国家健康 & 医疗机构

州卫生 & 医疗机构

在PCG,我们理解州医疗补助机构面临的挑战. 紧张的预算, 有限的工作人员, and a lack of quality data can hamper your efficiency, 成本效益, and ability to achieve the best outcomes. 

你们可以帮助. We work with 30 or more Medicaid agencies nationwide at any given time, 所以我们知道什么是有效的,什么是无效的——我们将与你分享葡京网站见解. 葡京网站团队有经过验证的流程, 系统, 数据库, and solutions ready to put to work for your state, 包括:

  • Claims processing services and solutions
  • Consulting and 咨询 services
  • Cost Allocation Plans and time studies
  • Cost settlement and supplemental payment strategies
  • Delivery system reform, performance management, and quality improvement
  • 健康 information technology (HIT)
  • 医疗保健的获取和市场
  • Medicaid administrative claiming
  • Medicaid cost 报告 services
  • Member eligibility verification data broker services
  • Provider management and program integrity
  • Rate setting and support services
  • Service delivery life cycle management
  • Revenue cycle management services

 

服务包括


Claims Processing Services and Solutions


PCG代表国家机构和支付人提供各种索赔处理服务和解决方案. Working with agencies across the country, we have developed innovative and efficient operational models, 以及我们为客户部署的技术工具,以具有竞争力的成本执行这些重要的业务功能. By entrusting us to perform these services, 葡京网站客户能够专注于更重要的和战略性的项目功能和责任.  葡京网站服务包括:

 

Consulting and Advisory Services


We provide a wide range of support, 培训, 和专业知识来帮助你们改善你们机构的运作和表现, with consulting services tailored to your needs, 包括:

 

Cost Allocation Plans and Time Studies


PCG专门从事公共援助成本分配计划和间接成本费率的机构,寻求从联邦项目偿还. We have expertise within the Uniform Administrative Requirements, 成本原则, and Audit Requirements for Federal Awards (2 CFR Part 200); 45 CFR 95.507-515; and various programmatic requirements that impact cost allocation and administrative claiming.

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Cost Settlement and Supplemental Payment Strategies


医疗补助机构和公共提供者对医疗安全网络系统至关重要.  To ensure they have the resources needed to provide that safety net, PCG与全国的医疗补助机构和公共提供者合作,通过成本结算和补充支付策略优化医疗补助资金流. 葡京网站工作涵盖了广泛的机构和社区提供者, 以及引进专有的基于网络的成本报告工具,以支持每年数百万的医疗补助补充支付. 葡京网站服务包括:

 

COVID-19大流行应对管理接触者追踪、病例调查、 & 暴露的通知


PCG已经在美国多个州雇佣了1万多名接触追踪人员.S. 并提供专业知识,立即启动这种可伸缩的解决方案,以满足您的州或社区的需求. We have built this work on a foundation of experience. 在过去的五年里, prior to the COVID-19 pandemic, 我们完成了125,000+ healthcare investigations, 评论, 和培训.

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Delivery System Reform, Performance Management, And 质量 Improvement


PCG provides our health care customers with delivery system reform, quality and performance improvement, 以及其他与国家卫生改革工作有关的技术咨询服务. 葡京网站客户范围从医疗补助机构,到医院系统,到基于社区的提供者.

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健康 Information Technology (HIT)


葡京网站健康信息技术(HIT)团队与州政府和政府机构合作, 重点关注医疗补助, Exchanges and health information technology, 促进医疗保健领域的技术进步.

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医疗保健的获取和市场


各州监管其私人保险市场,并实施医疗补助管理和收费服务计划,以确保居民获得医疗保健. This includes access to both physical and 行为健康care. 各州委托PCG组织其商业健康保险法规遵守情况.

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Medicaid Administrative Claiming


PCG与各机构合作,管理独立的医疗补助行政报销计划,除了报销努力,是更广泛的成本分配计划的一部分.

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Public Assistance Eligibility Data Management Services


确保医疗补助、SNAP和TANF会员文件的完整性是至关重要的. 我们提供一种行业领先的方法来验证福利资格,结合了来自几十个州的数据, federal and commercial sources with advanced predictive analytics to:

  • 在申请时及申请至续期期间,准确标示不符合资格
  • 加快资格确定并自动化资格重新确定
  • Make it easier to identify ineligibility and fraud


Our service is sustainable and scalable, 它得到的结果是:使用PCG会员资格验证服务的国家识别出5 - 15%的会员可能不合格, resulting in an average of $30 million in cost savings per year per 100,000 applications/renewals processed. 

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Provider Management and Program Integrity


PCG提供管理和支付完整性的创新方法是专门为医疗补助和HCBS / LTSS服务而设计的. Our approach is upstream, proactive, quick, and nimble.  Geared toward accountability and quantifiable future cost avoidance, we demonstrate bigger benefits than slow-moving, 大规模的, long-term audits geared only toward recoupments.

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Rate Setting and Support Services


PCG serves as a trusted partner to Medicaid, 公共卫生, 行为健康, 以及其他国家机构和支付机构建立服务的支付标准, 包括为机构和社区服务制定费率. 此外, 我们帮助各州解决了其他利率制定和支付相关问题, such as Disproportionate Share Hospital (DSH) payments, upper payment limit calculations, 和供应商评估. Not only do we help agencies establish and recalibrate rates, 我们还与客户合作,让利益相关者参与进来,并向供应商社区通报费率的变化, in order to promote transparency and build consensus. 葡京网站服务包括:


Service Delivery Lifecycle Management


PCG可以帮助确保您整个服务交付生命周期的遵从性和完整性, 使用从提供者注册开始的综合方法, continues through service authorization and service delivery, and ends in a reliable payment. 

Revenue Cycle Management Services


盈科一直与公众和其他供应商合作,以最大限度地提高收入来源,以确保服务和项目的可持续性. Our work includes outsourced billing services, come-behind billing services to optimize revenue collections, 编码服务, compliance and review services, and revenue cycle management assessment and 培训 services. We have a variety of billing solutions to process institutional, 专业, 和制药索赔.



相关产品


AlloCAP - Cost Allocation Plan Software


PCG’s proprietary web-based cost allocation tool, AlloCAP进口代理财务和统计信息,并根据代理成本分配计划执行成本分配. 它将成本分配给受益项目,并产生报告,显示实际成本的运营项目,并用于索赔行政成本. It has been implemented by agencies across the country.

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AlloTrac - 100%时间跟踪系统


PCG’s proprietary web-based cost tracking tool, AlloTrac用于在随机时刻采样不可行的情况下跟踪一组工人的时间. 它允许工人根据指定的活动以指定的增量跟踪他们的时间. The results are used to allocate the costs of the participating workers.

更瘦 

EasyRMTS - Random Moment Sampling Software


PCG’s web-based random moment sampling software, EasyRMTS是一个专有的基于web的随机矩采样工具,用于对一组工人进行统计有效随机矩-时间研究(RMTS). 它将用户决定的调查数量分配给一组工人,并在一个样本期间通过电子邮件管理这些调查. The results are used to allocate the costs of the sampled workers.

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