Client Spotlight: Physicians Medical Group of Santa Cruz County

Physicians Medical Group of Santa Cruz County (PMG) wins bragging rights for the highest claims per hour processed by a SymKey for EZ-CAP client! PMG’s SymKey processing just keeps picking up speed from 2,880 claims per hour in 2011 to 3,151 claims per hour in 2012, with a high volume of claims pouring through SymKey 1.31 for EZ-CAP 5.x on a daily basis. This speed is unprecedented, even for SymKey clients!

“PMG has been using SymKey for over four years and has consistently experienced extraordinary speeds. This can be attributed to their fine-tuned IT infrastructure that so readily supports both EZ-CAP and SymKey. We at HCIM have always been quite impressed with their systems and IT staff,” said Tom Streeter, HCIM’s SVP, Product Solutions.

How PMG uses SymKey to automate claims adjudication

“We are always seeking ways to improve time management in this constantly evolving environment of medical claims administration. Shifting common edits to be run by SymKey supports the more efficient use of claims staff time, which can be applied to the development of new scripts and review of complex claims. SymKey has been a valuable tool,” said Faye Merryman, Claims Supervisor at PMG.

“The primary advantage we’ve found with SymKey has been the ability to have scripts written to auto-adjudicate the most common edits or adjustments. We have a variety of contract designs specific to certain providers/specialties with unique reimbursement methodologies. One example that we are especially proud of is our shared endoscopic base procedure adjustment script that automates the correct calculation of a complex contract scenario that cannot be configured in EZ-CAP,” said Faye.

PMG’s Advice to other SymKey Users

“Include the appropriate staff (claims examiners, analysts, and other involved parties) to review processes with the goal of identifying the redundant, time consuming tasks associated with claims processing. Then they should prioritize the workflow processes to be automated and tackle them one at a time. Write the automated reports, test them, and then move on to the next scenario until the ‘low hanging fruit’ is working well. The next phase is to tackle the more complex, multi-layered processes,” said Cindy Martin, Chief Operations Officer at PMG.

What a great idea!

PMG uses SymKey to add the RBRVS modifier flags (including surgery global days) as a note to each claim. This saves research time during adjudication and also provides a quick reference in case the Provider or billing staff have questions or dispute reimbursement.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.