Appeals Services

Professional Medical Administrators is extremely aggressive in the area of denial resolution and appeals for over 13 years for existing clients.

Recent industry studies indicate that 10% to 15% of claims result in full or partial medical denials. Our experience indicates that 67% of these denials can be recovered through the filing of effective appeals. And, with the information developed through the preparation and filing of these successful appeals, you can significantly reduce future medical denial rates.

You are already aware of the reasons for medical denials. You also know that the recovery process is resource intensive, requiring a thorough understanding of the payors' authorization and appeal processes and clinical guidelines. And you understand that successful appeals require time and resources - especially clinical staff.

Too often, business office personnel are already dealing with more complexity than they can efficiently handle. They don't have the medical expertise needed to interpret medical records or establish medical necessity, and the addition of clinical resources may not be feasible. Your personnel are busy with patient care and are often unable to devote time to support the business office in developing appeals. Unfortunately this results in failed appeals, unnecessary managed care write-offs and lost revenue. This is specifically where Pro-Med can help.

Our extensive knowledge in virtually every category of DMEPOS give the supplier the advantage. We understand the legal process involved as well as the medical policy interpretation combined with our billing and collections expertise provide for an overall A/R solution.

Benefits Of Outsourcing Your Billing

There are many good reasons to outsource your billing to Pro-Med, but the biggest one is the ability to do what you do best, take care of your patients.

We work with you so you don't have to spend as much time on tedious billing, regulatory compliance, practice management, and accounting.

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