

 

Training Services

PCG Health can assist your agency or organization to develop and deliver a training curriculum to better help your staff understand the complex regulatory world in which we operate.

Learn more about PCG Health's Training Services

 

 

Waiver Design and Management

PCG Health helps states to obtain waivers and to design, develop, and implement innovative programs that will improve access, continuity, and quality of care, improve consumer satisfaction, and maintain compliance with Centers for Medicare and Medicaid Services (CMS) requirements for cost-effectiveness and budget neutrality.

 

Learn more about PCG Health's Waiver Design and Management Services

 

 

PCG Health's™ Medicare - Medicaid Products Include

EasyRMTS - Random Moment Time Study Solution

Public Consulting Group (PCG) is a national leader in the review, development, and administration of Random Moment Time Studies (RMTS). We can help you maximize the recovery of funds and ensure compliance with federal and state regulations regarding the operation of time studies.

Learn more about PCG Health's Random Moment Time Study Services

 

 

PCG Health's Medicare - Medicaid Subject Matter Experts

Janice Paterson, Esq, PMP

Ms. Paterson brings significant state Medicaid regulatory experience to her role at PCG, having served as Acting Medicaid Director and Bureau Chief, Medicaid Policy for the state of New Hampshire prior to joining the firm. At PCG, she has provided quality assurance analysis and services to the state of Maine, Department of Health and Human Services, and state of New York, Department of Health. She also participated in the independent verification and validation (IV&V) of the Medicaid Management Information Systems (MMIS) for the state of New Hampshire’s Department of Health and Human Services, providing evaluation of the general system design.

 

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Jim Waldinger

 

Jim Waldinger

Mr. Waldinger, a associate manager in our Boston office, focuses on Medicaid policy, analysis and implementation. He has extensive experience in state and Medicaid budgeting and finance, having served as Chief Financial Officer (CFO) and Budget Director for the Massachusetts Medicaid program, MassHealth, and, more recently, as CFO for the Massachusetts Behavioral Health Partnership, which managed the behavioral health needs of more than 300,000 Medicaid members.

 

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Tom Entrikin

A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.

 

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More Information

For more information about PCG Health's Medicare - Medicaid Services please contact us at
info@publicconsultinggroup.com or 1-800-210-6113.