Revenue Cycle Management Program

CPCA is excited to announce that we have partnered with PMG, Inc. to bring our members unmatched expertise in revenue cycle management (RCM) for community health centers. By helping to increase revenue from third-party payers, this partnership will help your health center better deliver quality health care to those you serve.

Recent Revenue Cycle Management Publishings:

Health Center Revenue Cycle Management Outsourcing: A Case Study Analysis
Capital Link Case Study Executive Summary

CPCA RCM Program Services:

PMG Services:

  • Billing to specific payers (Medi-Cal, Medicare, and private insurance), including claims management and the assurance of proper patient registration, eligibility determination and provider credentialing
  • Electronic remittance advice and posting to practice management system
  • Denial management and reporting due to eligibility and coding issues
  • Reporting and executive briefings on key performance indicators
    • Productivity
    • Financials
    • Denials
    • Ad Hoc
  • Performance benchmarking against similar organizations
  • Ongoing technical assistance and training programs
    • Coding training for providers
    • Front desk based on actual front end denial reason
  • Medical records review and provider coding audits
  • Best practice policy recommendations (self-pay, credit balance, etc.)
  • Interface with Medi-Cal, health plans, and other private payers to ensure appropriate payment of claims
  • Charge processing including pre-billing review
  • Claim scrubbing and edits
  • System configuration review
  • Encounter form review and development

CPCA Services: 

  • Manages the overall RCM contract
  • Provides ongoing program management
  • Facilitates a smooth and streamlined transition into the program
  • Ensures services meet or exceed expectations
  • Provides PMG staff with direct technical assistance regarding California-specific billing requirements
  • Communications with specific payers to ensure appropriate payment of claims
  • Addresses participants’ questions and concerns
  • Facilitates conversations between participants and PMG when necessary
  • One complimentary registration into CPCA’s Financial Management+ or Health Center Management+ programs
  • Two complimentary finance-related webinars per year for the life of the contract
  • Two complimentary technical assistance toolkits
  • One hour of Patient-Centered Medical Home transformation consultation

CPCA also offers:

  • A "Revenue Cycle Check-Up Assessment" of current revenue cycle process and identification of opportunities and challenges.  This assessment will be done for no cost!
  • A more extensive onsite evaluation of your RCM processes with recommended changes to your current process. 

In addition to services outline above, each Revenue Cycle Management member will receive a personal vendor management liaison to answer questions, expedite support issues, and ensure smooth transition to the RCM program.  

 

Questions? Please contact Ginger Smith, Director of Health Center Operations at gsmith@cpca.org

 

                       

      


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