University Health Center Third Party Billing Services

Growing financial pressures in higher education institutions have forced universities and colleges to seek additional methods in obtaining funding for campus Student Health Centers.  Implementing a third party medical billing solution for health services rendered on campus can assist with closing gaps in funding.

PCG offers solutions for first-time third party billing implementation, as well as outsourced billing and collection services. Our intimate knowledge of managed care and Medicaid reimbursement methodologies allows us the flexibility to customize our approach based on the needs and requirements of each university student health center.  We can assist in reducing costs, enhancing and streamlining workflows, and maximizing revenues without sacrificing patient care.

• Revenue Cycle Assessments
• Practice Management Technology
• Provider Credentialing
• Payer Contracting
• Training and Education
• Coding and Compliance
• Communication and Marketing

• Insurance Verification
• Electronic and Manual Claim Submission
• Payment Posting
• Claims Follow-up and Collection Processes
• Denial and Rejection Management
• Statistical and Financial Reporting
• Payer Reimbursement Monitoring

PCG has experience developing and implementing best practice solutions for front-end, intermediate, and back-end revenue cycle processes.  Our intimate knowledge of managed care reimbursement methodologies and claims operations gives us the flexibility to customize our approach based on the needs and requirements of each university student health center.  Our third party billing implementation services include:

An assessment of the revenue cycle operating environment is essential to establishing a baseline for understanding specific client needs.  PCG draws on our experience and expertise in addressing specific challenges or deficiencies present in current process.  We assess key elements, including front end registration and workflow, encounter data capture, coding and compliance requirements, third party payer rules and agreements, and client credentialing needs.  Outcomes include recommendations and implementation solutions specific to the revenue cycle challenges facing student health centers.

PCG has a technology development division with experience and expertise specifically in health and human service-based systems.   We offer complete technology solutions, including a practice management application for scheduling, registration, service documentation, coding, and billing and collections.  We also offer customized data capture systems and we use SQL database technology to warehouse data under strict HIPAA compliant guidelines.

Clinician credentialing is fundamental to providing patients with quality care by clinically appropriate staff.  The credentialing process involves initial and ongoing review of a staff member’s education, licensing, and standing to assure he/she meets the requirements associated with reported credentials and expected services.  PCG is experienced with documenting, coordinating and tracking efforts associated with clinician credentialing.  Our thorough understanding of regulatory requirements and annual review process is based on federal, state, and third party payer agencies.  Adherence to these regulations is essential to ensuring overall medical billing compliance.

PCG has more than 20 years of experience building positive relationships with both government and private health insurance payers.  We recognize the need for third party payer agreements as a way to maximize revenue and it is important to understand the value a particular health plan contract will bring to your practice area.  PCG offers assistance to our clients with negotiating fair reimbursement rates and other key factors impacting provider revenues.

Proper training and education of health services staff members, including physicians, mid-level clinicians, nurses, and administrative staff, as well as the continual retraining of all personnel are significant elements of an effective Student Health Center compliance program.   Our training experience includes delivering trainings on patient registrations, documentation of clinical visits, medical coding, procedure code and diagnosis code matching, and other customer service-related areas such as front desk activity, answering telephones, and responding to third party payer requests and inquiries.  Our instruction methods include face-to-face trainings, online Web-based training, as well as written training manuals and presentations.

PCG has a team of consultants specializing in medical coding and compliance procedures.  Team members have nationally recognized and certified coding credentials in CPT, ICD-9, HCPC and DSM-IV coding.  All of our medical coders have worked in a variety of settings for various clients, including acute care, community mental health centers, long term care hospitals, and federally qualified health centers.  PCG provides different levels of medical coding and compliance services based on student health center requirements.  PCG also offers assistance and guidance with establishing, implementing, and managing an auditing program to ensure sufficient documentation processes are in place to support third party billing.

PCG’s Marketing Communications staff can help student health centers create an effective plan for its marketing efforts.  Our staff includes veterans in public health marketing, corporate public relations, and public sector consulting.  PCG can assist with both the development and the distribution of information to students, faculty and staff, and other members of the campus community about the availability of insurance billing within student health services.  Our team is skilled at making full use of available sources of mass-communication commonly used by the university audience.  Through use of existing social media outlets, Web sites, and in print, PCG can facilitate the coordinated communication of data that is pertinent to the student health center and its patients. 

PCG performs outsourced third party billing and collections for various types of environments, including student health centers, public health clinics, state laboratories, and inpatient and outpatient practice settings.  We have the technology, resources, and experience to manage any size medical billing and collection operations.  Our services allow health centers to focus on patient care while PCG manages revenue operations.  Our outsourced billing and collection services include:

Obtaining accurate insurance information is critical to enhancing revenue and reducing claim denials for eligibility reasons.  PCG provides two solutions for verifying insurance information and eligibility.  Verification can be performed at the time of visit for walk-ins or the day before for scheduled appointments.  PCG will manage any necessary setup work to bring this capability to the student health center.  Prior to billing claims, PCG also submits HIPAA compliant 270 transactions direct to payers to verify eligibility.

Submitting claims in a timely manner is essential to any effective student health center revenue operation.  PCG submits claims electronically to all insurance payers accepting the HIPAA compliant 837 format.  This allows for faster processing and can increase cash flow, as well as substantially lowering outstanding A/R balances. All claims go through a scrubbing process prior to submission and reject if specified claiming rules are not met.  These claims are routed to billing specialist and corrected for submission.  When required, we also generate paper claims on the CMS 1500 and UB-04 forms.

Accurate payment posting and reconciliation is paramount for any revenue operation.  Business decisions are made based on reports generated directly from this data.  PCG applies various “checks and balances” to ensure accurate payment and denial posting.  Our internal claiming system accepts electronic payment files in the HIPAA compliant 835 format and data from all major insurance payers is imported and posted automatically to our system.  We also employ an experienced staff for manually posting non electronic payments and denials.  All payment data is reconciled to daily receipts and bank deposits to ensure payments are accurately posted. 

PCG understands the need for professional, yet aggressive claims follow-up and collection techniques to maximize client revenues.  PCG monitors outstanding balances closely and follows up on claims as necessary.  We use proven methods to identify and pursue outstanding claim balances.  Some of these methods consist of using online claim inquiry to payer databases, contacting payers directly via telephone, and an online rejection management system for submitting claims that did not pass pre-submission edits. We also use a standard invoice, statement, and collection letter process to pursue outstanding consumer balances.

Effective management and follow-up for denials and outstanding claims is critical to enhancing cash collection outcomes.  Historically, PCG has found there is always significant potential for improvement in most revenue operations denial management processes.  Our approach focuses on continued analysis of claim denial reasons and trends and implementing corrective actions to help lower and prevent denials.

Advanced reporting tools are essential to understanding current operations and identifying weaknesses within the revenue generation process. PCG has vast experience and knowledge in creating reporting solutions to assist client management with analyzing several key areas of operations.  This includes routine operation status reports, volume and claim submission trends, and payment and denial trends.  PCG develops and customizes reports to meet the specific needs of our clients.

PCG performs routine payer reimbursement reviews to monitor and track appropriate reimbursement levels.  These reviews allow us to quickly identify claims where reimbursement is below expectation.  When this occurs, PCG will contact the payer, question the reimbursement amounts, and work to obtain full payment.