PMMC

The PMMC Revenue Cycle Management and Managed Care Platform is a solution designed to enable revenue strategies for hospitals and health systems. According to the vendor, this platform caters to organizations of all sizes, including small clinics and large healthcare systems. Healthcare providers, revenue cycle management professionals, managed care professionals, hospital administrators, and healthcare financial analysts can all potentially benefit from the features and functionalities offered by this platform.

Key Features

Contract Governance: According to the vendor, the platform allows users to develop a reimbursement strategy with accurate contract governance as the foundation. It aims to ensure accurate reimbursement according to contract terms and provides tools to measure payer performance and identify trends and opportunities for improvement.

Payer Negotiations & Strategic Pricing: The vendor claims that the platform enables users to model payer contracts in real-time, helping them negotiate more favorable rates. It also provides insights into the impact of rate changes on current contracts and net patient revenue, allowing users to develop a competitive rate setting strategy based on accurate contract modeling.

Pricing Transparency: The vendor states that the platform supports a patient engagement strategy for pricing transparency. It aims to provide patients with accurate out-of-pocket cost estimates and helps organizations meet CMS requirements for price transparency.

Value-Based Reimbursement: According to the vendor, the platform provides a competitive advantage as the market shifts to value-based care. It incorporates current contract governance and risk assessment into value-based reimbursement strategies, with the goal of optimizing revenue and improving patient outcomes through value-based care models.

Revenue Cycle Analytics: The vendor claims that the platform offers insights into accounts receivable performance and allows users to evaluate payer performance. It aims to help identify areas for improvement and predict trends by analyzing denial rates and underpayment amounts.

Real-Time Patient Navigation: The vendor states that the platform allows users to track patients in real-time through episodic payment models. It also helps monitor and forecast revenue based on performance in bundled payment models, highlighting areas where intervention may be needed to reduce spending.

Denial Management: According to the vendor, the platform facilitates the quick identification and successful overturning of denied claims. It offers tools to categorize denials based on historical trends, with the aim of improving appeal processes and increasing collections.

Underpayment Recovery Services: The vendor claims that the platform helps identify and collect contractual underpayments. It also supports the review of payer audit systems to avoid future underpayment losses and aims to maximize revenue by collecting underpaid and denied claims.

Physician Contract Management: According to the vendor, the platform aims to help users maximize revenue and accurately reimburse on all payer contracts. It offers tools to identify and recover underpayments and tracking errors, with the goal of improving contract negotiations through accurate reimbursement modeling.

Hospital Contract Management: The vendor states that the platform aims to help users maximize revenue with accurate contract management. It offers tools to identify critical underpayments and denials, and supports the management of payer performance according to the contract.