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 can maximize the recovery of funds and assess structural and fiscal issues that impede your agency or county’s ability to maximize its revenue..
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..
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.
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.
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.
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.
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.
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.
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.
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.
PCG Health has conducted thousands of Medicaid provider site visits to proactively verify provider qualifications and protect public agencies and taxpayers from fraud, waste, and abuse by unscrupulous providers. More than 50 percent of unscheduled site visits result in noncompliance findings.
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.
PCG Health consultants have extensive experience with CMS requirements and provide clients with unmatched consulting services on state plan design.
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.
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.
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.
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.
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.
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.
For more information about PCG Health's Medicare - Medicaid Services please contact us at
firstname.lastname@example.org or 1-800-210-6113.