Physicians Integrated Medical Group Selects PCG Software
Virtual ExaminerŽ software to help independent practice association
retain premium dollars by identifying unclean claims
MALIBU, Calif. — September 25, 2007 — PCG Software, a leading provider of innovative software solutions designed to increase profitability for healthcare payer and provider organizations, today announced that Physicians Integrated Medical Group (PIMG) will implement the company’s Virtual Examiner software. The fraud and abuse prevention software will allow the independent practice association to retain premium dollars by identifying unclean claims as soon as they are submitted.
“We were looking for a software solution to help mitigate the rising increase in medical expenses, which had been occurring for the past 12 months,” says Jim Rodriquez, chief executive officer of PIMG. “Prior to installing Virtual Examiner, we were auditing all of our claims manually. We knew that in order to see substantial improvement to our bottom line, we would need to automate our claims adjudication process.”
Every time a claim was submitted to PIMG, there was the chance for inconsistencies with CPT codes or ICD-9 codes not matching up correctly. Virtual Examiner makes sure these codes are consistent to the level of care provided. Now, each time an inconsistency is detected, remittance advice will be sent back to the provider, explaining why the claim was denied or reduced. Virtual Examiner also helps providers become aware of claims that may be out of compliance with state and federal regulations.
Established in 1995, PIMG is a multi-specialty, independent practice association of more than 500 physicians serving the communities of San Francisco and San Mateo counties.
Virtual Examiner is a cost containment solution that evaluates claims for fraudulent and abusive billing practices, and identifies claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery possibilities.
About PCG Software
Established in 1984, PCG Software is a leading provider of innovative software solutions designed to slow the escalating costs of healthcare. The company works with healthcare payer organizations to increase profitability and maximize financial recoveries, while assisting their provider partners to improve the accuracy of billing processes.
The company’s flagship software solution enhances claims adjudication systems with more than 30 million edits per claim and uses investigative profiling reports to graphically indicate patterns of fraud and abuse. Through more accurate and efficient claims adjudication, this fraud and abuse prevention software acts as an automated cost containment system for national and regional health insurance plans, independent practice associations and third party administrators. More information about PCG Software can be found on the World Wide Web at www.pcgsoftware.com.
Press contact information:
Dave Anderson, Dodge Communications, (770) 998-0500 ext. 229
danderson@dodgecommunications.com
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