Plan Data Management, Inc. - Challanges & Solutions

Revenue Recovery And Enhancement

Easily Increase Your Revenues By Over A Million Dollars A Year Per Every 10,000 Members

Introduction

Finding ways to increase revenues is crucial to M+C plans in today's environment. To address this, Plan Data Management has developed proprietary software to identify all potential opportunities, along with programs to realize these opportunities for the plans which do not have the internal resources to do so themselves.

And there are plenty of opportunities. Even well managed plans could see a very significant increase in revenues. Outlined below are three key areas:

ESRD: If less than .3% of your 65+ membership is defined as ESRD by CMS, your plan is probably being significantly underpaid. CMS pays nearly $4,000 in additional premium a month for members who are ESRD certified. Not only that, but CMS will also repay plans that can demonstrate that they are owed monies for ESRD cases. We have seen plans owed over $60,000 for just one member.

WORKING AGED: If your plan has more than .07% of membership defined by CMS as Working Aged, the plan could be losing up to $250 a month for each member who is wrongly classified. Furthermore, a plan can retroactively be paid by CMS for these cases - our clients have seen a median return of $2,250 per case.

DUAL ELIGIBLE: Currently, it is likely that less than 2% of your plan membership is defined as Dual Eligible. Government studies suggest it should be significantly higher. Dual Eligible status increases the revenue stream by over $200 a month per member.

Addressing the above, as well as other opportunities such as Institutionalized, overpayments to providers and COB, will significantly improve your financial picture.

The Solution

Plan Data Management has an experienced team which can rapidly identify all opportunities for increasing revenues. And for those plans which do not have the staff to reconcile discrepancies, our team will efficiently and effectively work with CMS to ensure your plan is maximizing their revenues. Outlined below are the key areas in which we can assist you to recover monies owed by CMS.

COB/ESRD/INSTITUTIONALIZED/WORKING AGED RECOVERY: For plans which do not have the resources to do this internally, PDM has a full staff of highly qualified individuals who focus on this. They have already assisted numerous plans recover millions of dollars in Working Aged revenue.

PROVIDER OVERPAYMENTS RECOVERY: Our E*PAY™ service identifies all outstanding monies owed. For plans which do not have the resources, PDM will produce the bills to recover monies from these providers. We have already identified millions of dollars in provider overpayments for our E*PAY clients.