CHARLOTTE, N.C., Aug. 23 /PRNewswire/ -- The New York-based Montefiore Medical Group, a 1,000-member plus physician group for the Montefiore Medical Center, has selected Preferred Medical Marketing Corporation (PMMC) to monitor its managed care contractual agreements. PMMC will employ its sophisticated PMMC Physician PRO audit and claims recovery software to automatically review the group’s medical claims and ensure accurate reimbursement.
The Montefiore Medical Group represents the 1,062-bed Montefiore Medical Center, including the Henry and Lucy Moses Division, Jack D. Weiler Hospital, and The Children’s Hospital at Montefiore, a large home health care agency, and a 21-site medical group practice located throughout the Bronx and Westchester. The center includes the following specialties: cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children’s and women’s health, surgery and other surgical subspecialties -- a large spectrum of health services that lead to complex and continually changing managed care health plan contracts.
“We are focused on both internal and external factors with this system,” said Kwynn Smith, Associate Executive Director, Montefiore Medical Group. “Externally we want to audit our payers so that we ensure we are being reimbursed accurately. Internally, we want to improve our processes continuously. PMMC Physician PRO allows us to achieve both goals. We can self-correct internally when necessary as well as monitor the accuracy of managed care contract reimbursement.”
Nationwide, it is estimated that payment discrepancies from managed care insurers occurs in 2 percent to 10 percent of all claims processed due to complex and ongoing changes in reimbursement rates and terms. PMMC Physician PRO monitors actual payments made against calculated expected reimbursement, models prospective contract reimbursement rates and terms, and reports on insurance payer activity. When reimbursement discrepancies are identified, the insurance payers are notified for reprocessing. Physician groups that understand their managed care reimbursement can better negotiate future contracts with managed care organizations.
“Montefiore Medical Group is nationally recognized for excellence. After conducting an initial impact study in which PMMC analyzed their physician reimbursement back to the contractual terms with several key commercial payers, Montefiore Medical Group elected to expand its relationship with PMMC,” said Greg Kay, senior vice president, PMMC. “PMMC’s reimbursement analyst team, coupled with proven technology, delivers a unique service to improve Montefiore Medical Group’s revenue through enhanced contract management and payment monitoring.”
PMMC, headquartered in Charlotte, N.C., is a Microsoft-certified software development and consulting company. Since 1986, its innovative software and consultants have assisted over 300 hospitals and 13,000 physician clients improve their financial operations through enhanced contract management, payment verification, cost accounting, financial decision support and market-oriented consulting services. For more information, go to www.pmmconline.com.
Preferred Medical Marketing Corporation
CONTACT: Greg Kay of Preferred Medical Marketing Corporation,+1-704-543-8103
Web site: http://www.pmmconline.com/
