For more than twenty years, PCG Software has delivered innovative software solutions to payer and provider organizations nationwide. Learn how these solutions – designed to protect healthcare dollars from fraudulent and abusive billings – have helped our clients improve operational efficiency and profitability.
Below are recent examples of how PCG Software is Advancing Profitability for Healthcare:
Memorial Healthcare System
Code auditing work swamped the nine-person claims staff of one of Florida's largest healthcare systems. Virtual Examiner banished the paperwork and integrated seamlessly with existing processes.
Naperville Health Care Associates
This physician-hospital organization urgently needed a new claims code auditing system. Virtual Examiner was up and running within a month and has since led to a 56 percent savings increase on fee-for-service claims.
Physicians Integrated Medical Group
A fast-growing independent practice association in California wanted to cut down on medical billing expenses, particularly with regards to claims that did not match the level of care provided to patients. Virtual Examiner successfully flags unclean claims as soon as they come through the system, saving the organization time and money.
ProMed Health Care Administrators
In providing managed care services to physicians, it's critical to maintain accurate, up-to-date claims data. Virtual Examiner helps one firm in California defend its claims decisions and negotiate contracts with doctors.
St. Joseph's Medical Resources
This healthcare organization was struggling to review the claims for its 80,000 patients using an outdated, manual process. By adding Virtual Examiner, St. Joseph’s Medical Resources realized considerable cost savings by catching erroneous claims.
The Los Angeles-based technology and services provider for healthcare organizations focused relentlessly on helping its clients control costs, but it recognized that there are certain categories of improper billing that manual claims processing simply can’t recognize. Virtual Examiner helped SynerMed grow its TPA business at the expense of competitors who have not yet elected to enhance their FAW-detection capabilities.
Because of growing inefficiencies in the organization’s current system, the largest HMO in Wyoming needed to quickly update its claims auditing system. Since Virtual Examiner costs much less than the big systems with similar functionality, it turned out to be the ideal solution.