General Vendor Information

The principals of PMIS have worked in healthcare organizations-insurance carriers, software development organizations, and physician group practices-since 1973.  PMIS was incorporated in 1994 and its customers include primary care and specialist physicians, group practices, and practice management organizations.  PMIS is located at 1776 South Jackson Street, Suite 720 in Denver.  PMIS currently has over 20 employees (including Certified Professional Coders) and provides services to more than 30 practices (100+ providers) in the Front Range area.  PMIS manages over 25 million dollars annually in collected accounts receivable.

PMIS chose Groupcast [1] (formerly known as GPMS-Group Practice Management System) as the foundation for its information system solutions.  Groupcast is the leading provider of patient management, financial management, and decision support solutions for mid- to large-size group medical practices.  Groupcast customers include 138,000 physicians in:

            380 integrated delivery networks representing more than 500 hospitals

            175 large group practices (more than 200 physicians)

            665 mid-size group practices (less than 200 physicians)

Groupcast provides a fully integrated information system which includes:

           billing and accounts receivable processing to manage financial data and provide proper revenue collection;

           patient appointment scheduling and the production of numerous follow-up and reminder letters and reports;

           comprehensive standard and custom reporting;

on-line inquiry for patient management with archiving of financial and demographic data, near time eligibility verification and updates to patient insurance data; and

[1] Groupcast™ is a wholly owned subsidiary of GE Health Care.

PMIS also uses several other software products:

           Context Software’s CODELINK© for diagnosis and procedure coding, as well as CCI edits and Medicare RBRVS information

           Allscripts Healthcare Solutions TouchChart™ (electronic health record).

Scope of Services

The PMIS solution fulfills all of the system requirements typically used to evaluate practice management systems.  Working with the practice staff, PMIS will—

Participate in the design of forms, labels, templates, customized plain charge sheets, and other documents.

Develop and conduct staff/provider training, as requested.

Recommend changes in business policies and procedures to accommodate improved system and organization efficiencies. 

Provide automated eligibility verification at the time of service (or when the patient appointment is made).  PMIS performs special handling of “pending” Medicaid patient eligibility.

Provide for the collection of all source documents by the most efficient method available (mail or courier or electronic capture).

Perform charge entry and payment posting within one business day of receipt.

Submit electronic claims, and prepare and mail claims and patient statements.  PMIS provides stock report paper, claims, statements, and standard envelopes.  The practice is responsible for actual postage expenses.

Perform insurance follow-up and basic patient collection activities.

 Provide support via telephone (including toll-free calling) from 8:00 a.m. to 5:00 p.m. Monday through Friday.  PMIS supports a 30-minute turn-around time for telephone inquiries. 

Complete all transaction processing within the calendar month so that they are reflected in month-end reconciliations.

Provide month-end reporting within five business days of the end of the calendar month.  Provide standard and custom reporting as desired by the practice on a daily, monthly, or on-demand basis.

Standards

PMIS maintains internal processing standards for each client based on the particular practice mix and provider specialty.  For example:
            85% of patient responsibility accounts receivables less than 90 days old
            90% of health insurer responsibility accounts receivables less than 90 days old
            95% of patient and insurer inquiries resolved within 5 business days

Costs

PMIS total fee for the scope of services outlined above is a percent of total net collections. 

The additional costs of the electronic claim, postage expenses (paper claims for those carriers or instances when paper is required, correspondence, and patient statements) are billed separately.

Telecommunications

Telecommunications with PMIS will be handled through a HIPAA compliant, encrypted secure VPN Internet appliance.  This allows the medical practice to operate real-time over the internet rather than purchase software and computer server equipment.

The medical practice is responsible for some type of DSL service, a local area network, network laser printers with HP compatible drivers, personal computers with Windows 2000, XP or VISTA professional operating system, and 17” flat panel displays.  (All though other equipment will work effectively, there is some degrading of response time and image size on PC Display Monitors and smaller size screen areas.)

PMIS does provide on site technical support of customer on site equipment to essentially act as the in house IT department.  This is a separate service and is provided on an as needed or as scheduled service bases.  As such this service is ad hoc to the “BILLING SECRVICE” and is billed to the customer on a per hour bases of $125.00 or on a set fee per project.

Appointment Scheduling

Groupcast appointment scheduling includes manual and automatic scheduling options for the physicians, a facility, or a resource.  It accesses the patient registration and demographics while maintaining the physician schedule. 

Features include:

           A single desktop command center provides a consistent point of entry for all staff.

          View the day’s schedule quickly to make decisions about patient visits.

          Store all insurance coverage for a patient, regardless of insurance type and effective dates.

          Send real-time (or batch) inquiries to a clearinghouse to verify patient insurance eligibility.

          Link appointment scheduling to billing so that appointments are reconciled to charges—thereby, eliminating missing charges.

Insurance Processing

PMIS receives source documents via courier or electronic interface.  Source documents may include patient registration information, provider charge tickets (or “superbills”), and copies of daily cash logs.  These source documents are usually segregated into “charge” or “payment” batches and then logged by PMIS upon receipt.  The batches are then forwarded to the appropriate client team and entered within one business day of PMIS receipt.

PMIS does not require that providers code each superbill.  Using CPCs (Certified Professional Coder), the data is entered into Groupcast and claims are submitted to the various payers normally through an electronic clearing house.  Very small percentages are submitted by mail to those carriers that require specific types to be mailed or do not have an electronic claim capability.

Once a claim has been filed, client account representatives are responsible for tracking individual claims until resolved by the payer.  Account representatives handle correspondence and follow-up with payers to determine if particular claims are delayed in processing for reasons which can be controlled by PMIS.  For Medicaid pending eligibility, PMIS staff uses specific automated reporting to complete periodic inquiries with hospitals and with the county case workers.  Eligibility verification is incorporated in the electronic claim submission software bundle and is not an additional fee to the practice.

To ensure that payment is according to the provider’s contractual agreement, Groupcast provides an allowed amount based on the procedure code and insurer.  As payments are received copies of the Explanations of Benefit are forwarded to PMIS for posting.  Groupcast is a line-item posting accounts receivable system which allows PMIS to determine if the contractual allowances are correct and to appeal incorrect payments.

To promote better internal controls, PMIS does not receive actual monies.  Clients are responsible for making bank deposits and forwarding copies of those documents (and EOBs) to PMIS.

Self Pay Processing

Once an insurance claim has been adjudicated, patient responsibility may exist for deductibles, coinsurance, or non-covered benefit amounts. Monthly patient statements are mailed for such amounts due. A series of patient contact efforts are used including telephone calls and letters to encourage prompt payment. Monthly payment plan options or discounts for prompt payment are determined by each client. Based on each client’s preference, individual patient accounts are forwarded to the provider for “collection agency” review. If forwarded to an outside collection agency, PMIS does not pursue the account further. However, PMIS does collaborate with the collection agency to insure proper documentation.

Coding

Although the provider is ultimately responsible for choosing the appropriate description of the diagnosis and procedure, PMIS uses Certified Professional Coders so that the provider does not have to choose the corresponding code numbers. In circumstances where the information is inadequate or conflicting, PMIS will refer the situation to the provider for confirmation. PMIS frequently works with individual clients to provide coding guidance related to payer requirements.

HIPAA

All vendors and third-party software packages used by PMIS are HIPAA-compliant. PMIS has Business Associate Agreements with each client outlining the obligations of PMIS, permitted uses and disclosures, and obligations and requests by the client. PMIS staff is fully-trained regarding HIPAA regulations.

Reporting

See the attached listing of standard Groupcast reports as well as sample custom month-end reporting.

PMIS account managers meet with their clients, as frequently as needed, to ensure open communications.