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Back-office Operations Support with PMS
At PMS, we understand that managing the medical office operations is critical for the success of healthcare providers. Our team of experts specializes in back-office operations management & support for medical practices & hospitals of all sizes. We have the expertise to help you navigate the complex billing and reimbursement processes, reduce costs, and improve your financial performance. Our comprehensive suite of services covers the entire patient care cycle, from scheduling to payment. We work with you to identify areas of improvement and implement solutions that will streamline your billing processes, reduce denials, and maximize revenue.
Partnering with PMS
Patient Registration & benefits verification
We ensure that patient information is accurate and up-to-date, and verify their insurance eligibility to reduce claim denials. Our team of experts also provides training to your staff to improve the accuracy of patient data collection and registration.
Automated Authorization Submissions
Our system sidesteps manual roadblocks by submitting finalized patient authorizations straight to insurance companies. This eliminates delays caused by faxing, mailing, or repetitive phone follow-ups, allowing your team to focus on patient care rather than administrative hurdles.
Denial Management & Appeals
Our team of experts has a proven track record in identifying and appealing denied claims, and can help you recover lost revenue. We also work with your practice to identify and address the root causes of denials to prevent them from happening in the future.
Compliance Management
Our system updates automatically to align with evolving payer policies, CMS guidelines, and state-specific regulatory requirements for hospitals & practices. This includes automatic incorporation of updates to National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs),& Medicare Administrative Contractor (MAC) policies. By leveraging these automated compliance engines, the platform minimizes the risk of claim denials, audit exposure, compliance risk, and ensures adherence to HIPAA-aligned authorization protocols across all major payers.
Customized Reporting & Analytics
Get custom detailed reports and analytics to help you track key performance indicators such as authorization patterns, payers performance and potential for improvement. Our team also conducts regular meetings with your managers to review performance and help you make data driven decisions to improve your recovery. We deliver tailored financial reports, including aging analysis, denial trends, and reimbursement forecasts, giving you complete visibility into your revenue cycle health. Going beyond the numbers, we provide:
Financial Integrity Audits: We identify revenue leakage and underpayments through deep-dive claims analysis, ensuring every dollar earned is recovered.
Predictive Revenue Modeling: Utilize historical data to forecast future cash flows and proactively address shifts in payer behavior before they impact your bottom line.
Actionable Executive Dashboards: Transform complex datasets into clear, visual insights that allow your leadership to monitor hospital health in real-time.
Claims Submission & Management
We compile all necessary medical records, making everything accurate and complete for fast approvals. Our team of experts also reviews claim edits and rejections to identify patterns and proactively address issues.
Peer-to-Peer (P2P) Consultation
Our team of dedicated physicians & specialists conducts structured clinical discussions with the medical directors & physician reviewers from the insurance providers to establish the medical necessity criteria for the coverage approval on a case-by-case basis.
Instead of a non-clinical denial based purely on documentation, our P2P consultancy service allows doctor-to-doctor dialogue to justify why a treatment, test, or admission is appropriate. We help our client hospitals with the inpatient admissions, advanced imaging, specialty medication & procedure approvals on a daily basis. Our team helps the discharged patients transfers to a post-acute care/rehab facility as well.
" Team Prime provides outstanding back-office & billing support with great attention to detail. Their work has helped us reduce claim delays, improve revenue consistency while cutting down our denial rate by 25% ”
Dr. Khan (Medco Medical Group, Corona, CA)
" Prime Medical Solutions streamlined our operations with automated benefit verifications, remote staffing, claims submission & billing. "
Dr. Penunuri (Remedial Medical Group, Newport Beach, CA)
